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
(47072, 10057, 31506, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Dear Team,  Hope this email finds you well. Could you please provide me the latest update on enrollment status for the below mentioned provider and group.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Molly Joseph	1396380077  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 16:14:32', '2021-11-17 16:14:32'),
(47073, 10057, 31506, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning,  Provider 1396380077- is in credentialing process no effective date at this time.  Thanks, YA Account Management Region 3', NULL, NULL, '2021-11-30 10:35:05', '2021-11-30 10:35:05'),
(47074, 10057, 31506, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Thank you for the update.  Regards,', NULL, NULL, '2021-12-06 15:49:42', '2021-12-06 15:49:42'),
(47075, 10057, 31506, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-12-14 09:36:00', '2021-12-14 09:36:00'),
(47076, 10057, 31506, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,  Provider 1396380077- is currently in make par status with an effective date of 1/1/21.  Thanks Account Management', NULL, NULL, '2021-12-20 17:43:42', '2021-12-20 17:43:42'),
(47077, 10057, 31506, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings!  Thank you for providing me with the update. When can I get the welcome packet?  Regards,', NULL, NULL, '2021-12-27 10:43:45', '2021-12-27 10:43:45'),
(47078, 19067, 31506, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Molly Joseph & Group || Superior Health ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group with Ambetter.  If the Provider is Enrolled then provide us with Effective date and Welcome kit. It would be very helpful for us.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 Provider Name	NPI Joseph, Molly	1396380077   Eagerly waiting for your reply.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 13:59:03', '2022-01-04 13:59:03'),
(47079, 20067, 31506, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Molly Joseph & Group || Superior Health ||  Good afternoon!  Hope this email finds you in good spirits. Any update on the below-mentioned provider?  Kindly respond promptly. Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-20 15:05:05', '2022-01-20 15:05:05'),
(47080, 20067, 31506, NULL, '2022-02-03 00:00:00.000', 'Approved', 'Email received from: AM.Austin@superiorhealthplan.com  Sub: Enrollment Status || Columbus Urgent Care PA || Molly Joseph & Group || Superior Health ||  Provider: 1396380077, is in network effective 1/1/2022 and participating with Ambetter.    Thanks,   YA  Account Management  Region 3', NULL, NULL, '2022-01-27 09:22:38', '2022-01-27 09:22:38'),
(47081, 3040, 31507, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47082, 3040, 31507, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.co  Subject: Enroll Providers || Columbus Urgent Care PA || Providers || TRPN||   Greetings,   I wanted to know how to enroll the below mentioned provider.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you  ', NULL, NULL, '2021-06-07 18:22:11', '2021-06-07 18:22:11'),
(47083, 3040, 31507, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Providers || TRPN||  Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Max Flores.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 11:05:41', '2021-06-08 11:05:41'),
(47084, 3040, 31507, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: ccampos@trpnppo.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Providers || TRPN||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in TRPN for our group under the below location.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-25 13:58:09', '2021-06-25 13:58:09'),
(47085, 3040, 31507, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: RE: Enroll Providers || Columbus Urgent Care PA || Providers || TRPN||  Hi,  This provider is Active, effective date 05/25/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563', NULL, NULL, '2021-07-13 14:10:08', '2021-07-13 14:10:08'),
(47086, 3040, 31508, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47087, 3040, 31508, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Driscoll ||  Good afternoon Adil,  I have attached a map of our service area for your convenience.  We don’t have any members in the Columbus area.  If you have any plans on providing services within our area, we will be glad to work with you but, this practice is not within our service area.  If you need any further assistance on credentialing or contracting questions, please let me know.  I have attached our Request for Contract for your convenience.  Please use this form when requesting to add providers or contracts by emailing to dhpcpntracting@dchsytx.org  Thank you  Karla Claunch ', NULL, NULL, '2021-06-07 18:12:54', '2021-06-07 18:12:54'),
(47088, 3040, 31509, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47089, 3040, 31509, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 18:00:51', '2021-06-07 18:00:51'),
(47090, 3040, 31509, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 15:   Provider Name: Joseph, Molly Provider NPI# 1396380077   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 18:03:47', '2021-06-07 18:03:47'),
(47091, 3040, 31509, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:36', '2021-06-24 11:21:36'),
(47092, 3040, 31509, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:54', '2021-07-13 13:14:54'),
(47093, 3040, 31510, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47094, 1005, 31510, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare and Cigna\'s Enrollment.', NULL, NULL, '2021-06-07 16:39:58', '2021-06-07 16:39:58'),
(47095, 3040, 31510, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference.  ', NULL, NULL, '2021-06-15 09:38:22', '2021-06-15 09:38:22'),
(47096, 3040, 31510, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:21', '2021-07-22 10:06:21'),
(47097, 11056, 31510, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:26:54', '2021-08-04 15:26:54'),
(47098, 3040, 31510, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:21', '2021-08-17 10:58:21'),
(47099, 3040, 31510, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:18', '2021-08-17 13:14:18'),
(47100, 3040, 31511, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47101, 3040, 31511, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:Jennifer.Maligaya@healthsmart.com  Subject:Enroll Providers || Columbus Urgent Care PA || Providers || Anci Care ||  Greetings,   I wanted to know how to enroll the below mentioned provider.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:29:25', '2021-06-07 18:29:25'),
(47102, 3040, 31511, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:00', '2021-06-18 17:00:00'),
(47103, 3040, 31512, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47104, 3040, 31512, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com   Subject: Enroll Providers || Columbus Urgent Care PA || Providers || Triwest ||  Greetings,   I wanted to know how to enroll the below mentioned provider.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you  ', NULL, NULL, '2021-06-07 18:19:29', '2021-06-07 18:19:29'),
(47105, 3040, 31512, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:37:43', '2021-06-09 12:37:43'),
(47106, 3040, 31512, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:07', '2021-07-20 10:27:07'),
(47107, 3040, 31512, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:24', '2021-07-26 12:02:24'),
(47108, 3040, 31513, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47109, 1005, 31513, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Doesnt cover this area.', NULL, NULL, '2021-06-07 17:47:23', '2021-06-07 17:47:23'),
(47110, 3040, 31515, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:20', '2021-06-07 16:17:20'),
(47111, 3040, 31515, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'The insurance is not listed on the new structure sheet by billing team, hence it is not eligible for enrollment.  ', NULL, NULL, '2021-06-07 18:14:36', '2021-06-07 18:14:36'),
(47112, 3040, 31526, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:20', '2021-06-07 16:17:20'),
(47113, 3040, 31526, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-06-07 18:13:40', '2021-06-07 18:13:40'),
(47114, 3040, 31527, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:20', '2021-06-07 16:17:20'),
(47115, 1005, 31527, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:54:26', '2021-06-07 16:54:26'),
(47116, 3040, 31527, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task.  ', NULL, NULL, '2021-07-20 10:29:51', '2021-07-20 10:29:51'),
(47117, 3040, 31528, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:20', '2021-06-07 16:17:20'),
(47118, 1005, 31528, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent to: \"Simms, Michal J.\" michal.simms@christushealth.org Email sub:  Subject: Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   --  -- Regards,Benjamin Cooper | Claims Med | Office: (713) 429-4169 Ext: 403 | Fax: 718-640-2713 | kh@claimsmedinc.comCONFIDENTIALITY NOTICE: This e-mail andany files transmitted with it are the property of Claims Med or its affiliates,are confidential, and are intended solely for the use of the individual orentity to whom this e-mail is addressed. If you are not one of the namedrecipients or otherwise have reason to believe that you have received thise-mail in error, please notify the sender and delete this message immediatelyfrom your computer. Any other use, retention, dissemination, forwarding,printing or copying of this e-mail is strictly prohibited. ', NULL, NULL, '2021-06-07 17:44:01', '2021-06-07 17:44:01'),
(47119, 11056, 31528, NULL, '2021-06-30 00:00:00.000', 'In Process', 'Email sent to :  	hunter.barrett@christushealth.org  Sub :  Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Greetings,  Here is the prospective provider form which you have asked for. Please see the attachment.  If you need any information feel free to contact me. ', NULL, NULL, '2021-06-23 11:07:36', '2021-06-23 11:07:36'),
(47120, 3040, 31528, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to: CHP.NetworkDevelopment@christushealth.org  Subject: Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Hello,   Hope you are doing well. Please find attached the prospective provider form for the below mentioned providers to enroll in Christus Health plan in our group Columbus Urgent Care PA under the below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name:  Joseph, Molly Provider NPI# 1396380077  Provider 16:   Provider Name:  John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-07-13 09:36:21', '2021-07-13 09:36:21'),
(47121, 11056, 31528, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : hunter.barrett@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Would the provider bill as an Urgent Care/Ancillary?     Thanks,     Hunter Barrett  Network Contracting  CHRISTUS Health Plan  CHRISTUS Health  919 Hidden Ridge | Irving, Texas 75038  (o) 469.282.3113  www.christushealth.org    Replied :   Hello Hunter,   No, we are doing a group contract under the facility.   Thank you.', NULL, NULL, '2021-08-04 14:29:12', '2021-08-04 14:29:12'),
(47122, 3040, 31528, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Hello Hunter,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Christus Health plan in our group under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 14:19:48', '2021-08-17 14:19:48'),
(47123, 12062, 31528, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Sent a follow up mail as below;  To:hunter.barrett@christushealth.org Subject:RE: Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Hi Barrett,  Hope You are doing well !  I want to inquire about about the subject case, please advise if there is any further proceedings.   ', NULL, NULL, '2021-09-22 14:46:37', '2021-09-22 14:46:37'),
(47124, 12062, 31528, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Replied to an atatched email received ;  To:hunter.barrett@christushealth.org Subject :RE: Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Dear Barrett,  Thanks for you acknowledgement.   Can you check and advise any estimated time from now to which the provider must get enrolled? ', NULL, NULL, '2021-09-24 09:07:02', '2021-09-24 09:07:02'),
(47125, 10057, 31528, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : hunter.barrett@christushealth.org, CHP.NetworkDevelopment@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Good Morning,  Hope you are doing well. Please let me know the updated status for below mentioned providers under the location TIN.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-29 08:46:50', '2021-10-29 08:46:50'),
(47126, 10057, 31528, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : hunter.barrett@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Please reach out to our credentialing team directly for updates. I sent them the contract 3 months ago and they typically take 6 months to get the new application. Please allow them that 6 months.  CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health', NULL, NULL, '2021-11-02 09:08:09', '2021-11-02 09:08:09'),
(47127, 10057, 31528, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : michal.simms@christushealth.org  Sub : Enrollment Query - CUCC  Hello Michal,  Hope you are doing good!  Can you please help me out with the query of our providers, we have sent their applications back in April, but still didn\'t have any update. I have attached our group roster, please get back to me at your earliest convenience.  Regards, Alex', NULL, NULL, '2021-11-15 14:53:11', '2021-11-15 14:53:11'),
(47128, 10057, 31528, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : michal.simms@christushealth.org  Sub : Enrollment Query - CUCC  Hello Alex,  Our department email address is CHP.NetworkDevelopment@CHRISTUSHealth.org.  Please send your requests to that mailbox so that the requests are sent to the correct person handling a territory.  I do not see Columbus Urgent Care PA in our system.  Has the request been submitted to the department mailbox?  I do not handle Columbus, Texas region.  Thanks, Michal  CLAIMS MED PERSONNEL:  PLEASE DIRECT YOUR CONTRACTING INQUIRES TO CHP.NetworkDevelopment@CHRISTUSHealth.org', NULL, NULL, '2021-11-30 11:32:12', '2021-11-30 11:32:12'),
(47129, 10057, 31528, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : hunter.barrett@christushealth.org & CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Thank you for your response. Have a great day.  Regards,', NULL, NULL, '2021-12-06 17:09:31', '2021-12-06 17:09:31'),
(47130, 10057, 31528, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Good afternoon,  Hope this email finds you in good health. I\'m writing this email to check the latest update on the below mentioned providers and group enrollment status under the TIN.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-13 12:21:33', '2021-12-13 12:21:33'),
(47131, 10057, 31528, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org & hunter.barrett@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER, please reach out to me ASAP...  Kind Regards,', NULL, NULL, '2021-12-20 09:54:59', '2021-12-20 09:54:59'),
(47132, 10057, 31528, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enroll Group & Providers || Columbus Urgent Care PA || CHRISTUS HEALTH PLAN ||  Good Morning,  Hope this email finds you well. This is THIRD REMINDER on the below request.  your earliest response will be highly appreciated!  Regards,', NULL, NULL, '2021-12-28 11:47:15', '2021-12-28 11:47:15'),
(47133, 19067, 31528, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org  Subject: Enrollment Query  || Columbus Urgent Care PA || Providers & Group || CHRISTUS HEALTH PLAN ||  Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 13:45:25', '2022-01-04 13:45:25'),
(47134, 20067, 31528, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org, CHP.NetworkDevelopment@christushealth.org   Sub: Re: Enrollment Query || Columbus Urgent Care PA || Providers & Group || CHRISTUS HEALTH PLAN ||   Good Morning! Hope this email finds you well. We are continuously emailing you guys but haven\'t received any response from your side. Kindly respond to the previous request as soon as possible.  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-19 13:37:16', '2022-01-19 13:37:16'),
(47135, 20067, 31528, NULL, '2022-01-28 00:00:00.000', 'Approved', 'Received the following email from: Sonia.Gonzales@christushealth.org  Hello,  Perfect contract is effective as of 01/01/2022,  all claims should be billed on a CMS  with group information in box 31 instead of rendering provider.  Thanks and have a wonderful day!   Respectfully,  This is an Ancillary group contract.', NULL, NULL, '2022-01-21 14:11:23', '2022-01-21 14:11:23'),
(47136, 3040, 31529, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47137, 3040, 31529, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'CAQH is pending because of Mal practice and informed client and waiting for the response. ', NULL, NULL, '2021-06-08 08:27:32', '2021-06-08 08:27:32'),
(47138, 11056, 31529, NULL, '2021-06-30 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 314685', NULL, NULL, '2021-06-23 09:51:56', '2021-06-23 09:51:56'),
(47139, 3040, 31529, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to: txproviderupdatesubmission@bcbstx.com, tx_standard_contracting_team@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 314685 || Longpoint Medical Center || Joseph, Molly || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in BCBS in our group Longpoint Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-13 08:51:41', '2021-07-13 08:51:41'),
(47140, 1006, 31529, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received the following update from txproviderupdatesubmission@bcbstx.com:  Sub: Application ID: 314685 || Longpoint Medical Center || Joseph, Molly || BCBS || : Case Number - 02622235  \"Good afternoon,  I have located your application and see the provider’s record number for the group has been set up.  Molly Joseph Provider record # 8PU391  The application is currently in process in our contracting area.  For any questions regarding network contracting, credentialing, network effective dates or status requests, please reach out to your network representative.  If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number), fax, and email contact methods.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas\"', NULL, NULL, '2021-08-03 16:02:45', '2021-08-03 16:02:45'),
(47141, 11056, 31529, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email received from : tx_standard_contracting_team@bcbstx.com  Sub : Application ID: 314685 || Longpoint Medical Center || Joseph, Molly || BCBS || : Case Number - 02622237  Good afternoon,  Provider Joseph, Molly, APN, is active and is in network.  If you have any questions or concerns please use the contact information below.  Thank you,  Provider Relations Department - CM Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600, Houston, TX 77027-3279 phone (713) 663-1149 | fax (713) 663-1227 | email Provider_Relations_Houston@bcbstx.com Visit our website: www.bcbstx.com Experience. Wellness. Everywhere.', NULL, NULL, '2021-08-12 16:50:07', '2021-08-12 16:50:07'),
(47142, 3040, 31529, NULL, '2021-09-14 00:00:00.000', 'Approved', 'Email rcvd from: tx_standard_contracting_team@bcbstx.com  Subject: Application ID: 314685 || Longpoint Medical Center || Joseph, Molly || BCBS || : Case Number - 02622237  Good afternoon,  Provider Joseph, Molly, APN, is active and is in network.  If you have any questions or concerns please use the contact information below.  Thank you,  large-header-logo_TX Provider Relations Department - CM Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600, Houston, TX 77027-3279 phone (713) 663-1149 | fax (713) 663-1227 | email Provider_Relations_Houston@bcbstx.com Visit our website: www.bcbstx.com Experience. Wellness. Everywhere. ', NULL, NULL, '2021-09-07 09:12:48', '2021-09-07 09:12:48'),
(47143, 3040, 31530, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47144, 3040, 31530, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.', NULL, NULL, '2021-06-07 18:07:43', '2021-06-07 18:07:43'),
(47145, 3040, 31531, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47146, 3040, 31531, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.    ', NULL, NULL, '2021-06-07 18:34:52', '2021-06-07 18:34:52'),
(47147, 3040, 31531, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Request for enrollment submitted online.   Application no: 12651983 Provider ID: 4048834 ', NULL, NULL, '2021-06-18 14:05:39', '2021-06-18 14:05:39'),
(47148, 3040, 31531, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Ariana and she said the application is still in process and will take 90 to 120 calendar days. ', NULL, NULL, '2021-07-06 15:33:15', '2021-07-06 15:33:15'),
(47149, 3040, 31531, NULL, '2021-07-29 00:00:00.000', 'In Process', 'I had a word with (Paul) Cigna representative and he said the provider is out of network and application is still in the process.   ', NULL, NULL, '2021-07-22 10:52:37', '2021-07-22 10:52:37'),
(47150, 1006, 31531, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Received the following update from DiscoverCigna@information.cigna.com:  Sub: Cigna Credentialing Status Update: Credentialing Verification  \"CREDENTIALING STATUS UPDATE	 Status: Application complete. Credentialing process to begin.	 Re:	Reference number 12651983 Application complete: Credentialing process to begin Dear MOLLY JOSEPH,  We have confirmed that your application is complete, and have forwarded it for credentialing review  What happens next?  During this stage of the application process, Credentialing will perform primary source verification, and your application will be reviewed by the Credentialing committee. We will contact you if we need any additional information, and will let you know when this step is complete.  Sincerely, Cigna\"', NULL, NULL, '2021-08-02 08:31:28', '2021-08-02 08:31:28'),
(47151, 3040, 31531, NULL, '2021-09-17 00:00:00.000', 'Approved', 'I had a word with (Maurice) With Cigna representative  and he said the provider is effective 08/12/2021. ', NULL, NULL, '2021-09-10 13:09:44', '2021-09-10 13:09:44'),
(47152, 3040, 31532, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47153, 3040, 31532, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject:Enroll Providers ||Longpoint Medical Center || Providers || UHC ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:38:01', '2021-06-07 18:38:01'),
(47154, 3040, 31532, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Greetings,   Kindly disregard my previous email. I wanted to know how to enroll the below mentioned provider.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you  ', NULL, NULL, '2021-06-07 18:40:45', '2021-06-07 18:40:45'),
(47155, 3040, 31532, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Request was submitted online. Please see attachment ', NULL, NULL, '2021-06-24 17:01:28', '2021-06-24 17:01:28'),
(47156, 3040, 31532, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Status || Longpoint Medical Center || Joseph, Molly || UHC ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in UHC for our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-13 16:31:28', '2021-07-13 16:31:28'),
(47157, 3040, 31532, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject; Secure Message from amanda_vandiver@uhc.com  Adil,  Good afternoon.  Regarding the below, your request for updates is currently in process (Reference number PR-5997946) and you will be notified once it is completed.  Please allow 30-90 days.  Thank you!', NULL, NULL, '2021-08-30 11:39:57', '2021-08-30 11:39:57'),
(47158, 3040, 31532, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Joseph, Molly || UHC ||  Greetings,  Hope you are doing well. I received an email from UHC (Amanda_Vandiver) and stated in her email that the request is still in process and will be notified once it\'s completed. Can you please check & advise.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-30 11:42:51', '2021-08-30 11:42:51'),
(47159, 3040, 31532, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from amanda_park@uhc.com   Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry. The request to add the provider to the group contract was created on 7/6/21 under reference # PR-5997946. This request is still in process. Please allow 30-90 days for processing.  Please let us know if we can assist further via email.  Sincerely,  Amanda P UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-08-30 16:50:05', '2021-08-30 16:50:05'),
(47160, 10057, 31532, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Hello,  Hope all is well. I just wanted to know the enrollment status for below mentioned providers in UHC in our group under the below location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149  Your earliest response will be highly appreciated. Have a great evening.  Thanks & Regards,', NULL, NULL, '2021-10-14 16:26:10', '2021-10-14 16:26:10'),
(47161, 10057, 31532, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Good Afternoon,  Can I get the latest update on our below mentioned providers enrollment request?  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 14:23:28', '2021-11-23 14:23:28'),
(47162, 10057, 31532, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Hello,  Hope this email finds you well. I\'m writing this email to check the status for the below mentioned request.  Please revert back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-12-03 16:10:10', '2021-12-03 16:10:10'),
(47163, 10057, 31532, NULL, '2021-12-14 00:00:00.000', 'Approved', 'Email Received From : networkhelp@uhc.com  Sub : Secure Message from robin_joplin@uhc.com  Good Afternoon,  Thank you for contacting the Network Management Resource Team.  Molly Joseph is effective with the tax ID 8/23/21.  There are two ways you can submit your request to add the additional providers to the tax ID:                  a. For faster processing, submit a change request using our Link App called My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html).  This process will enable you to check your status online. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).                  b. If you don’t have access to My Practice Profile, then complete the attached form for each practitioner and send via email to hpdemo@uhc.com.   You should receive a reference number (starts with PR) for your request within an hour. If you have not received a PR number within 24 business hours (please double check spam/junk folder), please resubmit due to technical error. Please do not CC anyone on your request. This can cause an error and it may not be received.  Please let us know if we can be of further assistance.  Thank you.  Robin Joplin UnitedHealthcare Network Management Resource Team (NMRT) ', NULL, NULL, '2021-12-07 17:32:05', '2021-12-07 17:32:05'),
(47164, 3040, 31533, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47165, 1005, 31533, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:55:22', '2021-06-07 16:55:22'),
(47166, 3040, 31533, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-15 09:08:19', '2021-07-15 09:08:19'),
(47167, 3040, 31533, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:38:55', '2021-07-26 16:38:55'),
(47168, 11056, 31533, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:30:39', '2021-08-13 15:30:39'),
(47169, 3040, 31533, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:34', '2021-08-26 08:45:34');
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
(47170, 10057, 31533, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : kdelam@texaschildrens.org  Sub : Provider Contracts  Hello Elam,  Hope this email finds you well. I\'m writing this email to follow-up against Adil\'s email which was sent to you on 08/25/2021.  For any questions please reach out to me. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:26:51', '2021-10-08 13:26:51'),
(47171, 10057, 31533, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : kdelam@texaschildrens.org  Sub : Provider Contracts  Hello Elam,  Hope this email finds you well. I\'m writing this email to follow-up against Adil\'s email which was sent to you on 08/25/2021.  For any questions please reach out to me. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:41:27', '2021-10-08 13:41:27'),
(47172, 10057, 31533, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:01:53', '2021-10-21 11:01:53'),
(47173, 10057, 31533, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:46:32', '2021-10-29 09:46:32'),
(47174, 10057, 31533, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:39:48', '2021-11-22 13:39:48'),
(47175, 10057, 31533, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:30:37', '2021-12-02 14:30:37'),
(47176, 10057, 31533, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:53:58', '2021-12-09 11:53:58'),
(47177, 10057, 31533, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:56:41', '2021-12-16 14:56:41'),
(47178, 10057, 31533, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:50:04', '2021-12-22 13:50:04'),
(47179, 10057, 31533, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:04:25', '2021-12-29 12:04:25'),
(47180, 20067, 31533, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:57:24', '2022-01-12 14:57:24'),
(47181, 20067, 31533, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:57:52', '2022-01-19 09:57:52'),
(47182, 20067, 31533, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:42:05', '2022-01-28 14:42:05'),
(47183, 3040, 31534, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47184, 3040, 31534, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com, MDuffee@humana.com  Subject:Enroll Providers || Longpoint Medical Center || Providers || Humana ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you  ', NULL, NULL, '2021-06-08 08:37:59', '2021-06-08 08:37:59'),
(47185, 3040, 31534, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-08 16:38:19', '2021-06-08 16:38:19'),
(47186, 3040, 31534, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Greetings,   Hope you are doing well. Can you please advise the enrollment status for the below mentioned group and providers in Humana under the below Tax ID and location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#  76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 7: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 9: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-25 09:23:42', '2021-06-25 09:23:42'),
(47187, 3040, 31534, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Thank you for your prompt response. Please find the attached Standard Market Roster as per your previous email requested. All the providers CAQH updated.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#   Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 5: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-14 15:23:47', '2021-07-14 15:23:47'),
(47188, 3040, 31534, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: FW: Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Humana in our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID#    Practice NPI# 1770763815  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 2:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 3:  Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:  Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 5:  Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 6:  Provider Name: Joseph, Molly  Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you  ', NULL, NULL, '2021-08-26 10:56:45', '2021-08-26 10:56:45'),
(47189, 10057, 31534, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Evening,  Hope this email finds you well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Humana in our group under the below location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Stephen, Ani	1588959118 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Looking forward to your kind response, Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-10-08 16:29:03', '2021-10-08 16:29:03'),
(47190, 10057, 31534, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  All are loaded and linked to the TIN provided.', NULL, NULL, '2021-11-23 13:47:25', '2021-11-23 13:47:25'),
(47191, 10057, 31534, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Afternoon,  Hope you are doing well. Kindly share with me the effective dates along with the welcome letters for all the mentioned provides, also for facility contract / agreement as well.  Please get back to me as soon possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 13:49:06', '2021-11-23 13:49:06'),
(47192, 10057, 31534, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Please see item highlighted in yellow.  Please read the following instructions carefully:  For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.  Thank you,  HumanaHoustonPD', NULL, NULL, '2021-11-24 10:40:52', '2021-11-24 10:40:52'),
(47193, 10057, 31534, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Need to call on mentioned number in next 15 days.  800-448-6262 or 800-626-2741', NULL, NULL, '2021-12-03 15:34:27', '2021-12-03 15:34:27'),
(47194, 10057, 31534, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Called to check the status - 800-448-6262  Reference for this call : 200015318382 - Rep. Abby  Provider is effective from 07/23/2021.  Waiting to update location in provider directory  It takes 15 to 20 more day from today.', NULL, NULL, '2021-12-10 14:10:22', '2021-12-10 14:10:22'),
(47195, 10057, 31534, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Will Follow-up in Next Week.  Please see previous Call Comments. Thank you ', NULL, NULL, '2021-12-17 10:56:09', '2021-12-17 10:56:09'),
(47196, 10057, 31534, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To: HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Thank you for reaching out. We called and got the status from given numbers. However, we have been updated that providers are still in the middle of the directory portal.  Regards,', NULL, NULL, '2021-12-27 12:36:24', '2021-12-27 12:36:24'),
(47197, 20067, 31534, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Called Humana at 800-448-6262  Molly joseph   06/25/2021 effective date for all the network   Credentialing was completed on 07/30/2021 and location is updated in providers directory  Requested for the welcome letter  Ref 2000221097974 Rep: Mira T ', NULL, NULL, '2022-01-11 17:33:51', '2022-01-11 17:33:51'),
(47198, 20067, 31534, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Didn\'t receive the welcome letters till yet. Will follow-up next week', NULL, NULL, '2022-01-18 10:31:40', '2022-01-18 10:31:40'),
(47199, 20067, 31534, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from insurance rep: VDelaPaz2@humana.com  Sub: Humana_Welcome Letter Request_Interaction#:2000229422892  Hi Syed,     Thank you for reaching us out. This is regarding with your request for the welcome letter of the providers. This is to inform you that we can just provide the credentialing or welcome letters by individual providers only not by group.  And I do apologize but I tried to check all of the providers record if we have a copy of welcome letters, and since we have a limited access here in our end, and we cannot see the letters here, then, I cannot provide you the welcome letters of the providers.  My advice to you is to reach out with the individual providers to get the copy of the letters as we really send the letters by individual providers and by the date they are effective or credentialed.        Thank you,     Vanessa Dela Paz', NULL, NULL, '2022-02-21 17:10:27', '2022-02-21 17:10:27'),
(47200, 20067, 31534, NULL, '2022-03-18 00:00:00.000', 'Approved', 'Humana does not disperse welcome letters.   Provider is Effective from: 07/23/2021', NULL, NULL, '2022-03-11 10:23:06', '2022-03-11 10:23:06'),
(47201, 3040, 31535, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47202, 1005, 31535, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:49:33', '2021-06-07 16:49:33'),
(47203, 3040, 31535, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com, txcredentialing@amerigroup.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Amerigroup ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Amerigroup in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 08:41:20', '2021-07-15 08:41:20'),
(47204, 3040, 31535, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:11', '2021-07-26 15:24:11'),
(47205, 11056, 31535, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:26:45', '2021-08-13 14:26:45'),
(47206, 3040, 31535, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 14:59:47', '2021-08-25 14:59:47'),
(47207, 3040, 31535, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:57', '2021-09-09 13:07:57'),
(47208, 10057, 31535, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 15:11:49', '2021-10-18 15:11:49'),
(47209, 10057, 31535, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:02:39', '2021-11-11 13:02:39'),
(47210, 10057, 31535, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:55:22', '2021-11-30 10:55:22'),
(47211, 10057, 31535, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:11:36', '2021-12-06 16:11:36'),
(47212, 10057, 31535, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:53:10', '2021-12-13 10:53:10'),
(47213, 10057, 31535, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 14:03:13', '2021-12-20 14:03:13'),
(47214, 10057, 31535, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Call Details: (800) 600-4441  Rep: Victor  Ref # I146789022  Still in process, need to check next week, also send reminder to below mentioned emails.  latina.small@anthem.com nena.graves@amerigroup.com  Regards, Steve Albert', NULL, NULL, '2021-12-29 11:06:53', '2021-12-29 11:06:53'),
(47215, 20067, 31535, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning, Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers and if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Eagerly waiting for your response.   Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-10 12:18:44', '2022-01-10 12:18:44'),
(47216, 20067, 31535, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: latina.small@anthem.com  Sub: RE: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning,     Yes, I can look up and confirm the provider(s) status. Please allow me some time to review and respond.     Thank You in Advance,     Latina Small  Provider Experience Consultant  Amerigroup, Inc.', NULL, NULL, '2022-01-11 13:10:06', '2022-01-11 13:10:06'),
(47217, 20067, 31535, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon Latina and Nena! Hope this email finds you in good health. Haven\'t received any updates from your side. Kindly update me on the previous request.  Eagerly waiting for your response. Thanks & Regards. Syed Ahad', NULL, NULL, '2022-01-19 15:13:13', '2022-01-19 15:13:13'),
(47218, 20067, 31535, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning!  Eagerly waiting for your response. Kindly respond promptly,  Thank you,', NULL, NULL, '2022-01-28 11:57:30', '2022-01-28 11:57:30'),
(47219, 20067, 31535, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: latina.small@anthem.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||   Good Afternoon,     Sincere apologies for any delays. Please see the status for the providers below. If any providers need to be added to the group, please complete the attached LOI and Group App form and return to credentialing with a W9.        Group Name  Longpoint Medical Center  Tax ID  76-0612416  Group NPI  1770763815  Practice Location  9504 LONG POINT RD STE E Houston , TX 77055-4226     Provider Name     NPI  Amerigroup Status Update  Fernandus, Limy     1972005189  PAR - PR ID 12190801; Effective Date 11/11/2021(Medicaid, Medicare, CHIP)  PAUL, SIGI     1033623616  Non PAR  Jacob, Jaya     1194336149  Non PAR  Abraham, Jeena     1467901587  Non PAR  Thomas, Cini     1134777238  Non PAR  Kourouma , Odette Tiranke     1134525868  Non PAR  Rauf, Abdur     1497726202  PAR – PR ID 10007623; Effective Date 3/1/2012 (Medicaid, Medicare, CHIP, MMP)  Joseph, Molly     1396380077  Non PAR  John, Jeny     1073019493  Non PAR  Stephen, Ani     1588959118  Non PAR  Brown, Brittany     1275163537  Non PAR  Joseph, Vibitha     1952931560  PAR – PR ID 09743760; Effective Date 4/27/2020 (Medicare)  George, Jeemol     1497219067  Non PAR  Jose, Julie     1447883061  Non PAR  Abraham, Glory     1194206490  PAR – PR ID 08200815; Effective Date 10/01/2019 (Medicare)  Chennemkara, Mini Philip     1841755956  Non PAR  Piccione JR, James M     1356321509  Non PAR        Thank You in Advance,     Latina Small, MBA, BSBM', NULL, NULL, '2022-02-08 13:12:48', '2022-02-08 13:12:48'),
(47220, 20067, 31535, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com CC: latina.small@anthem.com  Sub: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Good Afternoon!  Hope you had a great weekend. Attached are the LOI and Group App for Non-par Providers along with W9.  Kindly let me know if anything else is required from my end.  Regards, ', NULL, NULL, '2022-02-21 13:41:32', '2022-02-21 13:41:32'),
(47221, 20067, 31535, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Secure Email received from:  TX Credentialing  Sub: RE: FW: {EXTERNAL} LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  the LOI has a mix match of the group name with the tax ID.     There is one tax ID listed on the LOI, the group name should correspond to the tax ID.', NULL, NULL, '2022-03-08 09:25:18', '2022-03-08 09:25:18'),
(47222, 20067, 31535, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub:   Good Morning!  Attached are the LOI and Group applications for the providers.  Let me know if anything else is required from my end.  Thank you,', NULL, NULL, '2022-03-08 09:55:32', '2022-03-08 09:55:32'),
(47223, 20067, 31535, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, latina.small@anthem.com   Sub:  Re: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Good Morning!  Hope this email finds you in good health. Any updates on the Submitted LOIs of Longpoint Medical Center providers.  Thank you, Syed', NULL, NULL, '2022-03-17 10:02:44', '2022-03-17 10:02:44'),
(47224, 20067, 31535, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com   Sub: FW: {EXTERNAL} Re: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Those were received and pending completion.     Check back in 7 business days', NULL, NULL, '2022-03-17 16:41:39', '2022-03-17 16:41:39'),
(47225, 3040, 31536, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47226, 1005, 31536, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:50:06', '2021-06-07 16:50:06'),
(47227, 3040, 31536, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task. ', NULL, NULL, '2021-06-14 10:50:32', '2021-06-14 10:50:32'),
(47228, 3040, 31536, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:07', '2021-07-20 10:43:07'),
(47229, 11056, 31536, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:31:20', '2021-08-09 10:31:20'),
(47230, 3040, 31536, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:57:52', '2021-08-17 13:57:52'),
(47231, 3040, 31537, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47232, 1005, 31537, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Aetna\' and Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:51:37', '2021-06-07 16:51:37'),
(47233, 11056, 31537, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:44:23', '2021-06-22 13:44:23');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(47234, 11056, 31537, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:51:24', '2021-06-22 13:51:24'),
(47235, 11056, 31537, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:51:24', '2021-06-22 13:51:24'),
(47236, 3040, 31537, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-09 15:11:17', '2021-07-09 15:11:17'),
(47237, 3040, 31537, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 14:04:23', '2021-08-30 14:04:23'),
(47238, 10057, 31537, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in First Health.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Abraham, Jeena	1467901587 John, Jeny	1073019493  Please feel free to reach out to me, if you need any other information. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 16:44:14', '2021-10-11 16:44:14'),
(47239, 10057, 31537, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani ', NULL, NULL, '2021-10-18 10:41:25', '2021-10-18 10:41:25'),
(47240, 10057, 31537, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:56:56', '2021-11-23 13:56:56'),
(47241, 10057, 31537, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Hope this email finds you in good health. Could you please provide me with the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:54:50', '2021-12-03 14:54:50'),
(47242, 10057, 31537, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-10 11:36:41', '2021-12-10 11:36:41'),
(47243, 10057, 31537, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:10:44', '2021-12-20 13:10:44'),
(47244, 10057, 31537, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:19:26', '2021-12-27 11:19:26'),
(47245, 20067, 31537, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to:  MadirajuP@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good afternoon, Hope you are doing well. Any updates on the below-mentioned request?  Kindly respond promptly, Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 16:01:16', '2022-01-11 16:01:16'),
(47246, 20067, 31537, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:23:41', '2022-01-20 10:23:41'),
(47247, 20067, 31537, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:28:04', '2022-01-20 10:28:04'),
(47248, 20067, 31537, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to:  pccdocsub@mitchell.com,MadirajuP@aetna.com  Sub: Re: Enrollment status || LONGPOINT MEDICAL CENTER || Group & Providers || First Health ||  Good Afternoon!  I would like to know the enrollment status of the below-mentioned providers.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 SIGI PAUL	1033623616 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Ani Stephen	1588959118 Jeena Abraham	1467901587 Glory Abraham	1194206490 James Piccione JR	1356321509 Mini Chennemkara	1841755956 Odette Korouma	1134525868 Abdur Rauf	1497726202 Jeemol George	1497219067  Thanks & Regards! Syed Ahad.', NULL, NULL, '2022-01-28 14:22:29', '2022-01-28 14:22:29'),
(47249, 20067, 31537, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:11:17', '2022-03-08 17:11:17'),
(47250, 3040, 31538, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47251, 3040, 31538, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'CAQH is pending because of Mal practice and informed client and waiting for the response. ', NULL, NULL, '2021-06-08 08:27:43', '2021-06-08 08:27:43'),
(47252, 11056, 31538, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Enrollment form has been submitted. Please see the attachment. Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.', NULL, NULL, '2021-06-23 15:49:10', '2021-06-23 15:49:10'),
(47253, 3040, 31538, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-07-09 15:52:13', '2021-07-09 15:52:13'),
(47254, 3040, 31538, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Health Smart for our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5: Provider Name: Joseph, Molly Provider NPI# 1396380077  Waiting for your response.   Thanks', NULL, NULL, '2021-07-23 13:48:28', '2021-07-23 13:48:28'),
(47255, 11056, 31538, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status - LPMC - Health Smart  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Health Smart.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 6: Provider Name: John, Jeny Provider NPI # : 1073019493  If you have any questions please let me know. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:31:48', '2021-08-09 13:31:48'),
(47256, 3040, 31538, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email rcvd to: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status - LPMC - Health Smart  Hi,  2. Below providers are currently in the credentialing process.  Providers Name  CHENNEMKARA, MINI P  JOSEPH, MOLLY  ', NULL, NULL, '2021-08-30 16:36:40', '2021-08-30 16:36:40'),
(47257, 10057, 31538, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : pr.south@healthsmart.com  Sub : Enrollment Status - LPMC - Health Smart  Hello,  Hope this email finds you well. I\'m writing this email to check the status for the below mentioned providers in Health Smart for our group under the below location  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Chennemkara, Mini Philip	1841755956  Please get back to me as soon as you get a chance. Waiting for your response.  Thanks & Regards,', NULL, NULL, '2021-10-14 15:07:39', '2021-10-14 15:07:39'),
(47258, 10057, 31538, NULL, '2021-11-10 00:00:00.000', 'Approved', '	 Email Received From : mdiprsupport@healthsmart.com  Sub : Enrollment Status - LPMC - Health Smart  Hi,  Please see the following Providers with effective dates..  PROVIDER NAME  EFFECTIVE DATE   JOHN, JENY  05/01/2021   JOSEPH, MOLLY  05/01/2021   CHENNEMKARA, MINI P  01/01/2021   Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-11-03 09:30:06', '2021-11-03 09:30:06'),
(47259, 3040, 31539, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47260, 3040, 31539, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:registrar@multiplan.com   Subject:Enroll Providers || Longpoint Medical Center || Providers || Multiplan ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you  ', NULL, NULL, '2021-06-07 18:55:17', '2021-06-07 18:55:17'),
(47261, 3040, 31539, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group Longpoint Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 11:17:50', '2021-06-17 11:17:50'),
(47262, 3040, 31539, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:13', '2021-07-06 11:57:13'),
(47263, 3040, 31539, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:24', '2021-07-27 16:42:24'),
(47264, 11056, 31539, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:49:29', '2021-08-09 12:49:29'),
(47265, 3040, 31539, NULL, '2021-08-27 00:00:00.000', 'Approved', 'I had a word with James Multiplan representative and he advised the provider is participating with Multiplan.  Ref # 7660656', NULL, NULL, '2021-08-20 16:24:47', '2021-08-20 16:24:47'),
(47266, 3040, 31539, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:46:37', '2021-08-20 16:46:37'),
(47267, 3040, 31540, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47268, 1005, 31540, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:45:00', '2021-06-07 16:45:00'),
(47269, 11056, 31540, NULL, '2021-07-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task.', NULL, NULL, '2021-06-23 16:11:02', '2021-06-23 16:11:02'),
(47270, 3040, 31541, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47271, 1005, 31541, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:45:32', '2021-06-07 16:45:32'),
(47272, 3040, 31541, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status       Submitted		 PEP Ticket Number 17867890 ', NULL, NULL, '2021-06-22 16:22:11', '2021-06-22 16:22:11'),
(47273, 3040, 31541, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Provider participating with Medicaid. Please see attachment. ', NULL, NULL, '2021-07-12 14:02:23', '2021-07-12 14:02:23'),
(47274, 3040, 31542, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47275, 1005, 31542, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Memorial Hermann enrollment is covered under Aetna plans, pending Aetna enrollment. ', NULL, NULL, '2021-06-07 16:52:49', '2021-06-07 16:52:49'),
(47276, 3040, 31542, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task.  ', NULL, NULL, '2021-06-16 16:58:50', '2021-06-16 16:58:50'),
(47277, 3040, 31542, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:55:07', '2021-07-20 10:55:07'),
(47278, 3040, 31542, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:14:11', '2021-07-27 16:14:11'),
(47279, 3040, 31544, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47280, 1005, 31544, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:53:54', '2021-06-07 16:53:54'),
(47281, 3040, 31544, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Molina Heath ||  Greetings,   Hope you are doing well. Please find attached the contract request form along with the Letter of intent to enroll the below mentioned providers in Moilna Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 09:03:56', '2021-07-15 09:03:56'),
(47282, 11056, 31544, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Molina Heath ||  Good morning!   Hope you are doing well. I want to know the enrollment status of the below mentioned providers in Moilna Healthcare in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead! ', NULL, NULL, '2021-08-11 10:33:24', '2021-08-11 10:33:24'),
(47283, 3040, 31544, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Molina Heath ||  Hello Thomas,    Hope you are doing well. I wanted to enroll the below mentioned providers in Moilna Healthcare in our group under the below locations. Can you please advise the process?  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-08-18 15:11:25', '2021-08-18 15:11:25'),
(47284, 10057, 31544, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:25:01', '2021-10-08 11:25:01'),
(47285, 10057, 31544, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.  The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:55:25', '2021-11-15 10:55:25'),
(47286, 3040, 31545, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47287, 1005, 31545, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:54:52', '2021-06-07 16:54:52'),
(47288, 3040, 31545, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Superior Healthplan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Health plan in our group under the below locations.   Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 08:32:13', '2021-07-15 08:32:13'),
(47289, 3040, 31545, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: shp.networkdevelopment@superiorhealthplan.com  Subject; NORMANDY URGENT CARE CENTER PA - Add provider  Greetings,   Hope you are doing well. Please find attached the Individual provider contracting packet as per previous email requested.   If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 14:21:07', '2021-07-22 14:21:07'),
(47290, 11056, 31545, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : NETOPS-ADMIN@centene.com  Sub : Fwd: NORMANDY URGENT CARE CENTER PA - Add provider  Dear Provider,     MOLLY JOSEPH     We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to shp.networkdevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.     To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/        For Re-Credentialing, please email your information to credentialing@centene.com.     Thank you,  Jeannie Lopez  Network Management & Contracting Department – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-08-12 09:49:26', '2021-08-12 09:49:26'),
(47291, 3040, 31545, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: NORMANDY URGENT CARE CENTER PA - Add provider  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Healthplan in our group under the below location.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-27 11:56:40', '2021-08-27 11:56:40'),
(47292, 10057, 31545, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings for the day!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-10-18 09:53:22', '2021-10-18 09:53:22'),
(47293, 10057, 31545, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello Veronica,  Hope this email finds you in good health. Can you please check the below mentioned remaining providers status along with the facility group contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Joseph, Molly - NUCC - IVUC - LPMC	1396380077 PAUL, SIGI - IVUC - LPMC	1033623616 Jacob, Jaya - IVUC - LPMC	1194336149  Kindly get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-22 11:40:51', '2021-11-22 11:40:51'),
(47294, 10057, 31545, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #69503 for Normandy Urgent Care Center and #69505 for Longpoint Medical Center.   Thank you,  Lionel Negrete Provider Account Manager', NULL, NULL, '2021-11-23 10:06:31', '2021-11-23 10:06:31'),
(47295, 10057, 31545, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello,  Can I get the update on provider Sigi Paul & Molly Joseph enrollment status?  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-03 10:50:16', '2021-12-03 10:50:16'),
(47296, 10057, 31545, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Called to check the status: 800-656-4817. Still in the process.  Need to check after 10 days.  Call Reference - 71689 - TIM', NULL, NULL, '2021-12-10 14:55:31', '2021-12-10 14:55:31'),
(47297, 10057, 31545, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Will Follow-up in Next Week.  Please see previous Call Comments. Thank you', NULL, NULL, '2021-12-17 10:59:46', '2021-12-17 10:59:46'),
(47298, 10057, 31545, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello Steve,  I hope this message finds you well.  Please find below the information requested.  Group Name:  NORMANDY URGENT CARE CENTER PA  TIN:  270796429  Provider(s):   MOLLY JOSEPH, NPI:  1396380077, contract status- pending completion.  Tentative effective date:  01/01/2022 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  09/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  10/01/2021  Group Name:  LONG POINT MEDICAL CENTER  TIN:  760612416  MOLLY JOSEPH, NPI:  1396380077, contract complete.  Effective date:  07/01/2021 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  07/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  07/01/2021.  Happy Holidays.  Thank you, Yvette Hernandez', NULL, NULL, '2021-12-23 10:54:32', '2021-12-23 10:54:32'),
(47299, 10057, 31545, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Thank you for your response Yvette. Is there any way that I can get welcome letters for all of them?  I really appreciate your kind assistance. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:18:17', '2021-12-30 13:18:17'),
(47300, 19067, 31545, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505     Good afternoon Steve,     Thank you for your email. Unfortunately, our department does not disperses Welcome Letters for providers.     I have sent our ECM team with your request to have welcome letters be issued out to you. Please await on a response from them with letters requested.    Thank you,   Yesenia Prado  Provider Account Manager  Nueces, Harris & Jefferson SDA', NULL, NULL, '2022-01-03 17:48:12', '2022-01-03 17:48:12'),
(47301, 20067, 31545, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@SuperiorHealthPlan.com  Sub: Fwd: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Hope this email finds you well.Any update on the previously mentioned request.  Thanks and regards Syed Ahad. ', NULL, NULL, '2022-01-12 15:22:16', '2022-01-12 15:22:16'),
(47302, 19067, 31545, NULL, '2022-01-20 00:00:00.000', 'Approved', 'See Attachment for Superior\'s Provider Directory.', NULL, NULL, '2022-01-13 15:19:02', '2022-01-13 15:19:02'),
(47303, 3040, 31546, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47304, 3040, 31546, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers ||Normandy Urgent Care Center , Imperial Valley Urgent Care Center & Longpoint Medical Center || Providers || Tricare ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you  ', NULL, NULL, '2021-06-07 18:42:50', '2021-06-07 18:42:50');
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
(47305, 3040, 31546, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:41:02', '2021-06-22 09:41:02'),
(47306, 3040, 31546, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Provider certification application form sent @ (608) 221-7535. Please see attachment. ', NULL, NULL, '2021-07-12 13:51:37', '2021-07-12 13:51:37'),
(47307, 11056, 31546, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you!  Have a great day!', NULL, NULL, '2021-08-11 13:20:38', '2021-08-11 13:20:38'),
(47308, 3040, 31546, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Yvonne,   Please note that I already sent the provider certification application form through fax for the below mentioned providers. Can you please check and advise?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 2:  Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-08-20 14:28:23', '2021-08-20 14:28:23'),
(47309, 3040, 31546, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon Adil,  You faxed the form to WPS. I do not have visual access to their system to see if an application was received. You may contact WPS at 1 800 444 5445 and ask to speak with the certifications Unit.    Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-08-30 09:36:02', '2021-08-30 09:36:02'),
(47310, 3040, 31546, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Greetings,  Hope you are doing well. I had a word with (Wyonna) Tricare representative and she advised the application was received for both the below mentioned providers. Provider Joseph, Molly is already certified on 08/12/2021 and already in the network but I couldn\'t find the provider on Tricare provider directory. The second provider she requested to send the copy of the state license through fax.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 2:  Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-30 09:37:02', '2021-08-30 09:37:02'),
(47311, 10057, 31546, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the updated status about our credentialing request. Provider Joseph, Molly is already certified on 08/12/2021 and already in the network but I couldn\'t find the provider on Tricare provider directory. The second provider she requested to send the copy of the state license through fax. But still not yet received any further update from your side.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Joseph, Molly	1073019493 John, Jeny	1073019493  Could you please check and revert back to me. Your early response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-11 14:42:41', '2021-10-11 14:42:41'),
(47312, 10057, 31546, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:23:38', '2021-11-11 17:23:38'),
(47313, 10057, 31546, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning,  Hope this email finds you well. Could you please let me know the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 09:49:40', '2021-12-02 09:49:40'),
(47314, 10057, 31546, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Steve,  The status is listed below. You can check status by using the self-service Provider Portal.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt, TRICARE Community Liaison II Humana Military', NULL, NULL, '2021-12-15 13:31:06', '2021-12-15 13:31:06'),
(47315, 10057, 31546, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Thank you for reaching out. Unfortunately, we do not have access to the provider self service portal. Is there any way that we can get the status for below mentioned providers enrollment status?  Your earliest response will be highly appreciated.  Kind Regards, Steve Albert ', NULL, NULL, '2021-12-21 15:14:13', '2021-12-21 15:14:13'),
(47316, 10057, 31546, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  We are requesting Providers to create a log in on the Provider Portal highlighted below is the link', NULL, NULL, '2021-12-29 13:10:05', '2021-12-29 13:10:05'),
(47317, 20067, 31546, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to:  ywyatt@humana.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon, Hope this email finds you well. I would like to know the enrollment status of the below-mentioned provider under these locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:20:38', '2022-01-12 14:20:38'),
(47318, 20067, 31546, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com   Sub: Enrollment Status Query -  Longpoint Medical Center - Tricare   Good Morning! Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Mini Chennemkara	1841755956 James Piccione JR	1356321509 Ani Stephen	1588959118 Molly Joseph	1396380077  Thanks & Regards Syed Ahad', NULL, NULL, '2022-01-18 10:14:16', '2022-01-18 10:14:16'),
(47319, 20067, 31546, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Sub: Enrollment Status Query - Longpoint Medical Center - Tricare  Good Morning  Syed,  We show all four Providers has been added.  You can check status on a provider by using our self  service Provider Portal see the link highlighted below.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt,  TRICARE Community Liaison II  Humana Military', NULL, NULL, '2022-01-19 09:43:45', '2022-01-19 09:43:45'),
(47320, 20067, 31546, NULL, '2022-01-28 00:00:00.000', 'Approved', 'Called Tricare and spoke to Ashley  Provider is In-Network ID: 471914151-77055-A009 Effective date: 01/15/2022 Ref#14977215', NULL, NULL, '2022-01-21 12:55:58', '2022-01-21 12:55:58'),
(47321, 3040, 31547, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47322, 1005, 31547, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:47:32', '2021-06-07 16:47:32'),
(47323, 3040, 31547, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:51:55', '2021-06-09 10:51:55'),
(47324, 3040, 31547, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:32:58', '2021-07-20 10:32:58'),
(47325, 11056, 31547, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:53:28', '2021-08-11 13:53:28'),
(47326, 3040, 31547, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:27:53', '2021-09-07 16:27:53'),
(47327, 10057, 31547, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:47:18', '2021-10-19 11:47:18'),
(47328, 10057, 31547, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  The providers below are PAR effective 5/1/2021. Any provider that is not on this list may need to be submitted to be added via our website or you will need to submit a roster with all pertinent information to have the providers added. If you need to add a location or make demographic changes to a provider please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-11-23 16:17:02', '2021-11-23 16:17:02'),
(47329, 10057, 31547, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-12-02 15:18:50', '2021-12-02 15:18:50'),
(47330, 10057, 31547, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:21:37', '2021-12-09 13:21:37'),
(47331, 10057, 31547, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:00:56', '2021-12-17 14:00:56'),
(47332, 10057, 31547, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:25:07', '2021-12-23 11:25:07'),
(47333, 10057, 31547, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:56:29', '2021-12-30 13:56:29'),
(47334, 20067, 31547, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email Received From: Ashley.Stevens@wellcare.com  Subject: : RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  May I please get the W-9 for :  Longpoint Medical Center  76-0612416    The providers are in the process of being loaded.  Thanks  Ashley Stevens  Contracts Coordinator, Contracting & Network Development   ', NULL, NULL, '2022-01-06 10:52:07', '2022-01-06 10:52:07'),
(47335, 20067, 31547, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Subject: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC    Good morning Ashley,  Kindly see the attachment for Longpoint Medical Center\'s W9.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-06 11:01:21', '2022-01-06 11:01:21'),
(47336, 20067, 31547, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email received from: ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good Afternoon,     All providers are still in progress for all 3 contract, however our credentialing department is asking for a Collaborative form to credential Jeny John 1073019493. Can you provide that for us?     Thanks     Ashley Stevens  Contracts Coordinator, Contracting & Network Development ', NULL, NULL, '2022-01-14 16:59:05', '2022-01-14 16:59:05'),
(47337, 20067, 31547, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good morning Ashley,  Hope you are doing great. Any updates on the previous request?  Thank you, Syed Ahad.', NULL, NULL, '2022-01-25 10:19:02', '2022-01-25 10:19:02'),
(47338, 20067, 31547, NULL, '2022-02-10 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good morning, I Hope this email finds you well. Kindly see the attachment for Jeny John 1073019493.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-02-03 14:44:22', '2022-02-03 14:44:22'),
(47339, 20067, 31547, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,   Please see list of par providers for Longpoint Medical Center.   Jeny John is almost complete for loading to this contract. I will let you know once complete.', NULL, NULL, '2022-02-08 10:25:12', '2022-02-08 10:25:12'),
(47340, 3040, 31548, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47341, 1005, 31548, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:46:18', '2021-06-07 16:46:18'),
(47342, 11056, 31548, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Railroad Medicare PTAN has been assigned. Please allow three business days for the activation of this new PTAN. Please see the attachment Ref no : 21180001174', NULL, NULL, '2021-06-29 14:22:03', '2021-06-29 14:22:03'),
(47343, 3040, 31548, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	MOLLY JOSEPH NP PROVIDER PTAN	Q00092288 PROVIDER NPI	1396380077 EFFECTIVE DATE	05/01/2021 END DATE	', NULL, NULL, '2021-07-12 09:13:21', '2021-07-12 09:13:21'),
(47344, 3040, 31549, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47345, 3040, 31549, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Enrollment Tracking Information Applicant Name: MOLLY JOSEPH  Tracking ID: T060720210004282  Reassignment Tracking ID: T060720210004394  Submitted Date: MON - JUNE 07 2021 06:18:22 PM EST  Submitted By: Molly joseph  Contact Email(s): NUCC@CLAIMSMEDINC.COM MOLLYJOSEPH60@YAHOO.COM', NULL, NULL, '2021-06-07 17:19:39', '2021-06-07 17:19:39'),
(47346, 3040, 31549, NULL, '2021-06-29 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: MOLLY JOSEPH Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1396380077 Individual Provider Transaction Access Number (PTAN): 1Q2511 Group Legal Business Name (LBN): NORMANDY URGENT CARE CENTER PA Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: MAY 01, 2021', NULL, NULL, '2021-06-22 14:17:25', '2021-06-22 14:17:25'),
(47347, 3040, 31550, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:26', '2021-06-07 16:17:26'),
(47348, 3040, 31550, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:Dmarley@ghn-mci.com  Subject:Enroll Providers || Longpoint Medical Center || Providers || Galaxy Health ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 19:01:18', '2021-06-07 19:01:18'),
(47349, 3040, 31550, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:29:42', '2021-06-15 14:29:42'),
(47350, 11056, 31550, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:02:31', '2021-07-01 14:02:31'),
(47351, 11056, 31550, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:45:41', '2021-07-09 16:45:41'),
(47352, 3040, 31550, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:52', '2021-07-30 14:55:52'),
(47353, 11056, 31550, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:55:01', '2021-08-12 14:55:01'),
(47354, 10057, 31550, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:39:08', '2021-10-08 10:39:08'),
(47355, 10057, 31550, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:26:09', '2021-11-23 17:26:09'),
(47356, 10057, 31550, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:01:21', '2021-12-03 15:01:21'),
(47357, 10057, 31550, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:13:40', '2021-12-10 13:13:40'),
(47358, 10057, 31550, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:49:53', '2021-12-17 10:49:53'),
(47359, 10057, 31550, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:41:25', '2021-12-23 10:41:25'),
(47360, 20067, 31550, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:39:15', '2022-01-11 15:39:15'),
(47361, 20067, 31550, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:41:10', '2022-01-20 10:41:10'),
(47362, 20067, 31550, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:30:29', '2022-01-28 14:30:29'),
(47363, 20067, 31550, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:56:39', '2022-02-18 13:56:39'),
(47364, 20067, 31550, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:15:29', '2022-03-08 10:15:29'),
(47365, 20067, 31550, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:29:01', '2022-03-08 14:29:01'),
(47366, 3040, 31551, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:27', '2021-06-07 16:17:27'),
(47367, 3040, 31551, NULL, '2021-06-14 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2021-06-07 18:48:19', '2021-06-07 18:48:19'),
(47368, 3040, 31552, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:27', '2021-06-07 16:17:27'),
(47369, 1005, 31552, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:49:05', '2021-06-07 16:49:05'),
(47370, 3040, 31552, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to:  AM.Houston@superiorhealthplan.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Health plan in our group under the below locations.   Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 08:37:06', '2021-07-15 08:37:06'),
(47371, 11056, 31552, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:30:26', '2021-08-13 16:30:26'),
(47372, 3040, 31552, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Hello,  I wanted to know the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616    Provider 3: Provider Name: Joseph, Molly Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-08-27 16:43:27', '2021-08-27 16:43:27');
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
(47373, 10057, 31552, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status Query - CUCC - Tricare  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in Ambetter.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Piccione JR, James M	1356321509 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Your earliest response will be highly appreciated. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 15:24:03', '2021-10-11 15:24:03'),
(47374, 10057, 31552, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good Morning,  Hope you are doing well. Could you please provide me with the latest enrollment updates on the below mentioned provider with all locations as per mentioned TIN\'s.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Joseph, Molly	1396380077  Please get to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-18 10:57:04', '2021-11-18 10:57:04'),
(47375, 10057, 31552, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hi,  At this time all requested information has been received for Molly Joseph (TIN: 270796429, NPI: 1396380077) and they are still being credentialed. Please reference ticket # 69130 if you have any questions.  Sincerely, Barbara McDonald  Account Manager, Provider Relations Region 7 (Harris & Jefferson) ', NULL, NULL, '2021-11-19 10:08:40', '2021-11-19 10:08:40'),
(47376, 10057, 31552, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Thank you for the update. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-01 10:00:22', '2021-12-01 10:00:22'),
(47377, 10057, 31552, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello,  Can I get the update on provider Sigi Paul & Molly Joseph enrollment status?  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-08 09:33:29', '2021-12-08 09:33:29'),
(47378, 10057, 31552, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings!  Any update on the below request. This is my second reminder.  Looking forward to your early response.  Thanks & Regards,', NULL, NULL, '2021-12-16 10:07:05', '2021-12-16 10:07:05'),
(47379, 10057, 31552, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good afternoon,  Your email was received. Your Account Manager will be contacting you to address your request. When contacting the Account Manager for updates on your issue, you can use this reference number #72511. If you need immediate assistance you can call to speak to an Account Manager by calling 1-800-656-4817 (English 1, Spanish 2) and option #3 for Provider Relations Team.  Thank you,  Teresa Rios Provider Account Manager', NULL, NULL, '2021-12-23 09:36:07', '2021-12-23 09:36:07'),
(47380, 10057, 31552, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello Teresa,  Thank you for your response. 2 weeks have passed and no one reached out.to me with the update. Please do the needful.  Looking forward to hearing from you.  Regards,', NULL, NULL, '2021-12-30 11:03:33', '2021-12-30 11:03:33'),
(47381, 20067, 31552, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good afternoon,  Hope you are doing well. I would like to know the enrollment status of the below-mentioned providers under these locations.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Provider Name	NPI	Location SIGI PAUL	1033623616	9504 LONG POINT RD STE E, Houston,TX 77055-4226 Molly Joseph	1396380077	9504 LONG POINT RD STE E, Houston,TX 77055-4226  Looking forward to hearing from you.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 14:00:29', '2022-01-06 14:00:29'),
(47382, 20067, 31552, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: AM.Houston@superiorhealthplan.com  Sub: Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello Syed,  The provider is effective 1/1/2022 and is listed with both of those address you provided below.     Timothy Do  Provider Account Manager II  Region 7 (Harris & Jefferson) ', NULL, NULL, '2022-01-11 10:05:53', '2022-01-11 10:05:53'),
(47383, 20067, 31552, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good morning, Hope all is well with you. Kindly send me the welcome kit for both providers mentioned below  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 10:10:23', '2022-01-11 10:10:23'),
(47384, 20067, 31552, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Sub: Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good Afternoon,     Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #75028        If you are in need of immediate assistance, you can call to speak to an Account Manager by phone at 1-800-656-4817 (English 1, Spanish 2), and Option 3  Provider Relations Team', NULL, NULL, '2022-01-19 10:23:39', '2022-01-19 10:23:39'),
(47385, 20067, 31552, NULL, '2022-02-03 00:00:00.000', 'Approved', 'Effective Date: 01/01/2022', NULL, NULL, '2022-01-27 14:56:22', '2022-01-27 14:56:22'),
(47386, 3040, 31553, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:27', '2021-06-07 16:17:27'),
(47387, 3040, 31553, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:trpndataentry@trpnppo.com, providerrelations@trpnppo.com  Subject:Enroll Providers || Longpoint Medical Center || Providers || TRPN ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:47:36', '2021-06-07 18:47:36'),
(47388, 11056, 31553, NULL, '2021-06-24 00:00:00.000', 'In Process', 'EMAIL sent to : lpmc@claimsmedinc.com  Sub:  Provider Update Information Form- TRPN  Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI: 1770763815 Practice TIN: 76-0612416 Primary Address: 9504 LONG POINT RD STE EHouston , TX 77055-4226  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 8:  Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 9: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 10:  Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 11:  Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 12:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 13:  Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 14:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-17 13:39:53', '2021-06-17 13:39:53'),
(47389, 3040, 31553, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Longpoint Medical Center under the below location. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI: 1770763815 Practice TIN: 76-0612416 Primary Address: 9504 LONG POINT RD STE EHouston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 8:  Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 9: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 10:  Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 11:  Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 12:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 13:  Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 14:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-05 15:37:09', '2021-07-05 15:37:09'),
(47390, 3040, 31553, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject:  Provider Update Information Form- TRPN  Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 01/01/2021,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 01/01/2021,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/28/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Julie Jose is Active, effective date 01/01/2021,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com', NULL, NULL, '2021-07-20 08:04:23', '2021-07-20 08:04:23'),
(47391, 3040, 31554, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:27', '2021-06-07 16:17:27'),
(47392, 3040, 31554, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-07 18:31:46', '2021-06-07 18:31:46'),
(47393, 3040, 31555, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:27', '2021-06-07 16:17:27'),
(47394, 3040, 31555, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org   Subject:Enroll Providers || Longpoint Medical Center || Providers || Christus Spohn ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you  ', NULL, NULL, '2021-06-07 19:05:44', '2021-06-07 19:05:44'),
(47395, 3040, 31555, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-18 11:45:52', '2021-06-18 11:45:52'),
(47396, 3040, 31555, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  Greetings,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416 Primary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226     Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:57:38', '2021-07-06 14:57:38'),
(47397, 3040, 31555, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  \"Hello,   We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416 Primary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you ', NULL, NULL, '2021-07-27 16:48:42', '2021-07-27 16:48:42'),
(47398, 3040, 31555, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:20', '2021-07-28 11:20:20'),
(47399, 3040, 31556, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:27', '2021-06-07 16:17:27'),
(47400, 1005, 31556, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare and Cigna\'s Enrollment.', NULL, NULL, '2021-06-07 16:39:54', '2021-06-07 16:39:54'),
(47401, 11056, 31556, NULL, '2021-06-30 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task. ', NULL, NULL, '2021-06-23 12:54:10', '2021-06-23 12:54:10'),
(47402, 3040, 31556, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 10:08:19', '2021-07-22 10:08:19'),
(47403, 11056, 31556, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring |  Adil,  I’ve also forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 09:56:37', '2021-08-09 09:56:37'),
(47404, 3040, 31556, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I didn\'t get any email from anyone regarding the enrollment. Can you please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 11:31:50', '2021-08-17 11:31:50'),
(47405, 10057, 31556, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com  Sub : Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon,  Hope this email finds you well, Please be informed that I have not yet received any email from any one, you are therefore requested to please update me about the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 15:19:32', '2021-10-06 15:19:32'),
(47406, 10057, 31556, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : JENNIFER.PEREZ@cigna.com  Sub : [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello,  May you reach out to the email listed on the letter of interest? The correct representative will be able to assist you further.  Thank you,  Jennifer Perez', NULL, NULL, '2021-11-09 16:08:51', '2021-11-09 16:08:51'),
(47407, 10057, 31556, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hey,  Can you please share with me the email address of the relevant person.  I truly appreciate your support.  Thanks & Regards,', NULL, NULL, '2021-11-23 17:00:36', '2021-11-23 17:00:36'),
(47408, 10057, 31556, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Received From : JENNIFER.PEREZ@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hi,  Please see below email address.  TXMAContracting@cigna.com  Jennifer Perez Network Operations Senior Analyst | Cigna-Medicare', NULL, NULL, '2021-12-03 14:40:53', '2021-12-03 14:40:53'),
(47409, 10057, 31556, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Received From : JENNIFER.PEREZ@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hi,  Please see below email address.  TXMAContracting@cigna.com  Jennifer Perez Network Operations Senior Analyst | Cigna-Medicare', NULL, NULL, '2021-12-03 14:41:10', '2021-12-03 14:41:10'),
(47410, 10057, 31556, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Morning,  Hope this email finds you well. I\'m writing this email to check the updated status for the below mentioned providers under the TIN.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-12-10 11:29:14', '2021-12-10 11:29:14'),
(47411, 10057, 31556, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Greetings!  Any update on the below request. This is my second reminder. Please get back to me as soon as possible.  Thanks & Regards, Steve Albert ', NULL, NULL, '2021-12-17 10:36:51', '2021-12-17 10:36:51'),
(47412, 10057, 31556, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good morning,  I\'m still waiting to get an update from your side?  Your earliest response would be appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-23 10:27:53', '2021-12-23 10:27:53'),
(47413, 10057, 31556, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request, the process is getting deley day by day.  Kindly revert back to me with the latest update.  Regards,', NULL, NULL, '2021-12-29 17:41:42', '2021-12-29 17:41:42'),
(47414, 20067, 31556, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from:  TXMAContracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||   Please fully complete the network interest form for consideration follow the website link below to download the form. Complete for each provider and send it back in and the review process will begin.        1.     TX/OK Cigna Medicare Network  a.     If interested in joining the Cigna Medicare network in the Texas/Oklahoma market, please fill out a Network Interest Form at one of the below links:                                            i.    Practitioner Network Interest Form (Physician/Medical Clinics) – https://medicareproviders.cigna.com/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-tx.pdf     ii. Facility/Ancillary Network Interest Form – https://medicareproviders.cigna.com/static/medicareproviders-cigna-com/docs/facility-network-interest-form-tx.pdf     *** Please ensure all sections are filled out correctly on the forms to prevent any delays on review. ***     2.   Network Interest Form  a.     All network interest forms submitted for the current month will be reviewed by the Network Interest Committee the first week of the following month.                                            i.    Example – If we receive an interest form sent on 11/05/2021, the Committee will review the first week of December.  *** Unless a holiday falls within the first week, it will then be reviewed the following week. ***  b.   Please avoid sending in duplicate requests to prevent any issues during the review process.     3.   Status Update  a.     Once the committee has reviewed the forms, you will receive one of the below responses:                                            i.    Approvals – A representative will reach out to initiate contracting and credentialing.                                           ii.    Denials – A letter will be sent to the contact email listed on the Network Interest Form.                                           iii.    Pendings – A representative will reach out if any additional information is needed.        Thank you,  Cigna Medicare', NULL, NULL, '2022-01-11 14:49:09', '2022-01-11 14:49:09'),
(47415, 20067, 31556, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Kindly see the attachments below  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:10:01', '2022-01-11 15:10:01'),
(47416, 20067, 31556, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon! Hope you are doing well.Haven\'t heard anything from you in the previous email. Kindly respond Promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 15:35:02', '2022-01-19 15:35:02'),
(47417, 20067, 31556, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longmont Medical Center || Group || Cigna Healthspring ||  Good afternoon!  Hope you are doing well, This is my MY SECOND REMINDER Kindly do the needful.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-28 13:44:57', '2022-01-28 13:44:57'),
(47418, 20067, 31556, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon!  I haven\'t heard from your side yet. Kindly respond to the request it\'s really very urgent.  Thank You.', NULL, NULL, '2022-02-08 13:57:41', '2022-02-08 13:57:41'),
(47419, 20067, 31556, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: txmacontracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Syed,     The corrected forms were received by you on 1/11/2022. The committee meeting has not met yet for the month, as they are reviewed the following month from when they’re received. Once a decision is made you will be contacted for the next steps.     2.   Network Interest Form  a.     All network interest forms submitted for the current month will be reviewed by the Network Interest Committee the first week of the following month.                                            i.    Example – If we receive an interest form sent on 11/05/2021, the Committee will review the first week of December.  *** Unless a holiday falls within the first week, it will then be reviewed the following week. ***  b.   Please avoid sending in duplicate requests to prevent any issues during the review process.     3.   Status Update  a.     Once the committee has reviewed the forms, you will receive one of the below responses:                                            i.    Approvals – A representative will reach out to initiate contracting and credentialing.                                           ii.    Denials – A letter will be sent to the contact email listed on the Network Interest Form.                                           iii.    Pending’s – A representative will reach out if any additional information is needed.           Thank you,', NULL, NULL, '2022-02-16 15:41:55', '2022-02-16 15:41:55'),
(47420, 20067, 31556, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||   Good Evening!  Any updates on the request? Has the committee meeting met?  Kindly update me.  Thank you', NULL, NULL, '2022-03-04 15:55:10', '2022-03-04 15:55:10'),
(47421, 20067, 31556, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Morning!  I have sent the network interest forms on 01/11/2022. Kindly update me on the request.   Thank you,', NULL, NULL, '2022-03-17 10:55:23', '2022-03-17 10:55:23'),
(47422, 3040, 31557, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:27', '2021-06-07 16:17:27'),
(47423, 3040, 31557, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com   Subject:Enroll Providers || Longpoint Medical Center || Providers || Anci Care ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you  ', NULL, NULL, '2021-06-07 19:08:40', '2021-06-07 19:08:40'),
(47424, 3040, 31557, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: pdavidson@anci-care.com  Subject:  RE: Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Anci Care||  Jennifer,  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Hi.  Would you please get the information to load this facility under Normandy Urgent Care? Parent Provider ID #437362  Thanks,  Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-06-24 15:13:39', '2021-06-24 15:13:39'),
(47425, 3040, 31557, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: jmaligaya@anci-care.com  Subject: RE: Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Anci Care||  Hello,  I have sent the information to our data management team.  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-06-24 15:14:27', '2021-06-24 15:14:27'),
(47426, 3040, 31557, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task. ', NULL, NULL, '2021-07-13 13:21:10', '2021-07-13 13:21:10'),
(47427, 3040, 31558, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:27', '2021-06-07 16:17:27'),
(47428, 3040, 31558, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:ccnprovider@triwest.com   Subject:Enroll Providers || Longpoint Medical Center || Providers || Triwest ||  Greetings,   I wanted to know how to enroll the below mentioned provider.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:39:56', '2021-06-07 18:39:56'),
(47429, 11056, 31558, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-06-18 10:30:27', '2021-06-18 10:30:27'),
(47430, 3040, 31558, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Re: Enroll Providers || Longpoint Medical Center || Providers || Triwest ||  Hello Jess,   Hope you are doing well. Can you please advise how to enroll the below mentioned group in Triwest. I already submitted the online application for the group.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-20 10:59:59', '2021-07-20 10:59:59'),
(47431, 3040, 31558, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-22 13:35:35', '2021-07-22 13:35:35'),
(47432, 3040, 31559, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:27', '2021-06-07 16:17:27'),
(47433, 1005, 31559, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Doesnt cover this area.', NULL, NULL, '2021-06-07 17:47:18', '2021-06-07 17:47:18'),
(47434, 3040, 31561, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:27', '2021-06-07 16:17:27'),
(47435, 3040, 31561, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Redundant task not cover under LPMC. ', NULL, NULL, '2021-06-08 08:28:17', '2021-06-08 08:28:17'),
(47436, 3040, 31572, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:28', '2021-06-07 16:17:28'),
(47437, 3040, 31572, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com  Subject:Enroll Providers || Longpoint Medical Center || Providers || Renaissance Physicians ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:52:30', '2021-06-07 18:52:30'),
(47438, 3040, 31572, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 13:49:39', '2021-06-17 13:49:39'),
(47439, 11056, 31572, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to :  TXGQProviderRelations@healthspring.com  Sub:  ENROLLMENT INFORMATION OF PROVIDERS- LPMC - Renaissance Physicians   Greetings,  Hope you are doing well. Here is the information of the providers filled in the form which you asked for and kindly see the attachments under below.  Practice Details:  Practice Name:Longpoint Medical Center  Practice Tax ID# 76-0612416  Practice NPI# 1770763815  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 16:    Provider Name: Joseph, Molly  Provider NPI# 1396380077     If you need further more information please feel free to call or email me. Waiting to hear from you soon.      Thank you!   Please see Attachments for the Form.', NULL, NULL, '2021-06-22 13:29:23', '2021-06-22 13:29:23'),
(47440, 3040, 31572, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com, Chukwuma.Ezeokoli@careallies.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello Ezeokoli!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Renaissance Physicians in our group Longpoint Medical Center under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-05 16:42:14', '2021-07-05 16:42:14'),
(47441, 3040, 31572, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: Chukwuma.Ezeokoli@careallies.com  Subject: RE: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hi Adil,  Thank you for your interest in joining the Renaissance Physicians Organization (RPO) network! Attached you will find a Letter of Interest, which is required for all prospective providers. Upon completion of the LOI, the West Houston Board will review and determine whether or not Longpoint Medical Center will be added to the network.  Can you please complete the attached Letter of Interest and return it to me at your earliest convenience? Additionally, can you clarify whether you are looking to contract as PCPs in our network or are you looking to contract as an Urgent Care provider?  Feel free to reach out with any questions!  Best, Chuma  Chuma Ezeokoli Network Operations Senior Analyst  CareAllies 2800 North Loop West, Suite 600 Houston, Texas 77092 Email:          Chukwuma.Ezeokoli@CareAllies.com Cell:             +1.832.206.0656 Fax:             +1.832.553.3418   cid:image001.png@01D2E428.EC444E90', NULL, NULL, '2021-07-26 12:54:14', '2021-07-26 12:54:14'),
(47442, 3040, 31572, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com  Subject: Re: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello Chuma,   Please note that we already sent the forms at TXGQProviderRelations@healthspring.com on 06/22/2021.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:56:06', '2021-07-26 12:56:06'),
(47443, 11056, 31572, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to  :  Chukwuma.Ezeokoli@careallies.   & TXGQProviderRelations@healthspring.com  Sub : Fwd: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:42:23', '2021-08-11 16:42:23'),
(47444, 3040, 31572, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com  Subject: Re: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello, Ezeokoli,   I wanted to know the enrollment status for the below mentioned providers and practice in Renaissance Physician in our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-09-07 11:25:02', '2021-09-07 11:25:02');
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
(47445, 10057, 31572, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : Chukwuma.Ezeokoli@careallies.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practice. Please get back to me as soon as you get a chance.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Thomas, Cini	1134777238 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 John, Jeny	1073019493 Joseph, Molly	1396380077  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 14:48:46', '2021-10-18 14:48:46'),
(47446, 10057, 31572, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : Chukwuma.Ezeokoli@careallies.com, providerservices@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello,  Hope all is well with you. Can I get the latest updates on below mentioned request.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 16:08:49', '2021-11-23 16:08:49'),
(47447, 10057, 31572, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : KJones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good afternoon! We received your inquiry below. We do not deal with any kind of medical facility we are a dental insurance carrier only. This was sent to us in error. Thanks  Kathy Jones Provider Services Representative Cell: 317-744-1241', NULL, NULL, '2021-11-24 09:21:14', '2021-11-24 09:21:14'),
(47448, 10057, 31572, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : kjones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Thank you for the update. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-03 15:50:16', '2021-12-03 15:50:16'),
(47449, 10057, 31572, NULL, '2021-12-22 00:00:00.000', 'Not Eligible', 'Email Received From : KJones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good afternoon! We received your inquiry below. We do not deal with any kind of medical facility we are a dental insurance carrier only. This was sent to us in error. Thanks  *** After discuss with ALEX did it not eligible *** Steve Albert', NULL, NULL, '2021-12-15 13:11:26', '2021-12-15 13:11:26'),
(47450, 3040, 31573, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:28', '2021-06-07 16:17:28'),
(47451, 1005, 31573, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:54:21', '2021-06-07 16:54:21'),
(47452, 10057, 31573, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com & MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the enrollment and provider directory status for remaining providers under the below mentioned locations with Molina Marketplace.  Also, I\'m able to see the groups on provider directory, I already got the effective dates via help desk, please send me the group agreement or facility contract at the earliest   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 15:39:26', '2021-12-30 15:39:26'),
(47453, 19067, 31573, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace     Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-05 17:27:08', '2022-01-05 17:27:08'),
(47454, 20067, 31573, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Status ||  Longpoint Medical center || Molina Marketplace  Good Morning! Hope all is well with you. I would like to know the enrollment status of the below-mentioned providers.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 Brown, Brittany	1275163537 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-18 09:40:38', '2022-01-18 09:40:38'),
(47455, 20067, 31573, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical center || Molina Marketplace  Good Morning,     Thank you for your inquiry.  Please see the status updates below for each provider.     Fernandus, Limy - If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  Brown, Brittany - provider loaded under the service location 9504 Long point but under different TIN # 270796429.  If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  Jacob, Jaya – The request on file is to load the provider under TIN # 27-0796429.  The request under credentialing.  If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  Thomas, Cini - provider loaded under the service location 9504 Long point but under different TIN # 270796429. If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  Rauf, Abdur – The provider showing under the below location eff 1/1/22  Joseph, Molly -  provider loaded under the service location 9504 Long point but under different TIN # 270796429.  If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  John, Jeny - The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.     Thank You,', NULL, NULL, '2022-01-28 15:21:17', '2022-01-28 15:21:17'),
(47456, 20067, 31573, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Status || Longpoint Medical center || Molina Marketplace  Good Afternoon,     Thank you for your inquiry.  The request for the below providers have been sent for loading in the billing system for TIN # 76-0612416.  There is no effective date at this time, please allow a few more weeks for this process to complete.     Brittany Brown  Jaya Jacob  Jeny John     There is no request on file for the below providers under TIN # 76-0612416     Fernandus, Limy, Thomas, Cini, Joseph, Molly ', NULL, NULL, '2022-02-16 14:39:01', '2022-02-16 14:39:01'),
(47457, 20067, 31573, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Status || Longpoint Medical center || Molina Marketplace   Good Afternoon!  Hope you had a great weekend. Can you please help me out with the current Credentialing Status of the listed providers?  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202  Thank you, Syed.', NULL, NULL, '2022-03-14 15:12:48', '2022-03-14 15:12:48'),
(47458, 3040, 31574, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:28', '2021-06-07 16:17:28'),
(47459, 1005, 31574, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll || Longpoint Medical Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below location.   Practice Details: Practice Name:Long Point Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-07 17:39:27', '2021-06-07 17:39:27'),
(47460, 3040, 31574, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Re: Need to Enroll || Longpoint Medical Center || Group & Providers || CHRISTUS HEALTH PLAN||  Hello, Michal,   Hope you are doing well. Can you please advise how to enroll the group and providers in Christus Health Plan. We need to do the group contract.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-14 08:35:42', '2021-06-14 08:35:42'),
(47461, 3040, 31574, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Health Plan ||  Greetings,  Hope you are doing well. I wanted to add the additional location in Christus Health Plan for our group under the below locations.   Practice Details:  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice 2:   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice 3:   Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Tertiary Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-14 15:01:30', '2021-06-14 15:01:30'),
(47462, 3040, 31574, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Re: Need to Enroll|| Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,  Hope you are doing well. Please find the attached Prospective Provider Form along with the Letter of Intent for below mentioned providers to enroll in Christus Health Plan in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Tertiary Address: 9504 LONG POINT RD STE E, Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-22 14:14:18', '2021-06-22 14:14:18'),
(47463, 11056, 31574, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enrollment Status || Longpoint Medical Center || CHRISTUS HEALTH PLAN ||  Greetings,  Hope you are doing well. I wanted to inquire about the enrollment status of  the below mentioned group and providers in Christus Health Plan.  Practice  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-06-29 13:17:52', '2021-06-29 13:17:52'),
(47464, 3040, 31574, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:21', '2021-07-19 09:23:21'),
(47465, 3040, 31574, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information please let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:06', '2021-07-28 11:39:06'),
(47466, 11056, 31574, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 16:59:53', '2021-08-11 16:59:53'),
(47467, 3040, 31574, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:40', '2021-08-17 15:02:40'),
(47468, 3040, 31574, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:38', '2021-09-14 16:14:38'),
(47469, 12062, 31574, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:14:48', '2021-09-22 13:14:48'),
(47470, 10057, 31574, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:31:49', '2021-10-18 16:31:49'),
(47471, 10057, 31574, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Hello,  Hope this email finds you in good health. Could you please let me know the updated status for the below mentioned updated status.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 15:52:57', '2021-11-23 15:52:57'),
(47472, 10057, 31574, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org vicki.guerra@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good afternoon,  Hope this email finds you well. I\'m writing this email to check the status for the below mentioned request.  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:31:52', '2021-12-03 14:31:52'),
(47473, 10057, 31574, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-13 10:59:35', '2021-12-13 10:59:35'),
(47474, 10057, 31574, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 10:05:04', '2021-12-20 10:05:04'),
(47475, 10057, 31574, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 12:01:43', '2021-12-28 12:01:43'),
(47476, 20067, 31574, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good afternoon, Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers, if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Joseph Molly	1396380077 Mini Channamakara	1841755956 Odette Kourouma	1134525868 Jeena Abraham	1467901587 SIGI PAUL	1033623616 Glory Abraham	1194206490 James Piccione JR	1356321509 Limy Fernandus	1972005189 Vibitha Joseph	1952931560 Brittany Brown	1275163537 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238 Jeemol George	1497219067 Julie Jose	1447883061 Jaya Jacob	1194336149 Jeny John	1073019493  Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well. Your earliest response would be greatly appreciated.  Eagerly waiting to hear from you,  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-10 13:20:24', '2022-01-10 13:20:24'),
(47477, 20067, 31574, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST - LPMC - CHRISTUS HEALTH PLAN  Good Afternoon! Hope this email finds you in good health. I sent the email 9 days ago but I haven\'t received any response yet. Kindly respond to the previous request.  Eager to hear from you. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-19 15:23:48', '2022-01-19 15:23:48'),
(47478, 20067, 31574, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good afternoon!  Hope this email finds you in good health. Kindly respond to the Urgent request.  Eagerly waiting to hear from you. Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-28 13:15:48', '2022-01-28 13:15:48'),
(47479, 20067, 31574, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Afternoon  Facility has been processed contract effective date 01/01/22  Thank you', NULL, NULL, '2022-02-08 13:44:06', '2022-02-08 13:44:06'),
(47480, 20067, 31574, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Morning!  Kindly send me a copy of the facility contract. I emailed you on 02/03/2022 and I haven\'t received any response from you yet.  Kindly respond promptly this is my SECOND reminder.  Thank you, ', NULL, NULL, '2022-02-18 09:50:26', '2022-02-18 09:50:26'),
(47481, 20067, 31574, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Evening!  Kindly send me the copy of the Facility contract. This is my THIRD REMINDER.  Kindly respond promptly.  Thank you,', NULL, NULL, '2022-03-04 15:33:54', '2022-03-04 15:33:54'),
(47482, 20067, 31574, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jrbrunin@christushealth.org  Sub:  Facility Contract Request || Longpoint Medical Center || Christus Health Plan   Hello Jackie!  This is Syed. I was trying to reach you but you were unavailable over the call. I want a copy of Facility Contract as it is effective from 01/01/2022. Also please confirm to me that all of the 17 providers have been linked to this group.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Sigi paul	1033623616 Mini Chennemkara	1841755956 Jeena Abraham	1467901587 Odette Kourouma	1134525868 James Piccione	1356321509 Glory Abraham	1194206490 Limy Fernandus	1972005189 Cini Thomas	1134777238 Ani Stephen	1588959118 Jeemol George	1497219067 Julie Jose	1447883061 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Abdur Rauf	1497726202  Thank you,', NULL, NULL, '2022-03-17 10:42:48', '2022-03-17 10:42:48'),
(47483, 3040, 31575, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:33', '2021-06-07 16:17:33'),
(47484, 3040, 31575, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'CAQH is pending because of Mal practice and informed client and waiting for the response.', NULL, NULL, '2021-06-08 08:24:06', '2021-06-08 08:24:06'),
(47485, 3040, 31575, NULL, '2021-06-18 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 311863', NULL, NULL, '2021-06-11 12:53:26', '2021-06-11 12:53:26'),
(47486, 3040, 31575, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in BCBS for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-29 12:56:45', '2021-06-29 12:56:45'),
(47487, 3040, 31575, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Latrice_Thomas@bcbstx.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Hello Latrice,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060       Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-19 10:54:01', '2021-07-19 10:54:01'),
(47488, 3040, 31575, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: Latrice_Thomas@bcbstx.com  Subject: Add Location || Imperial Valley Urgent Care Center || Jacob, Jaya & Joseph, Molly || BCBS ||  Hello Latrice,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-19 11:00:40', '2021-07-19 11:00:40'),
(47489, 11056, 31575, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com   &   latrice_thomas@bcbstx.com  Sub : Fwd: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Good morning Latrice!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations. Please respond to us soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 10:14:58', '2021-08-13 10:14:58'),
(47490, 3040, 31575, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email rcvd from: txproviderupdatesubmission@bcbstx.com  Subject: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Good afternoon, I have researched your request and listed the information below.  Group:  Normandy Urgent Care Center PA  Sigi Paul Provider Record # 8PR750  Jaya Jacob Provider Record # 8PR751  Molly Joseph Provider Record # 8PR752  The application is still in process, but both addresses are set to be added to all three provider records.  For any questions regarding network contracting, credentialing, network effective dates or status requests, please reach out to your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number), fax, and email contact methods. Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-09-07 09:19:49', '2021-09-07 09:19:49'),
(47491, 10057, 31575, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :  tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our groups under the below locations. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 PAUL, SIGI	1033623616 Joseph, Molly	1396380077 Jacob, Jaya	1194336149  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 13:27:13', '2021-10-18 13:27:13'),
(47492, 10057, 31575, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Hello,  I wanted to know the enrollment status for group NUCC and for IVUC providers under the mentioned TIN number.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Brown, Brittany	1275163537 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Jacob, Jaya	1194336149 George, Jeemol	1497219067  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 13:18:23', '2021-11-18 13:18:23'),
(47493, 10057, 31575, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: txproviderupdatesubmission@bcbstx.com  Sub : Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Good afternoon,  I have researched your request and listed the provider’s record numbers linked to the Tax ID below.   Provider Name	Provider record #	779 Normandy	16272 Imperial Valley John, Jeny	8PU638	Yes	Yes Joseph, Molly	8PR752	Yes	No Brown, Brittany	8MF387	Yes	No Thomas, Cini	8LW737	Yes	No Stephen, Ani	8MC701	Yes	No Rauf, Abdur	8CU663	Yes	No Kourouma , Odette Tiranke	8ME162	Yes	No Joseph, Vibitha	8MH707	Yes	No Jacob, Jaya	8PR751	Yes	No George, Jeemol	8ML243	Yes	No  All of the providers listed show the Normandy location as their primary service address.  However, the providers I indicated \"No\" in the column above do not have the Imperial Valley address listed as an additional location.  To add this address to these providers’ records, please submit a Demographic Change Request form via the following link information:   https://www.bcbstx.com/forms/provider/update_info.html Click on the link for Demographic Change Form - https://hcscproviderintake.secure.force.com/TXDemographUpdate  For any questions regarding network contracting, credentialing, network or PAR effective dates or status requests, please contact your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number) and fax contact methods.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-11-23 10:42:17', '2021-11-23 10:42:17'),
(47494, 10057, 31575, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Thank you for submitting the form.  Your case number: 03210174  Your request may take up to 30 days to complete. Once completed, a notification will be sent to the email address submitted with the Demographic Change Request Form.  Please close the tab using X (Close) Button.', NULL, NULL, '2021-12-03 11:38:16', '2021-12-03 11:38:16'),
(47495, 10057, 31575, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Email Received From : Carol_DelaO@bcbstx.com  Sub : PHI- Provider Roster - Normandy Urgent Care  Hello Steve –  Please find attach provider roster for provider.  Please review and let me know if you have any questions.  Thank you.  Carol DeLaO, Network Management Consultant  BlueCross BlueShield of Texas', NULL, NULL, '2021-12-10 10:44:29', '2021-12-10 10:44:29'),
(47496, 3040, 31576, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:33', '2021-06-07 16:17:33'),
(47497, 3040, 31576, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.', NULL, NULL, '2021-06-07 18:07:35', '2021-06-07 18:07:35'),
(47498, 3040, 31577, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:33', '2021-06-07 16:17:33'),
(47499, 3040, 31577, NULL, '2021-06-14 00:00:00.000', 'Approved', 'We have an ancillary contract with Cigna, attached for reference.  ', NULL, NULL, '2021-06-07 18:10:57', '2021-06-07 18:10:57'),
(47500, 3040, 31578, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:33', '2021-06-07 16:17:33'),
(47501, 3040, 31578, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:networkhelp@uhc.com  Subject;Enroll Providers ||Normandy Urgent Care Center , Imperial Valley Urgent Care Center & Longpoint Medical Center || Providers || UHC ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 19:14:15', '2021-06-07 19:14:15'),
(47502, 3040, 31578, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from andrew_vinson@uhc.com  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry.  Provider, Joseph, Molly, NPI: 1396380077, not linked to tin, not credentialed, non-participating. Follow steps below to credential provider.  A provider has to first meet the criteria for credentialing before contracting can begin. In order to credential this provider, please first make sure that the provider\'s CAQH application is up to date and has been attested. Next, submit this request electronically via the following hyperlink: https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html.    An OptumID will be required to access the credentialing tool. To register or view a guide, please go to UHCprovider.com/newuser. Should you need assistance in registering for an Optum ID or if you need assistance or status on updating your existing access, please contact the online/LINK help desk at (866)842-3278, option 1.   For assistance in provisioning your current Optum Login ID to access OnBoardPRO for this specific group/Tax ID, please see the attached quick reference guide on how to identify the group’s Tax ID password administrator.   For additional resources, please visit https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html?cid-none    Please let us know if we can assist further via email.   Andrew Vinson UnitedHealth Care Network Management Resource Team', NULL, NULL, '2021-06-24 16:55:17', '2021-06-24 16:55:17'),
(47503, 3040, 31578, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly || UHC ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in UHC in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-13 11:41:52', '2021-07-13 11:41:52'),
(47504, 3040, 31578, NULL, '2021-07-21 00:00:00.000', 'Approved', 'Email rcvd from; networkhelp@uhc.com  Subject: Secure Message from gregory.s.carte@optum.com  Thank you for contacting the Network Management Resource Team. The group’s contract does not require the providers to be credentialed or to have contract lines loaded to their individual records. The provider only has to be demographically linked to the TIN. I show that the provider is linked to the TIN as of 7/12/2021 for both of your Urgent Care Facilities.  Please let us know if we can assist further via email.   Sincerely,  Greg Carte UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-14 14:51:11', '2021-07-14 14:51:11'),
(47505, 3040, 31579, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:33', '2021-06-07 16:17:33'),
(47506, 1005, 31579, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:55:17', '2021-06-07 16:55:17');
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
(47507, 3040, 31579, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-15 09:08:19', '2021-07-15 09:08:19'),
(47508, 3040, 31579, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:38:54', '2021-07-26 16:38:54'),
(47509, 11056, 31579, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:20:03', '2021-08-13 15:20:03'),
(47510, 3040, 31579, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:33', '2021-08-26 08:45:33'),
(47511, 10057, 31579, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : kdelam@texaschildrens.org  Sub : Provider Contracts  Hello Elam,  Hope this email finds you well. I\'m writing this email to follow-up against Adil\'s email which was sent to you on 08/25/2021.  For any questions please reach out to me. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:26:09', '2021-10-08 13:26:09'),
(47512, 10057, 31579, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:40:40', '2021-10-08 13:40:40'),
(47513, 10057, 31579, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:05:32', '2021-10-21 11:05:32'),
(47514, 10057, 31579, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:49:22', '2021-10-29 09:49:22'),
(47515, 10057, 31579, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:34:50', '2021-11-22 13:34:50'),
(47516, 10057, 31579, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:25:06', '2021-12-02 14:25:06'),
(47517, 10057, 31579, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:51:34', '2021-12-09 11:51:34'),
(47518, 10057, 31579, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:54:46', '2021-12-16 14:54:46'),
(47519, 10057, 31579, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:48:03', '2021-12-22 13:48:03'),
(47520, 10057, 31579, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:02:54', '2021-12-29 12:02:54'),
(47521, 20067, 31579, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:57:17', '2022-01-12 14:57:17'),
(47522, 20067, 31579, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:55:23', '2022-01-19 09:55:23'),
(47523, 20067, 31579, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:26:03', '2022-01-28 10:26:03'),
(47524, 20067, 31579, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061  Thanks & Regards, Syed Ahad ', NULL, NULL, '2022-03-01 15:26:35', '2022-03-01 15:26:35'),
(47525, 22077, 31579, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response!  Thanks & Regards.', NULL, NULL, '2022-04-18 11:59:30', '2022-04-18 11:59:30'),
(47526, 3040, 31580, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:33', '2021-06-07 16:17:33'),
(47527, 3040, 31580, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: MDuffee@humana.com  Subject: Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Humana ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-08 08:32:12', '2021-06-08 08:32:12'),
(47528, 3040, 31580, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 08:40:54', '2021-06-08 08:40:54'),
(47529, 3040, 31581, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:33', '2021-06-07 16:17:33'),
(47530, 1005, 31581, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:49:28', '2021-06-07 16:49:28'),
(47531, 3040, 31581, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com, txcredentialing@amerigroup.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Amerigroup ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Amerigroup in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 08:41:23', '2021-07-15 08:41:23'),
(47532, 3040, 31581, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:10', '2021-07-26 15:24:10'),
(47533, 11056, 31581, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:16:57', '2021-08-13 14:16:57'),
(47534, 3040, 31581, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 14:59:47', '2021-08-25 14:59:47'),
(47535, 3040, 31581, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:57', '2021-09-09 13:07:57'),
(47536, 10057, 31581, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 15:07:20', '2021-10-18 15:07:20'),
(47537, 10057, 31581, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:05:02', '2021-11-11 13:05:02'),
(47538, 10057, 31581, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:50:45', '2021-11-30 10:50:45'),
(47539, 10057, 31581, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:07:30', '2021-12-06 16:07:30'),
(47540, 10057, 31581, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:50:08', '2021-12-13 10:50:08'),
(47541, 10057, 31581, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:57:49', '2021-12-20 13:57:49'),
(47542, 10057, 31581, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Call Details: (800) 600-4441  Rep: Victor  Ref # I146789022  Still in process, need to check next week, also send reminder to below mentioned emails.  latina.small@anthem.com nena.graves@amerigroup.com  Regards, Steve Albert', NULL, NULL, '2021-12-29 11:09:22', '2021-12-29 11:09:22'),
(47543, 19067, 31581, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:03:13', '2022-01-04 16:03:13'),
(47544, 20067, 31581, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:48:02', '2022-01-14 10:48:02'),
(47545, 20067, 31581, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-24 17:09:05', '2022-01-24 17:09:05'),
(47546, 20067, 31581, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  I added a column with my notes     Group Name  Normandy Urgent Care Center     Tax ID  27-0796429     Group NPI  1407171077     Provider Name  NPI  Location  AGP Notes  Jeny John  1073019493  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190140  Jeny John  1073019493  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Molly Joseph  1396380077  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Molly Joseph  1396380077  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Cini Thomas  1134777238  779 Normandy St STE 114, Houston, TX 77015-3441  Not par at this location, include phone and Fax  Cini Thomas  1134777238  16272 Imperial Valley DR STE K, Houston, TX 77060  -                                        Eff date 11/22/2021 P# 10869221  Ani Stephen  1588959118  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 12/20/2021.  P# 12190275  Ani Stephen  1588959118  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Abdur Rauf  1497726202  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 01641188  Abdur Rauf  1497726202  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 01641188  James Piccione JR  1356321509  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  James Piccione JR  1356321509  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Odette Kourouma  1134525868  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190157  Odette Kourouma  1134525868  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Vibitha Joseph  1952931560  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12221497  Vibitha Joseph  1952931560  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12221497  Julie Jose  1447883061  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 09807037  Julie Jose  1447883061  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 09807037  Jaya Jacob  1194336149  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12205914  Jaya Jacob  1194336149  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12205914  Jeemol George  1497219067  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 05/29/2020 (Amerivantage only) – 09805666   - not par at the Imperial Valley location, include the phone and fax  Limy Fernandus  1972005189  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190801  Limy Fernandus  1972005189  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Brittany Brown  1275163537  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 11/11/2021.  P# 09808410 (not par at the Imperial Valley location, include the phone and fax)  Jeena Abraham  1467901587  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 10286831  Jeena Abraham  1467901587  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Mini Chennemkara  1841755956  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190610  Mini Chennemkara  1841755956  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax', NULL, NULL, '2022-01-24 17:14:53', '2022-01-24 17:14:53'),
(47547, 20067, 31581, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-02-02 14:43:28', '2022-02-02 14:43:28'),
(47548, 20067, 31581, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Afternoon!  Hope you are doing well. Attached are the LOI for the Non-Par Providers. Can you please tell me how I can add a location under the remaining providers?  Thank you,', NULL, NULL, '2022-03-01 13:37:32', '2022-03-01 13:37:32'),
(47549, 20067, 31581, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: txcredentialing@amerigroup.com  Sub: FW: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Does this provider wish to be in the directory?  If so, please resend the lOI', NULL, NULL, '2022-03-18 17:01:37', '2022-03-18 17:01:37'),
(47550, 22077, 31581, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com  Subject: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hi,  Any update on the mentioned request?  Looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 13:58:54', '2022-04-14 13:58:54'),
(47551, 3040, 31582, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:33', '2021-06-07 16:17:33'),
(47552, 1005, 31582, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:50:00', '2021-06-07 16:50:00'),
(47553, 3040, 31582, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org, Rajika.Reid@communityhealthchoice.org  Subject:  Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. I wanted to follow up regarding the location addition status for below mentioned group. Also can you please send the copy of contract. I wanted to know if we have an ancillary contract do we need to enroll the providers separately or it will billed under the facility TIN?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-14 11:00:38', '2021-06-14 11:00:38'),
(47554, 11056, 31582, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,  Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you!', NULL, NULL, '2021-07-01 11:48:57', '2021-07-01 11:48:57'),
(47555, 3040, 31582, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task.  ', NULL, NULL, '2021-07-05 09:32:50', '2021-07-05 09:32:50'),
(47556, 3040, 31582, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task.  ', NULL, NULL, '2021-07-05 09:34:00', '2021-07-05 09:34:00'),
(47557, 3040, 31582, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:06', '2021-07-20 10:43:06');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(47558, 11056, 31582, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:23:33', '2021-08-09 10:23:33'),
(47559, 3040, 31582, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:57:51', '2021-08-17 13:57:51'),
(47560, 3040, 31583, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:33', '2021-06-07 16:17:33'),
(47561, 1005, 31583, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Aetna\' and Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:51:32', '2021-06-07 16:51:32'),
(47562, 11056, 31583, NULL, '2021-07-01 00:00:00.000', 'In Process', 'The enrollment form has been submitted for enrollment. Waiting for the contract. Please see the attachments.', NULL, NULL, '2021-06-23 14:42:05', '2021-06-23 14:42:05'),
(47563, 3040, 31583, NULL, '2021-07-19 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-07-12 16:22:51', '2021-07-12 16:22:51'),
(47564, 3040, 31584, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:33', '2021-06-07 16:17:33'),
(47565, 3040, 31584, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'CAQH is pending because of Mal practice and informed client and waiting for the response.', NULL, NULL, '2021-06-08 08:24:18', '2021-06-08 08:24:18'),
(47566, 11056, 31584, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Enrollment form has been submitted. Please see the attachment. Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.', NULL, NULL, '2021-06-23 15:49:01', '2021-06-23 15:49:01'),
(47567, 3040, 31584, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent  to: pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly || Health Smart ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Health Smart in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-12 14:54:21', '2021-07-12 14:54:21'),
(47568, 11056, 31584, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com   &   mdiprsupport@healthsmart.com  Sub : Enrollment Status Query - NUCC - IUVC - Health smart  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Health Smart in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name : Joseph, Molly Provider NPI # : 1396380077  Provider Name : John, Jeny Provider NPI # : 1073019493  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:42:36', '2021-08-09 13:42:36'),
(47569, 3040, 31584, NULL, '2021-09-06 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Enrollment Status Query - NUCC - IUVC - Health smart  Hi,  1. \" JOSEPH, MOLLY \" is effective date \" 05/01/2021 \".', NULL, NULL, '2021-08-30 15:02:32', '2021-08-30 15:02:32'),
(47570, 3040, 31585, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:33', '2021-06-07 16:17:33'),
(47571, 3040, 31585, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com   Subject:Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Multiplan||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:56:24', '2021-06-07 18:56:24'),
(47572, 3040, 31585, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 11:55:08', '2021-06-17 11:55:08'),
(47573, 3040, 31585, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:13', '2021-07-06 11:57:13'),
(47574, 3040, 31585, NULL, '2021-07-22 00:00:00.000', 'Approved', 'I had a word with Shanda Multiplan representative and she advised the provider is participating with Multiplan.   Ref: 7612502', NULL, NULL, '2021-07-15 09:33:44', '2021-07-15 09:33:44'),
(47575, 3040, 31586, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:33', '2021-06-07 16:17:33'),
(47576, 1005, 31586, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:44:55', '2021-06-07 16:44:55'),
(47577, 11056, 31586, NULL, '2021-06-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task. ', NULL, NULL, '2021-06-16 12:50:16', '2021-06-16 12:50:16'),
(47578, 3040, 31587, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47579, 1005, 31587, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:45:27', '2021-06-07 16:45:27'),
(47580, 3040, 31587, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status       Submitted		 PEP Ticket Number 17867890 ', NULL, NULL, '2021-06-22 16:22:06', '2021-06-22 16:22:06'),
(47581, 3040, 31587, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Provider participating with Medicaid. Please see attachment. ', NULL, NULL, '2021-07-12 14:02:23', '2021-07-12 14:02:23'),
(47582, 3040, 31588, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47583, 1005, 31588, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Memorial Hermann enrollment is covered under Aetna plans, pending Aetna enrollment. ', NULL, NULL, '2021-06-07 16:52:43', '2021-06-07 16:52:43'),
(47584, 3040, 31588, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task.  ', NULL, NULL, '2021-06-16 16:39:22', '2021-06-16 16:39:22'),
(47585, 3040, 31588, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:52:08', '2021-07-20 10:52:08'),
(47586, 11056, 31588, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : ProviderServices@memorialhermann.org  &  MHHPContracting@memorialhermann.org  Sub : Fwd: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group under the below locations for Ancillary contract in Memorial Hermann.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day! ', NULL, NULL, '2021-08-12 15:29:43', '2021-08-12 15:29:43'),
(47587, 3040, 31588, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task for more details. ', NULL, NULL, '2021-08-27 10:00:22', '2021-08-27 10:00:22'),
(47588, 3040, 31590, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47589, 1005, 31590, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:53:48', '2021-06-07 16:53:48'),
(47590, 3040, 31590, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Molina Heath ||  Greetings,   Hope you are doing well. Please find attached the contract request form along with the Letter of intent to enroll the below mentioned providers in Moilna Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 09:03:57', '2021-07-15 09:03:57'),
(47591, 11056, 31590, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Molina Heath ||  Good morning!   Hope you are doing well. I want to know the enrollment status of the below mentioned providers in Moilna Healthcare in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead! ', NULL, NULL, '2021-08-11 10:34:01', '2021-08-11 10:34:01'),
(47592, 3040, 31590, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Molina Heath ||  Hello Thomas,    Hope you are doing well. I wanted to enroll the below mentioned providers in Moilna Healthcare in our group under the below locations. Can you please advise the process?  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-08-18 15:11:25', '2021-08-18 15:11:25'),
(47593, 10057, 31590, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:32:38', '2021-10-08 11:32:38'),
(47594, 10057, 31590, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:39:23', '2021-11-15 10:39:23'),
(47595, 3040, 31591, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47596, 1005, 31591, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:54:46', '2021-06-07 16:54:46'),
(47597, 3040, 31591, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Superior Healthplan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Health plan in our group under the below locations.   Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 08:32:10', '2021-07-15 08:32:10'),
(47598, 3040, 31591, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: shp.networkdevelopment@superiorhealthplan.com  Subject; NORMANDY URGENT CARE CENTER PA - Add provider  Greetings,   Hope you are doing well. Please find attached the Individual provider contracting packet as per previous email requested.   If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 14:21:07', '2021-07-22 14:21:07'),
(47599, 11056, 31591, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : NETOPS-ADMIN@centene.com  Sub : Fwd: NORMANDY URGENT CARE CENTER PA - Add provider  Dear Provider,     MOLLY JOSEPH     We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to shp.networkdevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.     To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/        For Re-Credentialing, please email your information to credentialing@centene.com.     Thank you,  Jeannie Lopez  Network Management & Contracting Department – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-08-12 09:48:30', '2021-08-12 09:48:30'),
(47600, 3040, 31591, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: NORMANDY URGENT CARE CENTER PA - Add provider  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Healthplan in our group under the below location.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-27 11:56:40', '2021-08-27 11:56:40'),
(47601, 10057, 31591, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings for the day!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-10-18 09:53:06', '2021-10-18 09:53:06'),
(47602, 10057, 31591, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello Veronica,  Hope this email finds you in good health. Can you please check the below mentioned remaining providers status along with the facility group contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Joseph, Molly - NUCC - IVUC - LPMC	1396380077 PAUL, SIGI - IVUC - LPMC	1033623616 Jacob, Jaya - IVUC - LPMC	1194336149  Kindly get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-22 11:40:45', '2021-11-22 11:40:45'),
(47603, 10057, 31591, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #69503 for Normandy Urgent Care Center and #69505 for Longpoint Medical Center.   Thank you,  Lionel Negrete Provider Account Manager', NULL, NULL, '2021-11-23 10:06:20', '2021-11-23 10:06:20'),
(47604, 10057, 31591, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello,  Can I get the update on provider Sigi Paul & Molly Joseph enrollment status?  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-03 10:50:10', '2021-12-03 10:50:10'),
(47605, 10057, 31591, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Called to check the status: 800-656-4817. Still in the process.  Need to check after 10 days.  Call Reference - 71689 - TIM', NULL, NULL, '2021-12-10 14:55:09', '2021-12-10 14:55:09'),
(47606, 10057, 31591, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Will Follow-up in Next Week.  Please see previous Call Comments. Thank you', NULL, NULL, '2021-12-17 10:58:44', '2021-12-17 10:58:44'),
(47607, 10057, 31591, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello Steve,  I hope this message finds you well.  Please find below the information requested.  Group Name:  NORMANDY URGENT CARE CENTER PA  TIN:  270796429  Provider(s):   MOLLY JOSEPH, NPI:  1396380077, contract status- pending completion.  Tentative effective date:  01/01/2022 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  09/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  10/01/2021  Group Name:  LONG POINT MEDICAL CENTER  TIN:  760612416  MOLLY JOSEPH, NPI:  1396380077, contract complete.  Effective date:  07/01/2021 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  07/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  07/01/2021.  Happy Holidays.  Thank you, Yvette Hernandez', NULL, NULL, '2021-12-23 10:54:09', '2021-12-23 10:54:09'),
(47608, 10057, 31591, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Thank you for your response Yvette. Is there any way that I can get welcome letters for all of them?  I really appreciate your kind assistance. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:17:09', '2021-12-30 13:17:09'),
(47609, 19067, 31591, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505     Good afternoon Steve,     Thank you for your email. Unfortunately, our department does not disperses Welcome Letters for providers.     I have sent our ECM team with your request to have welcome letters be issued out to you. Please await on a response from them with letters requested.    Thank you,   Yesenia Prado  Provider Account Manager  Nueces, Harris & Jefferson SDA', NULL, NULL, '2022-01-03 17:48:17', '2022-01-03 17:48:17'),
(47610, 20067, 31591, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@SuperiorHealthPlan.com  Sub: Fwd: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Hope this email finds you well.Any update on the previously mentioned request.  Thanks and regards Syed Ahad. ', NULL, NULL, '2022-01-12 15:23:44', '2022-01-12 15:23:44'),
(47611, 19067, 31591, NULL, '2022-01-20 00:00:00.000', 'Approved', 'See attachment.', NULL, NULL, '2022-01-13 14:50:17', '2022-01-13 14:50:17'),
(47612, 3040, 31592, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47613, 3040, 31592, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers ||Normandy Urgent Care Center , Imperial Valley Urgent Care Center & Longpoint Medical Center || Providers || Tricare ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you  ', NULL, NULL, '2021-06-07 18:43:56', '2021-06-07 18:43:56'),
(47614, 3040, 31592, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:40:59', '2021-06-22 09:40:59'),
(47615, 3040, 31592, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Provider certification application form sent @ (608) 221-7535. Please see attachment. ', NULL, NULL, '2021-07-12 13:51:37', '2021-07-12 13:51:37'),
(47616, 11056, 31592, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you!  Have a great day!', NULL, NULL, '2021-08-11 13:20:06', '2021-08-11 13:20:06'),
(47617, 3040, 31592, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Yvonne,   Please note that I already sent the provider certification application form through fax for the below mentioned providers. Can you please check and advise?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 2:  Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-08-20 14:28:23', '2021-08-20 14:28:23'),
(47618, 3040, 31592, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon Adil,  You faxed the form to WPS. I do not have visual access to their system to see if an application was received. You may contact WPS at 1 800 444 5445 and ask to speak with the certifications Unit.    Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-08-30 09:36:01', '2021-08-30 09:36:01'),
(47619, 3040, 31592, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Greetings,  Hope you are doing well. I had a word with (Wyonna) Tricare representative and she advised the application was received for both the below mentioned providers. Provider Joseph, Molly is already certified on 08/12/2021 and already in the network but I couldn\'t find the provider on Tricare provider directory. The second provider she requested to send the copy of the state license through fax.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 2:  Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-30 09:37:01', '2021-08-30 09:37:01'),
(47620, 10057, 31592, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the updated status about our credentialing request. Provider Joseph, Molly is already certified on 08/12/2021 and already in the network but I couldn\'t find the provider on Tricare provider directory. The second provider she requested to send the copy of the state license through fax. But still not yet received any further update from your side.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Joseph, Molly	1073019493 John, Jeny	1073019493  Could you please check and revert back to me. Your early response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-11 14:42:26', '2021-10-11 14:42:26'),
(47621, 10057, 31592, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:29:44', '2021-11-11 17:29:44'),
(47622, 10057, 31592, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning,  Hope this email finds you well. Could you please let me know the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 09:49:57', '2021-12-02 09:49:57'),
(47623, 10057, 31592, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Steve,  The status is listed below. You can check status by using the self-service Provider Portal.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt, TRICARE Community Liaison II Humana Military', NULL, NULL, '2021-12-15 13:26:34', '2021-12-15 13:26:34'),
(47624, 10057, 31592, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Thank you for reaching out. Unfortunately, we do not have access to the provider self service portal. Is there any way that we can get the status for below mentioned providers enrollment status?  Your earliest response will be highly appreciated.  Kind Regards, Steve Albert ', NULL, NULL, '2021-12-21 15:13:39', '2021-12-21 15:13:39'),
(47625, 10057, 31592, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  We are requesting Providers to create a log in on the Provider Portal highlighted below is the link', NULL, NULL, '2021-12-29 13:09:15', '2021-12-29 13:09:15'),
(47626, 20067, 31592, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to:  ywyatt@humana.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon, Hope this email finds you well. I would like to know the enrollment status of the below-mentioned provider under these locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:20:28', '2022-01-12 14:20:28'),
(47627, 20067, 31592, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning!  Hope you had a great weekend. I haven\'t received the welcome packet yet. Please do the needful.  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-24 09:52:01', '2022-01-24 09:52:01'),
(47628, 20067, 31592, NULL, '2022-02-10 00:00:00.000', 'In Process', 'Additional location request form Faxed to Tricare at 608-221-7535  See the attachment', NULL, NULL, '2022-02-03 13:00:16', '2022-02-03 13:00:16'),
(47629, 20067, 31592, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Enrollment Status Query - NUCC - IVUC - Tricare   Good Afternoon!  Hope this email finds you in good condition. I would like to know the enrollment status of the below mentioned group and the providers  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Ani Stephen	1588959118 Mini Chennemkara	1841755956 Molly Joseph	1396380077  Thanks,', NULL, NULL, '2022-03-01 15:56:15', '2022-03-01 15:56:15'),
(47630, 20067, 31592, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Enrollment Status Query - NUCC - IVUC - Tricare   Good Afternoon!  Hope you are doing great. Kindly update me on the provider\'s status for both locations.  Thank you', NULL, NULL, '2022-03-18 12:50:27', '2022-03-18 12:50:27'),
(47631, 22077, 31592, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: 	Re: Enrollment Status Query - NUCC - IVUC - Tricare  Hi,  I would like to know the enrollment status for the following group and provider,  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Address	799 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Address	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935 Ani Stephen	1588959118 Mini Chennemkara	1841755956 Molly Joseph	1396380077  Thanks & Regards.', NULL, NULL, '2022-04-19 15:25:36', '2022-04-19 15:25:36'),
(47632, 3040, 31593, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47633, 1005, 31593, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:47:25', '2021-06-07 16:47:25'),
(47634, 3040, 31593, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:49:10', '2021-06-09 10:49:10'),
(47635, 3040, 31593, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:36:04', '2021-07-20 10:36:04'),
(47636, 11056, 31593, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:56:52', '2021-08-11 13:56:52');
