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
(31120, 11056, 23754, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:41:05', '2021-12-02 16:41:05'),
(31121, 11056, 23754, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:04:03', '2021-12-16 14:04:03'),
(31122, 11056, 23754, NULL, '2021-12-30 00:00:00.000', 'In Process', '	 Email sent to: JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope this email finds you well. You haven\'t gotten back to me on this. I am still waiting for the updates on the enrollment updates.  Please respond to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-23 16:08:19', '2021-12-23 16:08:19'),
(31123, 19067, 23754, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly get back to us once you have time.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:41:40', '2022-01-10 17:41:40'),
(31124, 19067, 23754, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad', NULL, NULL, '2022-01-26 17:35:12', '2022-01-26 17:35:12'),
(31125, 19067, 23754, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Subject: 	RE: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare    Hello!     This is the current status based on my last response to Claims Med Inc.  The information was provided on 12/23/21 and 1/13/22.   ', NULL, NULL, '2022-02-11 16:58:54', '2022-02-11 16:58:54'),
(31126, 19067, 23754, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Can I get the welcome kit for the providers who got affected?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:45:23', '2022-02-21 17:45:23'),
(31127, 19067, 23754, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello,  I haven\'t received the welcome letter for the providers. Kindly provide us with the welcome kit.  Thanks, ', NULL, NULL, '2022-03-15 17:58:06', '2022-03-15 17:58:06'),
(31128, 22077, 23754, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Enrollment Query || RHC || Providers || Tricare  Hi,  I would like to know the enrollment process for the following providers with the below-mentioned providers,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & Billing Location	500 E Caesar, Kingsville, TX 78363 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382 Patrick Ayarzagoitia	1649568239	6646 S. Staples St. 122, Corpus Christi, TX 78413 Katherine Rabagos	1134415631	6646 S. Staples St. 122, Corpus Christi, TX 78413 Petina Rogers	1801443916	6646 S. Staples St. 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	6646 S. Staples St. 122, Corpus Christi, TX 78413 Maegan Svatek	1639670250	3817 South Padre Island Drive, Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill, Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive, Corpus Christi, TX 78415 Traci Mason	1497127831	500 E Caesar, Kingsville, TX 78363  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-08 11:08:39', '2022-04-08 11:08:39'),
(31129, 22077, 23754, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Location added through the portal', NULL, NULL, '2022-04-25 08:07:40', '2022-04-25 08:07:40'),
(31130, 1006, 23755, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:36:48', '2021-03-25 11:36:48'),
(31131, 1006, 23755, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:15:28', '2021-04-08 18:15:28'),
(31132, 9057, 23755, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Dear Sir, We are facing problems while updating data in EMRB as the page setting didn\'t remain the same after adding status and notes. and we have to change the settings after each update', NULL, NULL, '2021-05-25 16:39:00', '2021-05-25 16:39:00'),
(31133, 1006, 23755, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:45:25', '2021-06-11 16:45:25'),
(31134, 1006, 23755, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:37:40', '2021-06-30 09:37:40'),
(31135, 1006, 23755, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks.  ', NULL, NULL, '2021-08-09 17:14:02', '2021-08-09 17:14:02'),
(31136, 1006, 23755, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:47:58', '2021-08-24 14:47:58'),
(31137, 11056, 23755, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:12:10', '2021-09-21 16:12:10'),
(31138, 11056, 23755, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:47:56', '2021-10-01 12:47:56'),
(31139, 11056, 23755, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:55:48', '2021-10-18 15:55:48'),
(31140, 11056, 23755, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:03:36', '2021-10-26 12:03:36'),
(31141, 11056, 23755, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:29:20', '2021-11-11 14:29:20'),
(31142, 11056, 23755, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:41:15', '2021-12-02 16:41:15'),
(31143, 11056, 23755, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:41:46', '2021-12-02 16:41:46'),
(31144, 11056, 23755, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:03:54', '2021-12-16 14:03:54'),
(31145, 11056, 23755, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective date  Maegan Svatek Np   KINGSVILLE - 6/1/2017 Staples - 6/1/2017   Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 14:54:27', '2021-12-21 14:54:27'),
(31146, 1006, 23756, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:36:49', '2021-03-25 11:36:49'),
(31147, 1006, 23756, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:15:32', '2021-04-08 18:15:32'),
(31148, 9057, 23756, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Dear Sir, We are facing problems while updating data in EMRB as the page setting didn\'t remain the same after adding status and notes. and we have to change the settings after each update', NULL, NULL, '2021-05-25 16:38:50', '2021-05-25 16:38:50'),
(31149, 1006, 23756, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:45:20', '2021-06-11 16:45:20'),
(31150, 1006, 23756, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:38:54', '2021-06-30 09:38:54'),
(31151, 1006, 23756, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks.  ', NULL, NULL, '2021-08-09 17:13:58', '2021-08-09 17:13:58'),
(31152, 1006, 23756, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:47:55', '2021-08-24 14:47:55'),
(31153, 11056, 23756, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:12:04', '2021-09-21 16:12:04'),
(31154, 11056, 23756, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:47:50', '2021-10-01 12:47:50'),
(31155, 11056, 23756, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:55:54', '2021-10-18 15:55:54'),
(31156, 11056, 23756, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:03:29', '2021-10-26 12:03:29'),
(31157, 11056, 23756, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:29:15', '2021-11-11 14:29:15'),
(31158, 11056, 23756, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:41:54', '2021-12-02 16:41:54'),
(31159, 11056, 23756, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:03:48', '2021-12-16 14:03:48'),
(31160, 11056, 23756, NULL, '2021-12-30 00:00:00.000', 'In Process', '	 Email sent to: JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope this email finds you well. You haven\'t gotten back to me on this. I am still waiting for the updates on the enrollment updates.  Please respond to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-23 16:07:38', '2021-12-23 16:07:38'),
(31161, 19067, 23756, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly get back to us once you have time.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:39:54', '2022-01-10 17:39:54'),
(31162, 19067, 23756, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad', NULL, NULL, '2022-01-26 17:35:05', '2022-01-26 17:35:05'),
(31163, 19067, 23756, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Subject: 	RE: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare    Hello!     This is the current status based on my last response to Claims Med Inc.  The information was provided on 12/23/21 and 1/13/22.   ', NULL, NULL, '2022-02-11 16:58:36', '2022-02-11 16:58:36'),
(31164, 19067, 23756, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Subject: 	RE: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare    Hello!     This is the current status based on my last response to Claims Med Inc.  The information was provided on 12/23/21 and 1/13/22.   ', NULL, NULL, '2022-02-11 16:58:43', '2022-02-11 16:58:43'),
(31165, 19067, 23756, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Can I get the welcome kit for the providers who got affected?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:45:19', '2022-02-21 17:45:19'),
(31166, 19067, 23756, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello,  I haven\'t received the welcome letter for the providers. Kindly provide us with the welcome kit.  Thanks, ', NULL, NULL, '2022-03-15 17:58:11', '2022-03-15 17:58:11'),
(31167, 22077, 23756, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Enrollment Query || RHC || Providers || Tricare  Hi,  I would like to know the enrollment process for the following providers with the below-mentioned providers,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & Billing Location	500 E Caesar, Kingsville, TX 78363 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382 Patrick Ayarzagoitia	1649568239	6646 S. Staples St. 122, Corpus Christi, TX 78413 Katherine Rabagos	1134415631	6646 S. Staples St. 122, Corpus Christi, TX 78413 Petina Rogers	1801443916	6646 S. Staples St. 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	6646 S. Staples St. 122, Corpus Christi, TX 78413 Maegan Svatek	1639670250	3817 South Padre Island Drive, Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill, Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive, Corpus Christi, TX 78415 Traci Mason	1497127831	500 E Caesar, Kingsville, TX 78363  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-08 11:08:28', '2022-04-08 11:08:28'),
(31168, 22077, 23756, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Location added through the portal', NULL, NULL, '2022-04-25 08:07:20', '2022-04-25 08:07:20'),
(31169, 1006, 23757, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:36:50', '2021-03-25 11:36:50'),
(31170, 1006, 23757, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:15:36', '2021-04-08 18:15:36'),
(31171, 9057, 23757, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Dear Sir, We are facing problems while updating data in EMRB as the page setting didn\'t remain the same after adding status and notes. and we have to change the settings after each update', NULL, NULL, '2021-05-25 16:41:19', '2021-05-25 16:41:19'),
(31172, 1006, 23757, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:45:17', '2021-06-11 16:45:17'),
(31173, 1006, 23757, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com  Sub : RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Kindly inform me about the enrollment status of the new groups\' locations. The form has been filled out and faxed @ (608) 221-7535 Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Provider 2: Provider Name: Francis, William Provider NPI# 457994436 Provider 3: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Please respond to me soon.  Thank you!', NULL, NULL, '2021-06-30 11:04:59', '2021-06-30 11:04:59'),
(31174, 1006, 23757, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks.  ', NULL, NULL, '2021-08-09 17:13:54', '2021-08-09 17:13:54'),
(31175, 1006, 23757, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:47:51', '2021-08-24 14:47:51'),
(31176, 11056, 23757, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:11:59', '2021-09-21 16:11:59'),
(31177, 11056, 23757, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:47:44', '2021-10-01 12:47:44'),
(31178, 11056, 23757, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:54:30', '2021-10-18 15:54:30'),
(31179, 11056, 23757, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:03:22', '2021-10-26 12:03:22');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(31180, 11056, 23757, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:28:32', '2021-11-11 14:28:32'),
(31181, 11056, 23757, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:28:46', '2021-11-11 14:28:46'),
(31182, 11056, 23757, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:42:07', '2021-12-02 16:42:07'),
(31183, 11056, 23757, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:03:39', '2021-12-16 14:03:39'),
(31184, 11056, 23757, NULL, '2021-12-30 00:00:00.000', 'In Process', '	 Email sent to: JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope this email finds you well. You haven\'t gotten back to me on this. I am still waiting for the updates on the enrollment updates.  Please respond to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-23 16:07:33', '2021-12-23 16:07:33'),
(31185, 19067, 23757, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly get back to us once you have time.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:39:46', '2022-01-10 17:39:46'),
(31186, 19067, 23757, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad', NULL, NULL, '2022-01-26 17:34:54', '2022-01-26 17:34:54'),
(31187, 19067, 23757, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Subject: 	RE: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare    Hello!     This is the current status based on my last response to Claims Med Inc.  The information was provided on 12/23/21 and 1/13/22.   ', NULL, NULL, '2022-02-11 16:58:26', '2022-02-11 16:58:26'),
(31188, 19067, 23757, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Can I get the welcome kit for the providers who got affected?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:45:12', '2022-02-21 17:45:12'),
(31189, 19067, 23757, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello,  I haven\'t received the welcome letter for the providers. Kindly provide us with the welcome kit.  Thanks, ', NULL, NULL, '2022-03-15 17:58:17', '2022-03-15 17:58:17'),
(31190, 22077, 23757, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Enrollment Query || RHC || Providers || Tricare  Hi,  I would like to know the enrollment process for the following providers with the below-mentioned providers,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & Billing Location	500 E Caesar, Kingsville, TX 78363 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382 Patrick Ayarzagoitia	1649568239	6646 S. Staples St. 122, Corpus Christi, TX 78413 Katherine Rabagos	1134415631	6646 S. Staples St. 122, Corpus Christi, TX 78413 Petina Rogers	1801443916	6646 S. Staples St. 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	6646 S. Staples St. 122, Corpus Christi, TX 78413 Maegan Svatek	1639670250	3817 South Padre Island Drive, Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill, Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive, Corpus Christi, TX 78415 Traci Mason	1497127831	500 E Caesar, Kingsville, TX 78363  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-08 11:08:14', '2022-04-08 11:08:14'),
(31191, 22077, 23757, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Location added through the portal', NULL, NULL, '2022-04-25 08:06:24', '2022-04-25 08:06:24'),
(31192, 1006, 23758, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:36:51', '2021-03-25 11:36:51'),
(31193, 1006, 23758, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:15:40', '2021-04-08 18:15:40'),
(31194, 9057, 23758, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:26:59', '2021-05-25 16:26:59'),
(31195, 1006, 23758, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:45:14', '2021-06-11 16:45:14'),
(31196, 1006, 23758, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:34:35', '2021-06-30 09:34:35'),
(31197, 1006, 23758, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks.  ', NULL, NULL, '2021-08-09 17:13:51', '2021-08-09 17:13:51'),
(31198, 1006, 23758, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:47:46', '2021-08-24 14:47:46'),
(31199, 11056, 23758, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:11:54', '2021-09-21 16:11:54'),
(31200, 11056, 23758, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:47:34', '2021-10-01 12:47:34'),
(31201, 11056, 23758, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:54:23', '2021-10-18 15:54:23'),
(31202, 11056, 23758, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:03:16', '2021-10-26 12:03:16'),
(31203, 11056, 23758, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:28:27', '2021-11-11 14:28:27'),
(31204, 11056, 23758, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:42:19', '2021-12-02 16:42:19'),
(31205, 11056, 23758, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:03:34', '2021-12-16 14:03:34'),
(31206, 11056, 23758, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective date  Traci S Mason Np  Calallen - 6/1/2017 Staples - 6/1/2017   Refcode: 14725307  Please see the attachments ', NULL, NULL, '2021-12-21 15:02:40', '2021-12-21 15:02:40'),
(31207, 1006, 23759, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:36:52', '2021-03-25 11:36:52'),
(31208, 1006, 23759, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:15:44', '2021-04-08 18:15:44'),
(31209, 9057, 23759, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Dear Sir, We are facing problems while updating data in EMRB as the page setting didn\'t remain the same after adding status and notes. and we have to change the settings after each update', NULL, NULL, '2021-05-25 16:41:41', '2021-05-25 16:41:41'),
(31210, 1006, 23759, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:45:11', '2021-06-11 16:45:11'),
(31211, 1006, 23759, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:33:31', '2021-06-30 09:33:31'),
(31212, 1006, 23759, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks.  ', NULL, NULL, '2021-08-09 17:13:47', '2021-08-09 17:13:47'),
(31213, 1006, 23759, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:47:23', '2021-08-24 14:47:23'),
(31214, 11056, 23759, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:11:49', '2021-09-21 16:11:49'),
(31215, 11056, 23759, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:47:16', '2021-10-01 12:47:16'),
(31216, 11056, 23759, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:54:17', '2021-10-18 15:54:17'),
(31217, 11056, 23759, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:03:10', '2021-10-26 12:03:10'),
(31218, 11056, 23759, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:28:21', '2021-11-11 14:28:21'),
(31219, 11056, 23759, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:42:26', '2021-12-02 16:42:26'),
(31220, 11056, 23759, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:03:26', '2021-12-16 14:03:26'),
(31221, 11056, 23759, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider       Effective dates   Mari K Capupus   Kingsville - 6/1/2017 CALLALEN - 6/1/2017 STAPLES  - 6/1/2017 SPID     - 6/1/2017  Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 13:34:46', '2021-12-21 13:34:46'),
(31222, 1006, 23760, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:36:52', '2021-03-25 11:36:52'),
(31223, 1006, 23760, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:15:48', '2021-04-08 18:15:48'),
(31224, 9057, 23760, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Dear Sir, We are facing problems while updating data in EMRB as the page setting didn\'t remain the same after adding status and notes. and we have to change the settings after each update', NULL, NULL, '2021-05-25 16:41:50', '2021-05-25 16:41:50'),
(31225, 1006, 23760, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:45:07', '2021-06-11 16:45:07'),
(31226, 1006, 23760, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:40:25', '2021-06-30 09:40:25'),
(31227, 1006, 23760, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks.  ', NULL, NULL, '2021-08-09 17:13:43', '2021-08-09 17:13:43'),
(31228, 1006, 23760, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:47:18', '2021-08-24 14:47:18'),
(31229, 11056, 23760, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:11:42', '2021-09-21 16:11:42'),
(31230, 11056, 23760, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:46:46', '2021-10-01 12:46:46'),
(31231, 11056, 23760, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:54:11', '2021-10-18 15:54:11'),
(31232, 11056, 23760, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:02:43', '2021-10-26 12:02:43'),
(31233, 11056, 23760, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:03:04', '2021-10-26 12:03:04'),
(31234, 11056, 23760, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:28:15', '2021-11-11 14:28:15'),
(31235, 11056, 23760, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:42:34', '2021-12-02 16:42:34');
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
(31236, 11056, 23760, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:42:49', '2021-12-02 16:42:49'),
(31237, 11056, 23760, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:03:18', '2021-12-16 14:03:18'),
(31238, 11056, 23760, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective dates   Juan Miguel Capupus   Kingsville - 6/1/2017 CALLALEN - 6/1/2017 STAPLES  - 6/1/2017 SPID     - 6/1/2017  Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 13:45:00', '2021-12-21 13:45:00'),
(31239, 1006, 23761, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:36:53', '2021-03-25 11:36:53'),
(31240, 1006, 23761, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:15:52', '2021-04-08 18:15:52'),
(31241, 9057, 23761, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:25:16', '2021-05-25 16:25:16'),
(31242, 1006, 23761, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:45:04', '2021-06-11 16:45:04'),
(31243, 1006, 23761, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:29:57', '2021-06-30 09:29:57'),
(31244, 1006, 23761, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks.  ', NULL, NULL, '2021-08-09 17:13:39', '2021-08-09 17:13:39'),
(31245, 1006, 23761, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:47:12', '2021-08-24 14:47:12'),
(31246, 11056, 23761, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:11:37', '2021-09-21 16:11:37'),
(31247, 11056, 23761, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:46:41', '2021-10-01 12:46:41'),
(31248, 11056, 23761, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:54:05', '2021-10-18 15:54:05'),
(31249, 11056, 23761, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:02:37', '2021-10-26 12:02:37'),
(31250, 11056, 23761, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:28:08', '2021-11-11 14:28:08'),
(31251, 11056, 23761, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:42:54', '2021-12-02 16:42:54'),
(31252, 11056, 23761, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:03:09', '2021-12-16 14:03:09'),
(31253, 11056, 23761, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope this email finds you well. You haven\'t gotten back to me on this. I am still waiting for the updates on the enrollment updates.  Please respond to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-23 16:07:15', '2021-12-23 16:07:15'),
(31254, 19067, 23761, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly get back to us once you have time.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:39:39', '2022-01-10 17:39:39'),
(31255, 19067, 23761, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad', NULL, NULL, '2022-01-26 17:34:48', '2022-01-26 17:34:48'),
(31256, 19067, 23761, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Subject: 	RE: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare    Hello!     This is the current status based on my last response to Claims Med Inc.  The information was provided on 12/23/21 and 1/13/22.   ', NULL, NULL, '2022-02-11 16:58:13', '2022-02-11 16:58:13'),
(31257, 19067, 23761, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Can I get the welcome kit for the providers who got affected?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:45:07', '2022-02-21 17:45:07'),
(31258, 19067, 23761, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello,  I haven\'t received the welcome letter for the providers. Kindly provide us with the welcome kit.  Thanks, ', NULL, NULL, '2022-03-15 17:58:27', '2022-03-15 17:58:27'),
(31259, 22077, 23761, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Enrollment Query || RHC || Providers || Tricare  Hi,  I would like to know the enrollment process for the following providers with the below-mentioned providers,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & Billing Location	500 E Caesar, Kingsville, TX 78363 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382 Patrick Ayarzagoitia	1649568239	6646 S. Staples St. 122, Corpus Christi, TX 78413 Katherine Rabagos	1134415631	6646 S. Staples St. 122, Corpus Christi, TX 78413 Petina Rogers	1801443916	6646 S. Staples St. 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	6646 S. Staples St. 122, Corpus Christi, TX 78413 Maegan Svatek	1639670250	3817 South Padre Island Drive, Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill, Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive, Corpus Christi, TX 78415 Traci Mason	1497127831	500 E Caesar, Kingsville, TX 78363  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-08 11:08:01', '2022-04-08 11:08:01'),
(31260, 22077, 23761, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Location added through the portal', NULL, NULL, '2022-04-25 08:05:32', '2022-04-25 08:05:32'),
(31261, 1006, 23762, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:36:54', '2021-03-25 11:36:54'),
(31262, 1006, 23762, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:15:55', '2021-04-08 18:15:55'),
(31263, 1006, 23762, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-06-03 14:08:52', '2021-06-03 14:08:52'),
(31264, 1006, 23762, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:45:01', '2021-06-11 16:45:01'),
(31265, 3040, 23762, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 17:00:28', '2021-06-30 17:00:28'),
(31266, 1006, 23762, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks.  ', NULL, NULL, '2021-08-09 17:13:29', '2021-08-09 17:13:29'),
(31267, 1006, 23762, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:47:06', '2021-08-24 14:47:06'),
(31268, 11056, 23762, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:11:30', '2021-09-21 16:11:30'),
(31269, 11056, 23762, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:45:41', '2021-10-01 12:45:41'),
(31270, 11056, 23762, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:53:58', '2021-10-18 15:53:58'),
(31271, 11056, 23762, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:02:30', '2021-10-26 12:02:30'),
(31272, 11056, 23762, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:26:33', '2021-11-11 14:26:33'),
(31273, 11056, 23762, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:43:00', '2021-12-02 16:43:00'),
(31274, 11056, 23762, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:02:42', '2021-12-16 14:02:42'),
(31275, 11056, 23762, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Group     Effective dates   CALALLEN  -  6/1/2017 STAPLES   -  6/1/2017 SPID     -  6/1/2017  Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 13:26:01', '2021-12-21 13:26:01'),
(31276, 1006, 23763, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:37:32', '2021-03-25 11:37:32'),
(31277, 1006, 23763, NULL, '2021-04-15 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract.  Contract and welcome letter are attached on group task for reference. ', NULL, NULL, '2021-04-08 18:19:40', '2021-04-08 18:19:40'),
(31278, 1006, 23775, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:41:24', '2021-03-25 11:41:24'),
(31279, 3040, 23775, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.', NULL, NULL, '2021-03-31 15:38:20', '2021-03-31 15:38:20'),
(31280, 9057, 23775, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Request isn\'t showing up on wellcare\'s end, talked to representative and he has forwarded our request to provider relations to call us back. ', NULL, NULL, '2021-05-26 14:30:59', '2021-05-26 14:30:59'),
(31281, 3040, 23775, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com   Subject: Enroll Group || Statcare Minor Emergency Clinic || Group || Wellcare ||  Greetings,   Hope all is well. I wanted to know the enrollment status for the below mentioned group in Wellcare under the below locations. We already sent the request for enrollment on 03/31/2021.   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Secondary Address: 4042 River Hill Corpus Christi , TX 78410 Tertiary Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-15 16:43:17', '2021-06-15 16:43:17'),
(31282, 11056, 23775, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com   Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare ||  Greetings,  Kindly respond soon. Hope all is well. I wanted to know the enrollment status for the below mentioned group in Wellcare under the below locations. We already sent the request for enrollment on 03/31/2021.  Practice: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Secondary Address: 4042 River Hill Corpus Christi , TX 78410 Tertiary Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Please get back to me as soon as you can get a chance. Waiting for your reply.  Thank you !', NULL, NULL, '2021-07-01 17:05:10', '2021-07-01 17:05:10'),
(31283, 1006, 23775, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference. ', NULL, NULL, '2021-07-15 11:03:37', '2021-07-15 11:03:37'),
(31284, 1006, 23775, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ ZASHBAUGH@centene.com & ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Address: 4042 River Hill Corpus Christi , TX 78410 Quaternary Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-24 13:15:08', '2021-08-24 13:15:08'),
(31285, 1006, 23775, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:41:33', '2021-09-01 15:41:33'),
(31286, 11056, 23775, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name                	Statcare Minor Emergency Clinic Tax ID	                            46-0575924 Group NPI	                    1689924904 Primary Location	             500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	     6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	             4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	     3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-22 10:45:44', '2021-09-22 10:45:44'),
(31287, 11056, 23775, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Phone: 866-615-9399  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2021-09-30 17:01:12', '2021-09-30 17:01:12'),
(31288, 11056, 23775, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-12 16:08:55', '2021-10-12 16:08:55'),
(31289, 11056, 23775, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Hello,   Your record has not been complete, but the effective date is still showing 10/1/121.    Once they complete your record. You will received a welcome packet.   Thank you,', NULL, NULL, '2021-10-20 14:12:42', '2021-10-20 14:12:42'),
(31290, 11056, 23775, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email sent to: 	SHP Network Development NPR Contracting  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-10 17:44:48', '2021-11-10 17:44:48'),
(31291, 11056, 23775, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: SHP Network Development NPR Contracting  Sub: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-19 17:50:37', '2021-11-19 17:50:37'),
(31292, 11056, 23775, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email received from:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com   Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Thank you,', NULL, NULL, '2021-12-01 13:13:53', '2021-12-01 13:13:53'),
(31293, 11056, 23775, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:43:31', '2021-12-16 16:43:31'),
(31294, 11056, 23775, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:38:47', '2021-12-23 15:38:47'),
(31295, 19067, 23775, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:20:15', '2022-01-10 17:20:15'),
(31296, 19067, 23775, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!  This is my THIRD REMINDER on the request below. Kindly respond in a timely manner.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-26 17:59:48', '2022-01-26 17:59:48'),
(31297, 19067, 23775, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello!  I haven\'t heard from you and it\'s been a while now. Kindly look into my requests and update me.  Waiting to hear from you soon!  Thanks, Hammad Ahmed.', NULL, NULL, '2022-02-11 17:09:10', '2022-02-11 17:09:10'),
(31298, 19067, 23775, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello!  Hope this email finds you well.  I haven\'t heard from you for 1 month. Kindly respond at your earliest convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:48:49', '2022-02-21 17:48:49'),
(31299, 19067, 23775, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: RE: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare    Hello,     Your request was forward to the correct dep to get you the welcome packet and welcome letter.', NULL, NULL, '2022-02-23 10:34:54', '2022-02-23 10:34:54'),
(31300, 19067, 23775, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Fwd: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare    Hi Zuzi,  I haven\'t received the welcome kit as far, can you request that department one more time to send us the approval letter?  Thanks,', NULL, NULL, '2022-03-15 18:03:15', '2022-03-15 18:03:15'),
(31301, 1006, 23776, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:41:25', '2021-03-25 11:41:25'),
(31302, 3040, 23776, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:47:52', '2021-03-31 15:47:52'),
(31303, 1006, 23777, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:41:26', '2021-03-25 11:41:26'),
(31304, 3040, 23777, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:48:06', '2021-03-31 15:48:06'),
(31305, 1006, 23778, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:41:27', '2021-03-25 11:41:27'),
(31306, 3040, 23778, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:48:22', '2021-03-31 15:48:22'),
(31307, 1006, 23779, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:41:28', '2021-03-25 11:41:28');
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
(31308, 3040, 23779, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:48:39', '2021-03-31 15:48:39'),
(31309, 1006, 23780, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:41:28', '2021-03-25 11:41:28'),
(31310, 3040, 23780, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:48:58', '2021-03-31 15:48:58'),
(31311, 1006, 23781, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:41:29', '2021-03-25 11:41:29'),
(31312, 3040, 23781, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:49:12', '2021-03-31 15:49:12'),
(31313, 1006, 23782, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:41:30', '2021-03-25 11:41:30'),
(31314, 3040, 23782, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:49:26', '2021-03-31 15:49:26'),
(31315, 1006, 23783, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:41:31', '2021-03-25 11:41:31'),
(31316, 3040, 23783, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:49:40', '2021-03-31 15:49:40'),
(31317, 1006, 23784, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:41:32', '2021-03-25 11:41:32'),
(31318, 3040, 23784, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:49:55', '2021-03-31 15:49:55'),
(31319, 1006, 23785, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:41:33', '2021-03-25 11:41:33'),
(31320, 3040, 23785, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:50:09', '2021-03-31 15:50:09'),
(31321, 1006, 23786, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:43:03', '2021-03-25 11:43:03'),
(31322, 1006, 23786, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:35:46', '2021-03-29 17:35:46'),
(31323, 1006, 23787, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:43:04', '2021-03-25 11:43:04'),
(31324, 1006, 23787, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:36:06', '2021-03-29 17:36:06'),
(31325, 1006, 23788, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:43:05', '2021-03-25 11:43:05'),
(31326, 1006, 23788, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:36:13', '2021-03-29 17:36:13'),
(31327, 1006, 23789, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:43:06', '2021-03-25 11:43:06'),
(31328, 1006, 23789, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:36:18', '2021-03-29 17:36:18'),
(31329, 1006, 23790, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:43:07', '2021-03-25 11:43:07'),
(31330, 1006, 23790, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:36:23', '2021-03-29 17:36:23'),
(31331, 1006, 23791, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:43:08', '2021-03-25 11:43:08'),
(31332, 1006, 23791, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:36:29', '2021-03-29 17:36:29'),
(31333, 1006, 23792, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:43:09', '2021-03-25 11:43:09'),
(31334, 1006, 23792, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:36:33', '2021-03-29 17:36:33'),
(31335, 1006, 23793, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:43:10', '2021-03-25 11:43:10'),
(31336, 1006, 23793, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:36:38', '2021-03-29 17:36:38'),
(31337, 1006, 23794, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:43:11', '2021-03-25 11:43:11'),
(31338, 1006, 23794, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:36:42', '2021-03-29 17:36:42'),
(31339, 1006, 23795, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:43:11', '2021-03-25 11:43:11'),
(31340, 1006, 23795, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:36:49', '2021-03-29 17:36:49'),
(31341, 1006, 23796, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:43:12', '2021-03-25 11:43:12'),
(31342, 1006, 23796, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:36:55', '2021-03-29 17:36:55'),
(31343, 1006, 23797, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:05', '2021-03-25 11:45:05'),
(31344, 1006, 23797, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 13:10:10', '2021-04-07 13:10:10'),
(31345, 1006, 23797, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:42:48', '2021-04-27 12:42:48'),
(31346, 1006, 23797, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:57:32', '2021-04-28 07:57:32'),
(31347, 9057, 23797, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:34:41', '2021-05-26 08:34:41'),
(31348, 3040, 23797, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:23:46', '2021-06-15 16:23:46'),
(31349, 1006, 23797, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:21:43', '2021-07-05 13:21:43'),
(31350, 1006, 23797, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:48:22', '2021-08-12 16:48:22'),
(31351, 1006, 23797, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:48:18', '2021-08-23 09:48:18'),
(31352, 1006, 23797, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:21:59', '2021-08-30 14:21:59'),
(31353, 11056, 23797, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : shonterence.adams@christushealth.org, michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Good evening!  Hope this email finds you well. I want to inquire about the status of adding the locations under the TIN & providers too. Have the highlighted locations been added or not yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the latest status regarding our request. Eagerly, waiting to get an update from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:53:34', '2021-09-21 16:53:34'),
(31354, 11056, 23797, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : shonterence.adams@christushealth.org, michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Good evening!  Hope this email finds you well. I want to inquire about the status of adding the locations under the TIN & providers too. Have the highlighted locations been added or not yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the latest status regarding our request. Eagerly, waiting to get an update from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:53:52', '2021-09-21 16:53:52'),
(31355, 11056, 23797, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:04:55', '2021-09-28 09:04:55'),
(31356, 11056, 23797, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:04:56', '2021-09-28 09:04:56'),
(31357, 11056, 23797, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:00:53', '2021-10-12 14:00:53'),
(31358, 11056, 23797, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:32:34', '2021-10-25 12:32:34'),
(31359, 11056, 23797, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:12:57', '2021-11-11 14:12:57'),
(31360, 11056, 23797, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:40:03', '2021-11-24 17:40:03'),
(31361, 11056, 23797, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:21:20', '2021-12-10 17:21:20'),
(31362, 19067, 23797, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:37:01', '2021-12-22 15:37:01'),
(31363, 11056, 23797, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Please see the attachments', NULL, NULL, '2021-12-23 14:16:20', '2021-12-23 14:16:20'),
(31364, 1006, 23798, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:06', '2021-03-25 11:45:06'),
(31365, 1006, 23798, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 13:10:14', '2021-04-07 13:10:14'),
(31366, 1006, 23798, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:42:43', '2021-04-27 12:42:43'),
(31367, 1006, 23798, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:57:17', '2021-04-28 07:57:17'),
(31368, 9057, 23798, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:34:59', '2021-05-26 08:34:59'),
(31369, 3040, 23798, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:23:42', '2021-06-15 16:23:42'),
(31370, 1006, 23798, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:21:51', '2021-07-05 13:21:51'),
(31371, 1006, 23798, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:48:19', '2021-08-12 16:48:19'),
(31372, 1006, 23798, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:48:15', '2021-08-23 09:48:15'),
(31373, 1006, 23798, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:21:54', '2021-08-30 14:21:54'),
(31374, 11056, 23798, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : shonterence.adams@christushealth.org, michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Good evening!  Hope this email finds you well. I want to inquire about the status of adding the locations under the TIN & providers too. Have the highlighted locations been added or not yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the latest status regarding our request. Eagerly, waiting to get an update from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:53:27', '2021-09-21 16:53:27'),
(31375, 11056, 23798, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:04:49', '2021-09-28 09:04:49'),
(31376, 11056, 23798, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:00:47', '2021-10-12 14:00:47'),
(31377, 11056, 23798, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:32:28', '2021-10-25 12:32:28'),
(31378, 11056, 23798, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:12:51', '2021-11-11 14:12:51'),
(31379, 11056, 23798, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:39:58', '2021-11-24 17:39:58'),
(31380, 11056, 23798, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:21:14', '2021-12-10 17:21:14'),
(31381, 19067, 23798, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:36:17', '2021-12-22 15:36:17'),
(31382, 11056, 23798, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Please see the attachments', NULL, NULL, '2021-12-23 14:16:32', '2021-12-23 14:16:32'),
(31383, 1006, 23799, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:07', '2021-03-25 11:45:07'),
(31384, 1006, 23799, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 13:10:18', '2021-04-07 13:10:18'),
(31385, 1006, 23799, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:42:39', '2021-04-27 12:42:39'),
(31386, 1006, 23799, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:57:03', '2021-04-28 07:57:03'),
(31387, 9057, 23799, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:35:21', '2021-05-26 08:35:21'),
(31388, 3040, 23799, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:23:39', '2021-06-15 16:23:39'),
(31389, 1006, 23799, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:21:57', '2021-07-05 13:21:57'),
(31390, 1006, 23799, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:48:15', '2021-08-12 16:48:15'),
(31391, 1006, 23799, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:48:11', '2021-08-23 09:48:11');
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
(31392, 1006, 23799, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:21:50', '2021-08-30 14:21:50'),
(31393, 11056, 23799, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : shonterence.adams@christushealth.org, michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Good evening!  Hope this email finds you well. I want to inquire about the status of adding the locations under the TIN & providers too. Have the highlighted locations been added or not yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the latest status regarding our request. Eagerly, waiting to get an update from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:53:20', '2021-09-21 16:53:20'),
(31394, 11056, 23799, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:04:42', '2021-09-28 09:04:42'),
(31395, 11056, 23799, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:00:38', '2021-10-12 14:00:38'),
(31396, 11056, 23799, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:32:22', '2021-10-25 12:32:22'),
(31397, 11056, 23799, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:12:46', '2021-11-11 14:12:46'),
(31398, 11056, 23799, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:39:52', '2021-11-24 17:39:52'),
(31399, 11056, 23799, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:21:09', '2021-12-10 17:21:09'),
(31400, 19067, 23799, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:36:06', '2021-12-22 15:36:06'),
(31401, 11056, 23799, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Please see the attachments', NULL, NULL, '2021-12-23 14:16:38', '2021-12-23 14:16:38'),
(31402, 1006, 23800, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:08', '2021-03-25 11:45:08'),
(31403, 1006, 23800, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 13:10:21', '2021-04-07 13:10:21'),
(31404, 1006, 23800, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:42:35', '2021-04-27 12:42:35'),
(31405, 1006, 23800, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:56:57', '2021-04-28 07:56:57'),
(31406, 9057, 23800, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:33:21', '2021-05-26 08:33:21'),
(31407, 3040, 23800, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:23:34', '2021-06-15 16:23:34'),
(31408, 1006, 23800, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:22:00', '2021-07-05 13:22:00'),
(31409, 1006, 23800, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:48:12', '2021-08-12 16:48:12'),
(31410, 1006, 23800, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:48:08', '2021-08-23 09:48:08'),
(31411, 1006, 23800, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:21:44', '2021-08-30 14:21:44'),
(31412, 11056, 23800, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : shonterence.adams@christushealth.org, michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Good evening!  Hope this email finds you well. I want to inquire about the status of adding the locations under the TIN & providers too. Have the highlighted locations been added or not yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the latest status regarding our request. Eagerly, waiting to get an update from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:53:13', '2021-09-21 16:53:13'),
(31413, 11056, 23800, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:04:36', '2021-09-28 09:04:36'),
(31414, 11056, 23800, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:00:30', '2021-10-12 14:00:30'),
(31415, 11056, 23800, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:32:14', '2021-10-25 12:32:14'),
(31416, 11056, 23800, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:12:41', '2021-11-11 14:12:41'),
(31417, 11056, 23800, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:39:47', '2021-11-24 17:39:47'),
(31418, 11056, 23800, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:21:04', '2021-12-10 17:21:04'),
(31419, 19067, 23800, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:35:57', '2021-12-22 15:35:57'),
(31420, 11056, 23800, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Please see the attachments', NULL, NULL, '2021-12-23 14:17:56', '2021-12-23 14:17:56'),
(31421, 1006, 23801, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:08', '2021-03-25 11:45:08'),
(31422, 1006, 23801, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 13:10:25', '2021-04-07 13:10:25'),
(31423, 1006, 23801, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:42:30', '2021-04-27 12:42:30'),
(31424, 1006, 23801, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:56:50', '2021-04-28 07:56:50'),
(31425, 9057, 23801, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:32:58', '2021-05-26 08:32:58'),
(31426, 3040, 23801, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:23:30', '2021-06-15 16:23:30'),
(31427, 1006, 23801, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:22:04', '2021-07-05 13:22:04'),
(31428, 1006, 23801, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:48:08', '2021-08-12 16:48:08'),
(31429, 1006, 23801, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:48:04', '2021-08-23 09:48:04'),
(31430, 1006, 23801, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:21:40', '2021-08-30 14:21:40'),
(31431, 11056, 23801, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : shonterence.adams@christushealth.org, michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Good evening!  Hope this email finds you well. I want to inquire about the status of adding the locations under the TIN & providers too. Have the highlighted locations been added or not yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the latest status regarding our request. Eagerly, waiting to get an update from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:53:07', '2021-09-21 16:53:07'),
(31432, 11056, 23801, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:04:30', '2021-09-28 09:04:30'),
(31433, 11056, 23801, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:00:24', '2021-10-12 14:00:24'),
(31434, 11056, 23801, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:32:09', '2021-10-25 12:32:09'),
(31435, 11056, 23801, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:12:36', '2021-11-11 14:12:36'),
(31436, 11056, 23801, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:39:41', '2021-11-24 17:39:41'),
(31437, 11056, 23801, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:20:59', '2021-12-10 17:20:59'),
(31438, 19067, 23801, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:36:27', '2021-12-22 15:36:27'),
(31439, 11056, 23801, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Please see the attachments', NULL, NULL, '2021-12-23 14:18:03', '2021-12-23 14:18:03'),
(31440, 1006, 23802, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:09', '2021-03-25 11:45:09'),
(31441, 1006, 23802, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 13:10:28', '2021-04-07 13:10:28'),
(31442, 1006, 23802, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:42:26', '2021-04-27 12:42:26'),
(31443, 1006, 23802, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:56:42', '2021-04-28 07:56:42');
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
(31444, 9057, 23802, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:32:43', '2021-05-26 08:32:43'),
(31445, 3040, 23802, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:23:27', '2021-06-15 16:23:27'),
(31446, 1006, 23802, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:22:08', '2021-07-05 13:22:08'),
(31447, 1006, 23802, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:48:05', '2021-08-12 16:48:05'),
(31448, 1006, 23802, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:48:01', '2021-08-23 09:48:01'),
(31449, 1006, 23802, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:21:35', '2021-08-30 14:21:35'),
(31450, 11056, 23802, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : shonterence.adams@christushealth.org, michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Good evening!  Hope this email finds you well. I want to inquire about the status of adding the locations under the TIN & providers too. Have the highlighted locations been added or not yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the latest status regarding our request. Eagerly, waiting to get an update from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:53:01', '2021-09-21 16:53:01'),
(31451, 11056, 23802, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:04:25', '2021-09-28 09:04:25'),
(31452, 11056, 23802, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:00:16', '2021-10-12 14:00:16'),
(31453, 11056, 23802, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:32:03', '2021-10-25 12:32:03'),
(31454, 11056, 23802, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:12:02', '2021-11-11 14:12:02'),
(31455, 11056, 23802, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:39:36', '2021-11-24 17:39:36'),
(31456, 11056, 23802, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:20:54', '2021-12-10 17:20:54'),
(31457, 19067, 23802, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:36:36', '2021-12-22 15:36:36'),
(31458, 11056, 23802, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Please see the attachments', NULL, NULL, '2021-12-23 14:18:08', '2021-12-23 14:18:08'),
(31459, 1006, 23803, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:10', '2021-03-25 11:45:10'),
(31460, 1006, 23803, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 13:10:31', '2021-04-07 13:10:31'),
(31461, 1006, 23803, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:42:21', '2021-04-27 12:42:21'),
(31462, 1006, 23803, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:56:35', '2021-04-28 07:56:35'),
(31463, 9057, 23803, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:32:34', '2021-05-26 08:32:34'),
(31464, 3040, 23803, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:23:23', '2021-06-15 16:23:23'),
(31465, 1006, 23803, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:22:11', '2021-07-05 13:22:11'),
(31466, 1006, 23803, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:48:01', '2021-08-12 16:48:01'),
(31467, 1006, 23803, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:47:58', '2021-08-23 09:47:58'),
(31468, 1006, 23803, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:21:31', '2021-08-30 14:21:31'),
(31469, 11056, 23803, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : shonterence.adams@christushealth.org, michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Good evening!  Hope this email finds you well. I want to inquire about the status of adding the locations under the TIN & providers too. Have the highlighted locations been added or not yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the latest status regarding our request. Eagerly, waiting to get an update from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:52:56', '2021-09-21 16:52:56'),
(31470, 11056, 23803, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:04:17', '2021-09-28 09:04:17'),
(31471, 11056, 23803, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:00:10', '2021-10-12 14:00:10'),
(31472, 11056, 23803, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:31:55', '2021-10-25 12:31:55'),
(31473, 11056, 23803, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:10:12', '2021-11-11 14:10:12'),
(31474, 11056, 23803, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:39:31', '2021-11-24 17:39:31'),
(31475, 11056, 23803, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:20:49', '2021-12-10 17:20:49'),
(31476, 19067, 23803, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:36:45', '2021-12-22 15:36:45'),
(31477, 11056, 23803, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Please see the attachments', NULL, NULL, '2021-12-23 14:18:14', '2021-12-23 14:18:14'),
(31478, 1006, 23804, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:11', '2021-03-25 11:45:11'),
(31479, 1006, 23804, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 13:10:36', '2021-04-07 13:10:36'),
(31480, 1006, 23804, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:42:17', '2021-04-27 12:42:17'),
(31481, 1006, 23804, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:56:27', '2021-04-28 07:56:27'),
(31482, 9057, 23804, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:32:20', '2021-05-26 08:32:20'),
(31483, 1006, 23804, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818 ', NULL, NULL, '2021-06-15 17:21:41', '2021-06-15 17:21:41'),
(31484, 1006, 23804, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:22:14', '2021-07-05 13:22:14'),
(31485, 1006, 23804, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:47:58', '2021-08-12 16:47:58'),
(31486, 1006, 23804, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:47:53', '2021-08-23 09:47:53'),
(31487, 1006, 23804, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:21:27', '2021-08-30 14:21:27'),
(31488, 11056, 23804, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : shonterence.adams@christushealth.org, michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Good evening!  Hope this email finds you well. I want to inquire about the status of adding the locations under the TIN & providers too. Have the highlighted locations been added or not yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the latest status regarding our request. Eagerly, waiting to get an update from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:52:50', '2021-09-21 16:52:50'),
(31489, 11056, 23804, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:04:11', '2021-09-28 09:04:11'),
(31490, 11056, 23804, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 14:00:04', '2021-10-12 14:00:04'),
(31491, 11056, 23804, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:31:49', '2021-10-25 12:31:49'),
(31492, 11056, 23804, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:10:07', '2021-11-11 14:10:07'),
(31493, 11056, 23804, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:39:25', '2021-11-24 17:39:25'),
(31494, 11056, 23804, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:20:45', '2021-12-10 17:20:45'),
(31495, 19067, 23804, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:35:46', '2021-12-22 15:35:46');
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
(31496, 11056, 23804, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Please see the attachments', NULL, NULL, '2021-12-23 14:18:20', '2021-12-23 14:18:20'),
(31497, 1006, 23805, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:12', '2021-03-25 11:45:12'),
(31498, 1006, 23805, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 13:10:40', '2021-04-07 13:10:40'),
(31499, 1006, 23805, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:42:13', '2021-04-27 12:42:13'),
(31500, 1006, 23805, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:56:20', '2021-04-28 07:56:20'),
(31501, 9057, 23805, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:32:12', '2021-05-26 08:32:12'),
(31502, 3040, 23805, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:22:53', '2021-06-15 16:22:53'),
(31503, 1006, 23805, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:22:17', '2021-07-05 13:22:17'),
(31504, 1006, 23805, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:47:54', '2021-08-12 16:47:54'),
(31505, 1006, 23805, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:47:48', '2021-08-23 09:47:48'),
(31506, 1006, 23805, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:21:22', '2021-08-30 14:21:22'),
(31507, 11056, 23805, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : shonterence.adams@christushealth.org, michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Good evening!  Hope this email finds you well. I want to inquire about the status of adding the locations under the TIN & providers too. Have the highlighted locations been added or not yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the latest status regarding our request. Eagerly, waiting to get an update from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:52:44', '2021-09-21 16:52:44'),
(31508, 11056, 23805, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:04:04', '2021-09-28 09:04:04'),
(31509, 11056, 23805, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 13:59:59', '2021-10-12 13:59:59'),
(31510, 11056, 23805, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:31:43', '2021-10-25 12:31:43'),
(31511, 11056, 23805, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:10:03', '2021-11-11 14:10:03'),
(31512, 11056, 23805, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:39:19', '2021-11-24 17:39:19'),
(31513, 11056, 23805, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:20:28', '2021-12-10 17:20:28'),
(31514, 19067, 23805, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.  ', NULL, NULL, '2021-12-22 15:35:12', '2021-12-22 15:35:12'),
(31515, 11056, 23805, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Please see the attachments', NULL, NULL, '2021-12-23 14:18:26', '2021-12-23 14:18:26'),
(31516, 1006, 23806, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:13', '2021-03-25 11:45:13'),
(31517, 1006, 23806, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 13:10:44', '2021-04-07 13:10:44'),
(31518, 1006, 23806, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:42:08', '2021-04-27 12:42:08'),
(31519, 1006, 23806, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:56:15', '2021-04-28 07:56:15'),
(31520, 9057, 23806, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:37:12', '2021-05-26 08:37:12'),
(31521, 3040, 23806, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:22:42', '2021-06-15 16:22:42'),
(31522, 1006, 23806, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:22:21', '2021-07-05 13:22:21'),
(31523, 1006, 23806, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:47:51', '2021-08-12 16:47:51'),
(31524, 1006, 23806, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:47:45', '2021-08-23 09:47:45'),
(31525, 1006, 23806, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:21:16', '2021-08-30 14:21:16'),
(31526, 11056, 23806, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : shonterence.adams@christushealth.org, michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Good evening!  Hope this email finds you well. I want to inquire about the status of adding the locations under the TIN & providers too. Have the highlighted locations been added or not yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the latest status regarding our request. Eagerly, waiting to get an update from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:52:38', '2021-09-21 16:52:38'),
(31527, 11056, 23806, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:03:59', '2021-09-28 09:03:59'),
(31528, 11056, 23806, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 13:59:53', '2021-10-12 13:59:53'),
(31529, 11056, 23806, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:31:37', '2021-10-25 12:31:37'),
(31530, 11056, 23806, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:09:58', '2021-11-11 14:09:58'),
(31531, 11056, 23806, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:39:14', '2021-11-24 17:39:14'),
(31532, 11056, 23806, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:18:18', '2021-12-10 17:18:18'),
(31533, 11056, 23806, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:20:18', '2021-12-10 17:20:18'),
(31534, 19067, 23806, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org, shonterence.adams@christushealth.org  Subject: Enrollment Query || Group & Providers || RHC || Christus Health Plan ||   Hello,  Hope you\'re having a productive day.  I would like to know the enrollment status for the mentioned providers under these locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Juan Capupus	1891168597	4042 River Hill Corpus Christi, TX 78410 Juan Capupus	1891168597	3817 South Padre Island Drive Corpus Christi, TX 78415 Patrick Ayarzagoitia	1649568239	4042 River Hill Corpus Christi, TX 78410 Patrick Ayarzagoitia	1649568239	3817 South Padre Island Drive Corpus Christi, TX 78415 Mari Capupus	1740517945	4042 River Hill Corpus Christi, TX 78410 Mari Capupus	1740517945	3817 South Padre Island Drive Corpus Christi, TX 78415 Katherine Rabagos	1134415631	4042 River Hill Corpus Christi, TX 78410 Katherine Rabagos	1134415631	3817 South Padre Island Drive Corpus Christi, TX 78415 Petina Rogers	1801443916	4042 River Hill Corpus Christi, TX 78410 Petina Rogers	1801443916	3817 South Padre Island Drive Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill Corpus Christi, TX 78410 Maegan Svatek	1639670250	3817 South Padre Island Drive Corpus Christi, TX 78415 Traci Mason	1497127831	4042 River Hill Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive Corpus Christi, TX 78415 Mary Gonzalez	1952713083	4042 River Hill Corpus Christi, TX 78410 Mary Gonzalez	1952713083	3817 South Padre Island Drive Corpus Christi, TX 78415 William Francis	1457994436	4042 River Hill Corpus Christi, TX 78410 William Francis	1457994436	3817 South Padre Island Drive Corpus Christi, TX 78415 Rose Trevino	1437174794	4042 River Hill Corpus Christi, TX 78410 Rose Trevino	1437174794	3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly respond promptly,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-22 15:35:35', '2021-12-22 15:35:35'),
(31535, 11056, 23806, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Please see the attachments', NULL, NULL, '2021-12-23 14:18:33', '2021-12-23 14:18:33'),
(31536, 1006, 23807, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:14', '2021-03-25 11:45:14'),
(31537, 1006, 23807, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Submitted credentialing/location addition application to michal.simms@christushealth.org via Christus Health secure portal:   Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello, Michal   Here\'s the application with all of the addresses listed, I couldn\'t find a checklist with the required documents but I did attach the Malpractice on the form. Please let me know if anything else is required to proceed and what the processing time frame will be?   Thanks again for all the help!\"  Copy of the application is attached in group task since this is an ancillary contract request.  ', NULL, NULL, '2021-04-07 13:09:48', '2021-04-07 13:09:48'),
(31538, 1006, 23807, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Michal requested more documents for the credentialing process, sent the following email to her @ Simms, Michal michal.simms@christushealth.org: ​  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Michal,  Here\'s the CLIA for both groups as well, do let me know if there\'s anything else that\'s needed to continue with our request. ', NULL, NULL, '2021-04-12 12:01:08', '2021-04-12 12:01:08'),
(31539, 1006, 23807, NULL, '2021-05-04 00:00:00.000', 'In Process', 'We received the following email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Good morning,  I’m following up to determine if you will send other documents needed to go along with your credentialing application.  I will need your W9 at least.  Let me know if you have submitted all you can.  Feel free to call me with questions.  Thanks, Michal\"  Sent her reply with all W9\'s of the groups. ', NULL, NULL, '2021-04-27 12:42:02', '2021-04-27 12:42:02'),
(31540, 1006, 23807, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following update from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Hello Brad,  Thank you for your quick response.  The request to credential the additional locations was submitted to credentialing – reference # FL01346390.  Please allow 90 days for the verification and loading process to be completed.  Best regards, Michal   Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan\"', NULL, NULL, '2021-04-28 07:56:03', '2021-04-28 07:56:03'),
(31541, 9057, 23807, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent email to michal.simms@christushealth.org Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello Michal, We submitted a request for the addition of a location for the following practice  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the current status regarding our request. Please get back to me as soon as you\'re able.  Thanks', NULL, NULL, '2021-05-26 08:37:22', '2021-05-26 08:37:22'),
(31542, 3040, 23807, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Credentialing, please advise us of the status of the Uniflow listed above.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan  469-282-3227  210-766-8818', NULL, NULL, '2021-06-15 16:22:49', '2021-06-15 16:22:49'),
(31543, 1006, 23807, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  \"Hello Michal,   I hope you\'re doing well, I wanted to follow up on the status of the location addition. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-05 13:22:25', '2021-07-05 13:22:25'),
(31544, 1006, 23807, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Received reply:   \"Good afternoon,  The Uniflow above was submitted with a completed application on 4/12/21 to credential a new location to an existing agreement; it is still open.  Please process and advise.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818\"  Sent f/u email @ michal.simms@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org:  Sub: FL01346390  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible as this request has been in process since April.   Thank you.\"', NULL, NULL, '2021-08-12 16:47:45', '2021-08-12 16:47:45'),
(31545, 1006, 23807, NULL, '2021-08-30 00:00:00.000', 'In Process', 'We received the following reply from michal.simms@christushealth.org:  Sub: FL01346390  \"Hello Brad,  I see three locations in our credentialing system but I need Credentialing to confirm.  Shon, will you please assist.  Statcare Minor Emergency Clinic TIN 460575924 FL01346390  Thanks, Michal\"  Haven\'t received any reply from Shon, sent a f/u email to both of them:  \"Hello Michal & Shonterence,   I still haven\'t received a reply on this, I\'d appreciate it if you could get back to me as soon as possible on this.  Also, there should be 4 locations listed, they are as follows:  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-23 09:47:42', '2021-08-23 09:47:42'),
(31546, 1006, 23807, NULL, '2021-09-06 00:00:00.000', 'In Process', 'We received the following reply from shonterence.adams@christushealth.org:  Sub: RE: FL01346390  \"Good morning,  Our facility processing coordinator is out today as well as the credentialing supervisor. However I have included her in this email so she can get this request assigned to a processing coordinator upon her return tomorrow. Our processing time is 180 days from the date a complete application is received. Although we aim to complete request within 90days, unfortunately we are receiving an influx of request. I entered the “ Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 and 4042 River Hill, Corpus Christi, TX 78410” so it is prepared for processing tomorrow.  Do the locations share a license? If so, I will add them as additional practice locations.  The locations credentialed are Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 (should this location remain)  They are also due for recredentialing soon. If additional information is required the assigned coordinator will f/u with you.  Best Regards ,  Shon Adams, MS, CPCS Credentialing Manager CHRISTUS Health O: (469) 282-3260 F: (210) 766-9380 www.christushealthplan.org\"  Replied with:   \"Hello Shon,   I appreciate the update, and yes all 4 locations have the same licenses. Please remove 5950 Saratoga Boulevard, Corpus Christi, TX 78414-4100 address.   Do let me know if anything else is required to proceed with this request.  Thank you!\"', NULL, NULL, '2021-08-30 14:20:43', '2021-08-30 14:20:43'),
(31547, 11056, 23807, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : shonterence.adams@christushealth.org, michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Good evening!  Hope this email finds you well. I want to inquire about the status of adding the locations under the TIN & providers too. Have the highlighted locations been added or not yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Kindly let us know the latest status regarding our request. Eagerly, waiting to get an update from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:52:20', '2021-09-21 16:52:20'),
(31548, 11056, 23807, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:00:13', '2021-09-28 09:00:13'),
(31549, 11056, 23807, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for your continued participation as a network provider. We are missing the reappointment applications for the following facilities:  CHRISTUS Health Plan  Statcare Minor Emergency Clinic  1689924904  Active  5950 Saratoga Boulevard   TX   Please provide these items to the Credentialing Verification Unit no later than October 04, 2021 .  Documentation can be sent via email to CHRISTUS.HP.Facility@christushealth.org. If you have any questions, please contact the email above or call 469-282-2949.   Sincerely, Credentialing Verification Unit CHRISTUS Health Plan/US Family Health Plan     All applications and supporting documents are to be sent to department email inbox CHRISTUS.HP.Facility@christushealth.org .', NULL, NULL, '2021-09-28 09:00:30', '2021-09-28 09:00:30'),
(31550, 11056, 23807, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email sent to : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good evening!  Hope you are doing great.  Here it is. Any further documents or information is needed please let me know. Please inform me if corrections are needed.  Thank you!    Please see the attachment', NULL, NULL, '2021-10-12 13:58:43', '2021-10-12 13:58:43');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(31551, 11056, 23807, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Dear Credentialing Contact,   Thank you for providing the requested application. It appears we’re reaching out for the following location: 5950 Saratoga Boulevard; unfortunately, I was unable to locate that facility on the application. Will you please confirm this location? Thank you!', NULL, NULL, '2021-10-25 12:31:05', '2021-10-25 12:31:05'),
(31552, 11056, 23807, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: tyesha.sullivan@christushealth.org  Sub : RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic   Good afternoon!  Hope this email finds you well. Have all the locations been updated and listed under the facility Tax I.D yet or not?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415  If you have further queries or concerns or require documents please do not hesitate to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 14:09:29', '2021-11-11 14:09:29'),
(31553, 11056, 23807, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  tyesha.sullivan@christushealth.org  &   michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope you both are doing well. Please let me know that Are all locations listed under the TIN and the providers of the facility. Please also do provide the welcome letters for the providers and executed agreement for the practice and locations   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	4042 River Hill, Corpus Christi , TX 78410 Additional Location	3817 South Padre Island Drive, Corpus Christi , TX 78415 Provider Name	NPI Katherine Rabagos	1134415631 Patrick Ayarzagoitia	1649568239 Rose Trevino	1437174794 William Francis	1457994436 Mary Gonzalez	1952713083 Traci Mason	1497127831 Juan Capupus	1891168597 Mari Capupus	1740517945 Petina Rogers	1801443916 Maegan Svatek	1639670250 Hannah Felhofer	1801387220  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-24 17:38:58', '2021-11-24 17:38:58'),
(31554, 11056, 23807, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Sub:  RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Good afternoon!  Hope this email finds you well. Tones of thanks to you for prompt responses and proper guidance to me. I am very grateful to you for this.  Please also list the 5th location address under the TIN: 2102 FM 2165, Rockport, TX 78382 Contact no. : 361-556-5770                     Fax no. : 361-556-5771   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:17:58', '2021-12-10 17:17:58'),
(31555, 11056, 23807, NULL, '2021-12-30 00:00:00.000', 'Approved', 'Email received from: michal.simms@christushealth.org  Sub: RE: Demographic Updates Needed - StatCare Minor Emergency Clinic - Christus Health plan  Good morning Ahmed,     Credentialing is working on getting copies of appointment letters to you, but I did find out that these two locations were approved for a 12/1/2021 effective date; included below are committee approval (10/12/21) and recred (10/1/24) dates:  Since we have an Ancillary Agreement for StatCare Minor Emergency Clinic, we are not required to credential or load the providers who work there.  As long as the providers bill under the group NPI – known as “group to group” billing.  Those providers will not be listed in our system – the participating provider is StatCare Minor Emergency Clinic.    Another email received from:  tyesha.sullivan@christushealth.org  Sub: RE: First Notification: Incomplete/Missing Reappointment Application for Statcare Minor Emergency Clinic  Hi Ahmed,   Thank you for your message. I have included a status for the facility we have currently. Regarding any contract information. Please be sure to contact the contractor for your area. I have included their contact information below. Thank you!  Statcare Minor Emergency Clinic - East Ceasar 500 East Caesar Avenue, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - River Hill 4042 River Hill Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - South Padre  3817 South Padre Island Drive, has been recredentialed, next credentialing date 10/01/2024 Statcare Minor Emergency Clinic - Staples 6646 South Staples has been recredentialed, next credentialing date 10/01/2024   Remember billing should be “group to group” and not billed with individual NPI’s. Have a good day.  Thanks, Michal   Please see the attachments', NULL, NULL, '2021-12-23 14:06:01', '2021-12-23 14:06:01'),
(31556, 1006, 23808, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:51', '2021-03-25 11:45:51'),
(31557, 1006, 23808, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:47:22', '2021-04-08 18:47:22'),
(31558, 9057, 23808, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:18:39', '2021-05-25 10:18:39'),
(31559, 1006, 23808, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I want to check in on the status of this request for enrollment, as we still haven\'t heard anything back as of yet?   Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-04 14:20:51', '2021-06-04 14:20:51'),
(31560, 1006, 23808, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:05', '2021-06-11 14:14:05'),
(31561, 3040, 23808, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:01', '2021-06-30 15:21:01'),
(31562, 1006, 23808, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:11:38', '2021-07-01 14:11:38'),
(31563, 1006, 23808, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:42:14', '2021-07-12 13:42:14'),
(31564, 1006, 23808, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:07:43', '2021-08-02 17:07:43'),
(31565, 1006, 23808, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:48:36', '2021-08-05 09:48:36'),
(31566, 11056, 23808, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:42:57', '2021-09-30 13:42:57'),
(31567, 1006, 23809, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:52', '2021-03-25 11:45:52'),
(31568, 1006, 23809, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:47:26', '2021-04-08 18:47:26'),
(31569, 9057, 23809, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:18:47', '2021-05-25 10:18:47'),
(31570, 1006, 23809, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I want to check in on the status of this request for enrollment, as we still haven\'t heard anything back as of yet?   Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-04 14:20:55', '2021-06-04 14:20:55'),
(31571, 1006, 23809, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:02', '2021-06-11 14:14:02'),
(31572, 3040, 23809, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:01', '2021-06-30 15:21:01'),
(31573, 1006, 23809, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:11:35', '2021-07-01 14:11:35'),
(31574, 1006, 23809, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:42:18', '2021-07-12 13:42:18'),
(31575, 1006, 23809, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:07:38', '2021-08-02 17:07:38'),
(31576, 1006, 23809, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:48:31', '2021-08-05 09:48:31'),
(31577, 11056, 23809, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:43:34', '2021-09-30 13:43:34'),
(31578, 1006, 23810, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:53', '2021-03-25 11:45:53'),
(31579, 1006, 23810, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:47:31', '2021-04-08 18:47:31'),
(31580, 9057, 23810, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:18:54', '2021-05-25 10:18:54'),
(31581, 1006, 23810, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I want to check in on the status of this request for enrollment, as we still haven\'t heard anything back as of yet?   Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-04 14:20:58', '2021-06-04 14:20:58'),
(31582, 1006, 23810, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:59', '2021-06-11 14:13:59'),
(31583, 3040, 23810, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:20:59', '2021-06-30 15:20:59'),
(31584, 1006, 23810, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:11:31', '2021-07-01 14:11:31'),
(31585, 1006, 23810, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:42:21', '2021-07-12 13:42:21'),
(31586, 1006, 23810, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:07:35', '2021-08-02 17:07:35'),
(31587, 1006, 23810, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:48:28', '2021-08-05 09:48:28'),
(31588, 11056, 23810, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:43:40', '2021-09-30 13:43:40'),
(31589, 1006, 23811, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:53', '2021-03-25 11:45:53'),
(31590, 1006, 23811, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:47:34', '2021-04-08 18:47:34'),
(31591, 9057, 23811, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:19:02', '2021-05-25 10:19:02'),
(31592, 1006, 23811, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I want to check in on the status of this request for enrollment, as we still haven\'t heard anything back as of yet?   Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-04 14:21:02', '2021-06-04 14:21:02'),
(31593, 1006, 23811, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:56', '2021-06-11 14:13:56'),
(31594, 3040, 23811, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:20:59', '2021-06-30 15:20:59'),
(31595, 1006, 23811, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:11:28', '2021-07-01 14:11:28'),
(31596, 1006, 23811, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:42:30', '2021-07-12 13:42:30'),
(31597, 1006, 23811, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:07:31', '2021-08-02 17:07:31'),
(31598, 1006, 23811, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:48:23', '2021-08-05 09:48:23'),
(31599, 11056, 23811, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:43:45', '2021-09-30 13:43:45'),
(31600, 1006, 23812, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:54', '2021-03-25 11:45:54'),
(31601, 1006, 23812, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:47:38', '2021-04-08 18:47:38'),
(31602, 9057, 23812, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:19:11', '2021-05-25 10:19:11'),
(31603, 1006, 23812, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I want to check in on the status of this request for enrollment, as we still haven\'t heard anything back as of yet?   Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-04 14:21:05', '2021-06-04 14:21:05'),
(31604, 1006, 23812, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:13:53', '2021-06-11 14:13:53'),
(31605, 3040, 23812, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:20:58', '2021-06-30 15:20:58'),
(31606, 1006, 23812, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:11:25', '2021-07-01 14:11:25'),
(31607, 1006, 23812, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:42:33', '2021-07-12 13:42:33'),
(31608, 1006, 23812, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:07:27', '2021-08-02 17:07:27'),
(31609, 1006, 23812, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:48:09', '2021-08-05 09:48:09'),
(31610, 11056, 23812, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:43:51', '2021-09-30 13:43:51'),
(31611, 1006, 23813, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:45:55', '2021-03-25 11:45:55'),
(31612, 1006, 23813, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:47:44', '2021-04-08 18:47:44');
