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
(33050, 3040, 25374, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  We have completed the request for the following providers:  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 6: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 7: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let us know if you have any questions.  Thanks   Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-07-27 14:13:17', '2021-07-27 14:13:17'),
(33051, 3040, 25375, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:25', '2021-04-26 14:17:25'),
(33052, 1006, 25375, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:49:12', '2021-04-30 15:49:12'),
(33053, 3040, 25375, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:47:26', '2021-06-01 09:47:26'),
(33054, 11056, 25375, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:36:39', '2021-06-18 16:36:39'),
(33055, 3040, 25375, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:03', '2021-07-05 14:48:03'),
(33056, 3040, 25375, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:16:25', '2021-07-15 11:16:25'),
(33057, 3040, 25376, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:25', '2021-04-26 14:17:25'),
(33058, 3040, 25376, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:45:28', '2021-05-03 07:45:28'),
(33059, 3040, 25376, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:45:26', '2021-05-27 10:45:26'),
(33060, 3040, 25376, NULL, '2021-06-22 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, '2021-06-15 13:26:15', '2021-06-15 13:26:15'),
(33061, 11056, 25376, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:29:16', '2021-07-01 13:29:16'),
(33062, 3040, 25376, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:50', '2021-07-08 16:56:50'),
(33063, 3040, 25377, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:25', '2021-04-26 14:17:25'),
(33064, 3040, 25377, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:16', '2021-05-05 14:14:16'),
(33065, 3040, 25377, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:00', '2021-06-01 09:31:00'),
(33066, 3040, 25377, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:43', '2021-06-18 15:40:43'),
(33067, 3040, 25377, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:12', '2021-07-16 11:35:12'),
(33068, 3040, 25378, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:25', '2021-04-26 14:17:25'),
(33069, 3040, 25378, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:20', '2021-04-30 09:16:20'),
(33070, 3040, 25383, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:26', '2021-04-26 14:17:26'),
(33071, 1006, 25383, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, 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, '2021-04-30 13:56:22', '2021-04-30 13:56:22'),
(33072, 3040, 25384, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:26', '2021-04-26 14:17:26'),
(33073, 3040, 25384, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:24:41', '2021-04-30 10:24:41'),
(33074, 3040, 25384, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:16:57', '2021-05-03 11:16:57'),
(33075, 3040, 25385, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:26', '2021-04-26 14:17:26'),
(33076, 3040, 25385, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:47', '2021-04-29 16:04:47'),
(33077, 3040, 25386, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:26', '2021-04-26 14:17:26'),
(33078, 3040, 25386, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 15:01:32', '2021-04-26 15:01:32'),
(33079, 3040, 25387, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:26', '2021-04-26 14:17:26'),
(33080, 3040, 25387, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 10:08:21', '2021-04-29 10:08:21'),
(33081, 3040, 25388, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:26', '2021-04-26 14:17:26'),
(33082, 3040, 25388, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:56:15', '2021-04-30 08:56:15'),
(33083, 3040, 25388, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.  If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:01:37', '2021-05-28 11:01:37'),
(33084, 3040, 25388, 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 16:23:04', '2021-06-16 16:23:04'),
(33085, 3040, 25388, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:18', '2021-07-20 11:30:18'),
(33086, 3040, 25388, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:03', '2021-07-27 16:19:03'),
(33087, 3040, 25390, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:26', '2021-04-26 14:17:26'),
(33088, 1006, 25390, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:12:07', '2021-04-30 16:12:07'),
(33089, 3040, 25390, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:04', '2021-06-01 12:54:04'),
(33090, 3040, 25390, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:33', '2021-06-18 16:22:33'),
(33091, 3040, 25390, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:15', '2021-07-20 11:18:15'),
(33092, 3040, 25390, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  We have completed the request for the following providers:  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 6: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 7: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let us know if you have any questions.  Thanks   Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-07-27 14:13:20', '2021-07-27 14:13:20'),
(33093, 3040, 25391, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:26', '2021-04-26 14:17:26'),
(33094, 1006, 25391, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:49:09', '2021-04-30 15:49:09'),
(33095, 3040, 25391, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:47:46', '2021-06-01 09:47:46'),
(33096, 11056, 25391, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:35:59', '2021-06-18 16:35:59'),
(33097, 3040, 25391, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:02', '2021-07-05 14:48:02'),
(33098, 3040, 25391, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:11:06', '2021-07-15 11:11:06'),
(33099, 3040, 25392, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:26', '2021-04-26 14:17:26'),
(33100, 3040, 25392, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:34', '2021-05-05 14:14:34'),
(33101, 3040, 25392, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:06', '2021-06-01 09:31:06'),
(33102, 3040, 25392, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:40', '2021-06-18 15:40:40'),
(33103, 3040, 25392, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:12', '2021-07-16 11:35:12'),
(33104, 3040, 25393, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:26', '2021-04-26 14:17:26'),
(33105, 3040, 25393, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:37', '2021-04-30 09:16:37'),
(33106, 3040, 25398, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:27', '2021-04-26 14:17:27'),
(33107, 1006, 25398, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, 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, '2021-04-30 13:56:17', '2021-04-30 13:56:17'),
(33108, 3040, 25399, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:27', '2021-04-26 14:17:27'),
(33109, 3040, 25399, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:26:22', '2021-04-30 10:26:22'),
(33110, 3040, 25399, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:19:34', '2021-05-03 11:19:34'),
(33111, 3040, 25400, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:27', '2021-04-26 14:17:27'),
(33112, 3040, 25400, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:39', '2021-04-29 16:04:39'),
(33113, 3040, 25401, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:27', '2021-04-26 14:17:27'),
(33114, 3040, 25401, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 15:00:51', '2021-04-26 15:00:51'),
(33115, 3040, 25402, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:27', '2021-04-26 14:17:27'),
(33116, 3040, 25402, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:17:45', '2021-04-29 09:17:45'),
(33117, 3040, 25403, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:27', '2021-04-26 14:17:27'),
(33118, 3040, 25403, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:56:06', '2021-04-30 08:56:06'),
(33119, 3040, 25403, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.  If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:01:41', '2021-05-28 11:01:41'),
(33120, 3040, 25403, 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 16:23:01', '2021-06-16 16:23:01');
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
(33121, 3040, 25403, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:18', '2021-07-20 11:30:18'),
(33122, 3040, 25403, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:03', '2021-07-27 16:19:03'),
(33123, 3040, 25405, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:27', '2021-04-26 14:17:27'),
(33124, 1006, 25405, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:49:06', '2021-04-30 15:49:06'),
(33125, 3040, 25405, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:47:49', '2021-06-01 09:47:49'),
(33126, 11056, 25405, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:35:19', '2021-06-18 16:35:19'),
(33127, 3040, 25405, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:02', '2021-07-05 14:48:02'),
(33128, 3040, 25405, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:04:55', '2021-07-15 11:04:55'),
(33129, 3040, 25406, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:27', '2021-04-26 14:17:27'),
(33130, 3040, 25406, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:46:32', '2021-05-03 07:46:32'),
(33131, 3040, 25406, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:45:31', '2021-05-27 10:45:31'),
(33132, 3040, 25406, NULL, '2021-06-22 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, '2021-06-15 13:26:12', '2021-06-15 13:26:12'),
(33133, 11056, 25406, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:29:10', '2021-07-01 13:29:10'),
(33134, 3040, 25406, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:49', '2021-07-08 16:56:49'),
(33135, 3040, 25407, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:28', '2021-04-26 14:17:28'),
(33136, 3040, 25407, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:27', '2021-05-05 14:14:27'),
(33137, 3040, 25407, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:10', '2021-06-01 09:31:10'),
(33138, 3040, 25407, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:37', '2021-06-18 15:40:37'),
(33139, 3040, 25407, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:11', '2021-07-16 11:35:11'),
(33140, 3040, 25408, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:28', '2021-04-26 14:17:28'),
(33141, 3040, 25408, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:31', '2021-04-30 09:16:31'),
(33142, 3040, 25413, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:28', '2021-04-26 14:17:28'),
(33143, 1006, 25413, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, 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, '2021-04-30 13:56:10', '2021-04-30 13:56:10'),
(33144, 3040, 25414, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:28', '2021-04-26 14:17:28'),
(33145, 3040, 25414, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:25:45', '2021-04-30 10:25:45'),
(33146, 3040, 25414, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:18:50', '2021-05-03 11:18:50'),
(33147, 3040, 25415, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:28', '2021-04-26 14:17:28'),
(33148, 3040, 25415, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:33', '2021-04-29 16:04:33'),
(33149, 3040, 25416, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:28', '2021-04-26 14:17:28'),
(33150, 3040, 25416, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 15:00:33', '2021-04-26 15:00:33'),
(33151, 3040, 25417, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:28', '2021-04-26 14:17:28'),
(33152, 3040, 25417, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:17:16', '2021-04-29 09:17:16'),
(33153, 3040, 25418, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:29', '2021-04-26 14:17:29'),
(33154, 3040, 25418, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:55:55', '2021-04-30 08:55:55'),
(33155, 3040, 25418, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.  If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:01:45', '2021-05-28 11:01:45'),
(33156, 3040, 25418, 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 16:22:58', '2021-06-16 16:22:58'),
(33157, 3040, 25418, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:18', '2021-07-20 11:30:18'),
(33158, 3040, 25418, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:02', '2021-07-27 16:19:02'),
(33159, 3040, 25420, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:29', '2021-04-26 14:17:29'),
(33160, 1006, 25420, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:12:05', '2021-04-30 16:12:05'),
(33161, 3040, 25420, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:08', '2021-06-01 12:54:08'),
(33162, 3040, 25420, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:31', '2021-06-18 16:22:31'),
(33163, 3040, 25420, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:15', '2021-07-20 11:18:15'),
(33164, 3040, 25420, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,    Hope you are doing well. Please advise the enrollment status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.      Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations)  Practice Tax-ID# 81-5123542  Practice NPI# 1518404631  Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider 1:  Provider Name: Garcia, Homero  Provider NPI# 1730564857     Provider 2:  Provider Name: Lira, Arturo Alejandro  Provider NPI# 1245789502     Provider 3:  Provider Name: Lopez, Mayra Alejandra  Provider NPI# 1265945125    Provider 4:  Provider Name: Hernandez, Juan  Provider NPI# 1225617558    If you need any additional information please let me know. Waiting to hear from you soon.     Thank you   ', NULL, NULL, '2021-09-07 13:57:07', '2021-09-07 13:57:07'),
(33165, 10057, 25420, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lira, Arturo Alejandro	1245789502 Lopez, Mayra Alejandra	1265945125 Hernandez, Juan	1225617558  Please get back to me as soon as you get a chance. Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 13:25:27', '2021-10-19 13:25:27'),
(33166, 10057, 25420, NULL, '2021-11-18 00:00:00.000', 'Not Eligible', 'Left Practice.  Please see attachment:', NULL, NULL, '2021-11-11 17:49:19', '2021-11-11 17:49:19'),
(33167, 3040, 25421, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:29', '2021-04-26 14:17:29'),
(33168, 1006, 25421, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:49:02', '2021-04-30 15:49:02'),
(33169, 3040, 25421, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:47:53', '2021-06-01 09:47:53'),
(33170, 11056, 25421, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:34:50', '2021-06-18 16:34:50'),
(33171, 3040, 25421, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:01', '2021-07-05 14:48:01'),
(33172, 3040, 25421, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 10:55:06', '2021-07-15 10:55:06'),
(33173, 3040, 25422, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:29', '2021-04-26 14:17:29'),
(33174, 3040, 25422, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:46:05', '2021-05-03 07:46:05'),
(33175, 3040, 25422, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:45:34', '2021-05-27 10:45:34'),
(33176, 3040, 25422, NULL, '2021-06-22 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, '2021-06-15 13:26:08', '2021-06-15 13:26:08'),
(33177, 11056, 25422, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:28:49', '2021-07-01 13:28:49'),
(33178, 3040, 25422, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:49', '2021-07-08 16:56:49'),
(33179, 3040, 25423, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:29', '2021-04-26 14:17:29'),
(33180, 3040, 25423, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:22', '2021-05-05 14:14:22'),
(33181, 3040, 25423, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:13', '2021-06-01 09:31:13'),
(33182, 3040, 25423, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:34', '2021-06-18 15:40:34'),
(33183, 3040, 25423, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:10', '2021-07-16 11:35:10'),
(33184, 3040, 25424, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:29', '2021-04-26 14:17:29'),
(33185, 3040, 25424, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:26', '2021-04-30 09:16:26'),
(33186, 3040, 25429, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:30', '2021-04-26 14:17:30'),
(33187, 1006, 25429, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, 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, '2021-04-30 13:56:04', '2021-04-30 13:56:04'),
(33188, 3040, 25430, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:30', '2021-04-26 14:17:30');
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
(33189, 3040, 25430, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:25:16', '2021-04-30 10:25:16'),
(33190, 3040, 25430, NULL, '2021-05-10 00:00:00.000', 'Revalidated', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:18:13', '2021-05-03 11:18:13'),
(33191, 3040, 25431, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:30', '2021-04-26 14:17:30'),
(33192, 3040, 25431, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:45', '2021-04-29 16:04:45'),
(33193, 3040, 25432, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:30', '2021-04-26 14:17:30'),
(33194, 3040, 25432, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 15:01:18', '2021-04-26 15:01:18'),
(33195, 3040, 25433, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:30', '2021-04-26 14:17:30'),
(33196, 3040, 25433, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 10:08:07', '2021-04-29 10:08:07'),
(33197, 3040, 25434, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:30', '2021-04-26 14:17:30'),
(33198, 3040, 25434, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:56:12', '2021-04-30 08:56:12'),
(33199, 3040, 25434, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.  If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:01:50', '2021-05-28 11:01:50'),
(33200, 3040, 25434, 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 16:22:54', '2021-06-16 16:22:54'),
(33201, 3040, 25434, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:17', '2021-07-20 11:30:17'),
(33202, 3040, 25434, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:01', '2021-07-27 16:19:01'),
(33203, 3040, 25436, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:30', '2021-04-26 14:17:30'),
(33204, 1006, 25436, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:12:01', '2021-04-30 16:12:01'),
(33205, 3040, 25436, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:12', '2021-06-01 12:54:12'),
(33206, 3040, 25436, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:29', '2021-06-18 16:22:29'),
(33207, 3040, 25436, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:14', '2021-07-20 11:18:14'),
(33208, 3040, 25436, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  We have completed the request for the following providers:  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 6: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 7: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let us know if you have any questions.  Thanks   Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-07-27 14:13:21', '2021-07-27 14:13:21'),
(33209, 3040, 25437, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:30', '2021-04-26 14:17:30'),
(33210, 1006, 25437, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:48:59', '2021-04-30 15:48:59'),
(33211, 3040, 25437, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:47:56', '2021-06-01 09:47:56'),
(33212, 11056, 25437, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:34:26', '2021-06-18 16:34:26'),
(33213, 3040, 25437, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:00', '2021-07-05 14:48:00'),
(33214, 3040, 25437, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 10:46:26', '2021-07-15 10:46:26'),
(33215, 3040, 25438, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:30', '2021-04-26 14:17:30'),
(33216, 3040, 25438, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:46:57', '2021-05-03 07:46:57'),
(33217, 3040, 25438, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:45:39', '2021-05-27 10:45:39'),
(33218, 3040, 25438, NULL, '2021-06-22 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, '2021-06-15 13:26:05', '2021-06-15 13:26:05'),
(33219, 11056, 25438, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:28:42', '2021-07-01 13:28:42'),
(33220, 3040, 25438, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:49', '2021-07-08 16:56:49'),
(33221, 3040, 25439, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:30', '2021-04-26 14:17:30'),
(33222, 3040, 25439, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:32', '2021-05-05 14:14:32'),
(33223, 3040, 25439, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:16', '2021-06-01 09:31:16'),
(33224, 3040, 25439, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:31', '2021-06-18 15:40:31'),
(33225, 3040, 25439, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:09', '2021-07-16 11:35:09'),
(33226, 3040, 25440, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:31', '2021-04-26 14:17:31'),
(33227, 3040, 25440, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:35', '2021-04-30 09:16:35'),
(33228, 3040, 25445, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:31', '2021-04-26 14:17:31'),
(33229, 1006, 25445, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, 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, '2021-04-30 13:55:58', '2021-04-30 13:55:58'),
(33230, 3040, 25446, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:31', '2021-04-26 14:17:31'),
(33231, 3040, 25446, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:26:11', '2021-04-30 10:26:11'),
(33232, 3040, 25446, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:19:20', '2021-05-03 11:19:20'),
(33233, 3040, 25447, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33234, 1019, 25447, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 06:56:08', '2021-04-30 06:56:08'),
(33235, 3040, 25448, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33236, 1019, 25448, NULL, NULL, 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  As per Brad.', NULL, NULL, '2021-04-30 06:55:44', '2021-04-30 06:55:44'),
(33237, 3040, 25449, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33238, 1006, 25449, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:36:43', '2021-04-30 13:36:43'),
(33239, 3040, 25450, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33240, 1006, 25450, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:36:40', '2021-04-30 13:36:40'),
(33241, 3040, 25452, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33242, 1006, 25452, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:36:34', '2021-04-30 13:36:34'),
(33243, 3040, 25453, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33244, 1006, 25453, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:36:31', '2021-04-30 13:36:31'),
(33245, 3040, 25454, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33246, 1006, 25454, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:36:27', '2021-04-30 13:36:27'),
(33247, 3040, 25455, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33248, 1006, 25455, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:36:24', '2021-04-30 13:36:24'),
(33249, 3040, 25456, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33250, 1006, 25456, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:36:21', '2021-04-30 13:36:21'),
(33251, 3040, 25462, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33252, 1006, 25462, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:36:02', '2021-04-30 13:36:02'),
(33253, 3040, 25463, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33254, 1006, 25463, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:35:59', '2021-04-30 13:35:59'),
(33255, 3040, 25464, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33256, 3040, 25464, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:43', '2021-04-29 16:04:43'),
(33257, 3040, 25465, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33258, 3040, 25465, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 15:01:09', '2021-04-26 15:01:09'),
(33259, 3040, 25466, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33260, 3040, 25466, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 10:07:55', '2021-04-29 10:07:55'),
(33261, 3040, 25467, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33262, 3040, 25467, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:56:09', '2021-04-30 08:56:09'),
(33263, 3040, 25467, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.   If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:11:03', '2021-05-28 11:11:03'),
(33264, 3040, 25467, 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 16:22:51', '2021-06-16 16:22:51'),
(33265, 3040, 25467, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:17', '2021-07-20 11:30:17'),
(33266, 3040, 25467, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:01', '2021-07-27 16:19:01'),
(33267, 3040, 25469, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33268, 1006, 25469, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:13:29', '2021-04-30 16:13:29'),
(33269, 3040, 25469, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:24', '2021-06-01 12:54:24'),
(33270, 3040, 25469, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:27', '2021-06-18 16:22:27'),
(33271, 3040, 25469, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:13', '2021-07-20 11:18:13'),
(33272, 3040, 25469, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The group and provider below shows PAR effective 5/1/2021.', NULL, NULL, '2021-07-27 14:10:49', '2021-07-27 14:10:49'),
(33273, 3040, 25470, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33274, 1006, 25470, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:50:35', '2021-04-30 15:50:35'),
(33275, 3040, 25470, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:48:13', '2021-06-01 09:48:13'),
(33276, 11056, 25470, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:48:13', '2021-06-18 16:48:13');
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
(33277, 3040, 25470, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:48:00', '2021-07-05 14:48:00'),
(33278, 3040, 25470, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 12:03:36', '2021-07-15 12:03:36'),
(33279, 3040, 25471, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33280, 3040, 25471, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:46:50', '2021-05-03 07:46:50'),
(33281, 3040, 25471, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:47:17', '2021-05-27 10:47:17'),
(33282, 3040, 25471, NULL, '2021-06-22 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, '2021-06-15 13:26:01', '2021-06-15 13:26:01'),
(33283, 11056, 25471, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:33:26', '2021-07-01 13:33:26'),
(33284, 3040, 25471, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:48', '2021-07-08 16:56:48'),
(33285, 3040, 25472, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33286, 3040, 25472, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:31', '2021-05-05 14:14:31'),
(33287, 3040, 25472, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:25', '2021-06-01 09:31:25'),
(33288, 3040, 25472, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:28', '2021-06-18 15:40:28'),
(33289, 3040, 25472, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:09', '2021-07-16 11:35:09'),
(33290, 3040, 25473, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:47', '2021-04-26 14:17:47'),
(33291, 3040, 25473, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:34', '2021-04-30 09:16:34'),
(33292, 3040, 25478, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33293, 1006, 25478, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, 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, '2021-04-30 13:59:32', '2021-04-30 13:59:32'),
(33294, 3040, 25479, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33295, 3040, 25479, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:26:04', '2021-04-30 10:26:04'),
(33296, 3040, 25479, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:19:09', '2021-05-03 11:19:09'),
(33297, 3040, 25480, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33298, 3040, 25480, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:30', '2021-04-29 16:04:30'),
(33299, 3040, 25481, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33300, 3040, 25481, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 15:00:02', '2021-04-26 15:00:02'),
(33301, 3040, 25482, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33302, 3040, 25482, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:16:46', '2021-04-29 09:16:46'),
(33303, 3040, 25483, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33304, 3040, 25483, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:55:49', '2021-04-30 08:55:49'),
(33305, 3040, 25483, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.   If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:11:08', '2021-05-28 11:11:08'),
(33306, 3040, 25483, 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 16:22:47', '2021-06-16 16:22:47'),
(33307, 3040, 25483, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:16', '2021-07-20 11:30:16'),
(33308, 3040, 25483, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:00', '2021-07-27 16:19:00'),
(33309, 3040, 25485, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33310, 1006, 25485, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:13:26', '2021-04-30 16:13:26'),
(33311, 3040, 25485, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:27', '2021-06-01 12:54:27'),
(33312, 3040, 25485, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:24', '2021-06-18 16:22:24'),
(33313, 3040, 25485, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:13', '2021-07-20 11:18:13'),
(33314, 3040, 25485, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  We have completed the request for the following providers:  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 6: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 7: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let us know if you have any questions.  Thanks   Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-07-27 14:13:22', '2021-07-27 14:13:22'),
(33315, 3040, 25486, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33316, 1006, 25486, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:50:32', '2021-04-30 15:50:32'),
(33317, 3040, 25486, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:48:17', '2021-06-01 09:48:17'),
(33318, 11056, 25486, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:47:24', '2021-06-18 16:47:24'),
(33319, 3040, 25486, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:47:59', '2021-07-05 14:47:59'),
(33320, 3040, 25486, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:56:38', '2021-07-15 11:56:38'),
(33321, 3040, 25487, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33322, 3040, 25487, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:45:44', '2021-05-03 07:45:44'),
(33323, 3040, 25487, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:47:20', '2021-05-27 10:47:20'),
(33324, 3040, 25487, NULL, '2021-06-22 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, '2021-06-15 13:25:57', '2021-06-15 13:25:57'),
(33325, 11056, 25487, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:33:16', '2021-07-01 13:33:16'),
(33326, 3040, 25487, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:48', '2021-07-08 16:56:48'),
(33327, 3040, 25488, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33328, 3040, 25488, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:19', '2021-05-05 14:14:19'),
(33329, 3040, 25488, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:28', '2021-06-01 09:31:28'),
(33330, 3040, 25488, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:26', '2021-06-18 15:40:26'),
(33331, 3040, 25488, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:08', '2021-07-16 11:35:08'),
(33332, 3040, 25489, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33333, 3040, 25489, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:23', '2021-04-30 09:16:23'),
(33334, 3040, 25494, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33335, 1006, 25494, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, 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, '2021-04-30 13:59:29', '2021-04-30 13:59:29'),
(33336, 3040, 25495, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33337, 3040, 25495, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:24:56', '2021-04-30 10:24:56'),
(33338, 3040, 25495, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:17:29', '2021-05-03 11:17:29'),
(33339, 3040, 25495, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:17:35', '2021-05-03 11:17:35'),
(33340, 3040, 25496, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33341, 3040, 25496, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:02:09', '2021-04-29 16:02:09'),
(33342, 3040, 25497, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:48', '2021-04-26 14:17:48'),
(33343, 3040, 25497, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 14:59:17', '2021-04-26 14:59:17'),
(33344, 3040, 25498, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33345, 3040, 25498, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:16:01', '2021-04-29 09:16:01'),
(33346, 3040, 25499, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33347, 3040, 25499, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:55:41', '2021-04-30 08:55:41'),
(33348, 3040, 25499, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org, ProviderServices@memorialhermann.org  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis || Memorial Hermann ||  Greetings,   Hope you are doing well. Please find the attached request for participation to enroll the below mentioned provider in Memorial Hermann under the below location.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-04 15:52:22', '2021-05-04 15:52:22'),
(33349, 3040, 25499, NULL, '2021-06-04 00:00:00.000', 'New/Not Initiated', 'Email sent to:Enterprise.Credentialing@memorialhermann.org, ProviderServices@memorialhermann.org  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis || Memorial Hermann ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers for our group Valley Med Urgent Care under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you  ', NULL, NULL, '2021-05-28 12:10:24', '2021-05-28 12:10:24');
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
(33350, 3040, 25499, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to:Enterprise.Credentialing@memorialhermann.org, ProviderServices@memorialhermann.org  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis || Memorial Hermann ||  Greetings,   I wanted to know the enrollment status for the below mentioned providers for our group Valley Med Urgent Care under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-04 16:27:29', '2021-06-04 16:27:29'),
(33351, 3040, 25499, 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 16:22:44', '2021-06-16 16:22:44'),
(33352, 3040, 25499, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:16', '2021-07-20 11:30:16'),
(33353, 3040, 25499, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:19:00', '2021-07-27 16:19:00'),
(33354, 3040, 25501, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33355, 1006, 25501, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:13:23', '2021-04-30 16:13:23'),
(33356, 3040, 25501, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:30', '2021-06-01 12:54:30'),
(33357, 3040, 25501, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:22', '2021-06-18 16:22:22'),
(33358, 3040, 25501, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:12', '2021-07-20 11:18:12'),
(33359, 3040, 25501, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  We have completed the request for the following providers:  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 6: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 7: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let us know if you have any questions.  Thanks   Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-07-27 14:13:14', '2021-07-27 14:13:14'),
(33360, 3040, 25502, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33361, 1006, 25502, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:50:29', '2021-04-30 15:50:29'),
(33362, 3040, 25502, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:48:21', '2021-06-01 09:48:21'),
(33363, 11056, 25502, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:46:52', '2021-06-18 16:46:52'),
(33364, 3040, 25502, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:47:58', '2021-07-05 14:47:58'),
(33365, 3040, 25502, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:44:50', '2021-07-15 11:44:50'),
(33366, 3040, 25503, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33367, 3040, 25503, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:47:23', '2021-05-27 10:47:23'),
(33368, 3040, 25503, NULL, '2021-06-22 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, '2021-06-15 13:25:53', '2021-06-15 13:25:53'),
(33369, 11056, 25503, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:32:42', '2021-07-01 13:32:42'),
(33370, 3040, 25503, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:47', '2021-07-08 16:56:47'),
(33371, 3040, 25504, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33372, 3040, 25504, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:12', '2021-05-05 14:14:12'),
(33373, 3040, 25504, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:33', '2021-06-01 09:31:33'),
(33374, 3040, 25504, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:23', '2021-06-18 15:40:23'),
(33375, 3040, 25504, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:07', '2021-07-16 11:35:07'),
(33376, 3040, 25505, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33377, 3040, 25505, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:15', '2021-04-30 09:16:15'),
(33378, 3040, 25510, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33379, 1006, 25510, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, 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, '2021-04-30 13:59:26', '2021-04-30 13:59:26'),
(33380, 3040, 25511, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33381, 3040, 25511, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:24:00', '2021-04-30 10:24:00'),
(33382, 3040, 25511, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:16:32', '2021-05-03 11:16:32'),
(33383, 3040, 25512, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33384, 3040, 25512, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:32', '2021-04-29 16:04:32'),
(33385, 3040, 25513, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33386, 3040, 25513, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 15:00:15', '2021-04-26 15:00:15'),
(33387, 3040, 25514, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33388, 3040, 25514, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:17:05', '2021-04-29 09:17:05'),
(33389, 3040, 25515, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33390, 3040, 25515, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:55:52', '2021-04-30 08:55:52'),
(33391, 3040, 25515, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.   If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:11:16', '2021-05-28 11:11:16'),
(33392, 3040, 25515, 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 16:22:41', '2021-06-16 16:22:41'),
(33393, 3040, 25515, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:16', '2021-07-20 11:30:16'),
(33394, 3040, 25515, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:18:59', '2021-07-27 16:18:59'),
(33395, 3040, 25517, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33396, 1006, 25517, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:13:21', '2021-04-30 16:13:21'),
(33397, 3040, 25517, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:33', '2021-06-01 12:54:33'),
(33398, 3040, 25517, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:19', '2021-06-18 16:22:19'),
(33399, 3040, 25517, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:12', '2021-07-20 11:18:12'),
(33400, 3040, 25517, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,    Hope you are doing well. Please advise the enrollment status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.      Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations)  Practice Tax-ID# 81-5123542  Practice NPI# 1518404631  Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider 1:  Provider Name: Garcia, Homero  Provider NPI# 1730564857     Provider 2:  Provider Name: Lira, Arturo Alejandro  Provider NPI# 1245789502     Provider 3:  Provider Name: Lopez, Mayra Alejandra  Provider NPI# 1265945125    Provider 4:  Provider Name: Hernandez, Juan  Provider NPI# 1225617558    If you need any additional information please let me know. Waiting to hear from you soon.     Thank you   ', NULL, NULL, '2021-09-07 13:57:05', '2021-09-07 13:57:05'),
(33401, 10057, 25517, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lira, Arturo Alejandro	1245789502 Lopez, Mayra Alejandra	1265945125 Hernandez, Juan	1225617558  Please get back to me as soon as you get a chance. Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 13:25:20', '2021-10-19 13:25:20'),
(33402, 10057, 25517, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Dear Provider:  Thank you for your interest in joining the Wellcare network.  Please allow us 30 calendar days to review your request.  A Centene contracting representative will reach out to you within 30 calendar days.  Please note:  In response to your request to join the Wellcare network, you may receive correspondence from a Superior Health Plan email address.   Thank you once again for your interest.  Sincerely, Network Management', NULL, NULL, '2021-11-17 10:10:01', '2021-11-17 10:10:01'),
(33403, 10057, 25517, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  I have submitted the remaining below mentioned provider forms via your website, let me know the update.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Garcia, Homero	1730564857 Juan Hernandez	1225617558 Lopez, Mayra	1265945125  Please find the attached forms for your reference as well.  Thanks & Regards,', NULL, NULL, '2021-11-30 16:10:49', '2021-11-30 16:10:49'),
(33404, 10057, 25517, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned providers request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 15:40:03', '2021-12-07 15:40:03'),
(33405, 10057, 25517, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:30:53', '2021-12-17 15:30:53'),
(33406, 10057, 25517, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:31:22', '2021-12-17 15:31:22'),
(33407, 10057, 25517, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Thank you for reaching out. Can I get the welcome packets of mentioned providers?  Looking forward to hearing from you soon.  Regards,', NULL, NULL, '2021-12-27 12:57:32', '2021-12-27 12:57:32'),
(33408, 10057, 25517, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,  Here is a list of par providers for your contract, and the welcome letter.  Please see attachment.  Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-30 14:27:39', '2021-12-30 14:27:39'),
(33409, 20067, 25517, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || WellCare ||   Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Juan Hernandez	1225617558 Homero garcia	1730564857 Mayra Lopez	1265945125  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:53:46', '2022-01-05 17:53:46'),
(33410, 20067, 25517, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon!  Hope you had a great weekend. Any updates on the below-mentioned request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 14:23:25', '2022-01-18 14:23:25'),
(33411, 20067, 25517, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Received the effective date but not confirm for which location, Will approve the task next week after the confirmation.', NULL, NULL, '2022-01-31 09:50:02', '2022-01-31 09:50:02'),
(33412, 20067, 25517, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||   Good Morning,   Welcome letters will only have one address on them. The provider was requested to be loaded to 3 addresses and they are par for them all: ', NULL, NULL, '2022-02-08 12:40:34', '2022-02-08 12:40:34'),
(33413, 3040, 25518, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:49', '2021-04-26 14:17:49'),
(33414, 1006, 25518, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:50:27', '2021-04-30 15:50:27'),
(33415, 3040, 25518, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:48:24', '2021-06-01 09:48:24'),
(33416, 11056, 25518, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:46:22', '2021-06-18 16:46:22'),
(33417, 3040, 25518, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:47:58', '2021-07-05 14:47:58'),
(33418, 3040, 25518, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:37:16', '2021-07-15 11:37:16'),
(33419, 3040, 25519, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:50', '2021-04-26 14:17:50'),
(33420, 3040, 25519, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:45:56', '2021-05-03 07:45:56'),
(33421, 3040, 25519, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:47:28', '2021-05-27 10:47:28'),
(33422, 3040, 25519, NULL, '2021-06-22 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, '2021-06-15 13:25:50', '2021-06-15 13:25:50');
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
(33423, 11056, 25519, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:32:35', '2021-07-01 13:32:35'),
(33424, 3040, 25519, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:47', '2021-07-08 16:56:47'),
(33425, 3040, 25520, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:50', '2021-04-26 14:17:50'),
(33426, 3040, 25520, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:21', '2021-05-05 14:14:21'),
(33427, 3040, 25520, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:36', '2021-06-01 09:31:36'),
(33428, 3040, 25520, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:20', '2021-06-18 15:40:20'),
(33429, 3040, 25520, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:07', '2021-07-16 11:35:07'),
(33430, 3040, 25521, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:50', '2021-04-26 14:17:50'),
(33431, 3040, 25521, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:25', '2021-04-30 09:16:25'),
(33432, 3040, 25526, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:50', '2021-04-26 14:17:50'),
(33433, 1006, 25526, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, 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, '2021-04-30 13:59:22', '2021-04-30 13:59:22'),
(33434, 3040, 25527, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:50', '2021-04-26 14:17:50'),
(33435, 3040, 25527, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:25:07', '2021-04-30 10:25:07'),
(33436, 3040, 25527, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:17:58', '2021-05-03 11:17:58'),
(33437, 3040, 25528, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:50', '2021-04-26 14:17:50'),
(33438, 3040, 25528, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:02:26', '2021-04-29 16:02:26'),
(33439, 3040, 25529, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:50', '2021-04-26 14:17:50'),
(33440, 3040, 25529, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 14:59:34', '2021-04-26 14:59:34'),
(33441, 3040, 25530, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:50', '2021-04-26 14:17:50'),
(33442, 3040, 25530, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:16:16', '2021-04-29 09:16:16'),
(33443, 3040, 25531, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:50', '2021-04-26 14:17:50'),
(33444, 3040, 25531, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:55:43', '2021-04-30 08:55:43'),
(33445, 3040, 25531, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.   If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:11:19', '2021-05-28 11:11:19'),
(33446, 3040, 25531, 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 16:22:37', '2021-06-16 16:22:37'),
(33447, 3040, 25531, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:15', '2021-07-20 11:30:15'),
(33448, 3040, 25531, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:18:58', '2021-07-27 16:18:58'),
(33449, 3040, 25533, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:50', '2021-04-26 14:17:50'),
(33450, 1006, 25533, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:13:17', '2021-04-30 16:13:17'),
(33451, 3040, 25533, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:37', '2021-06-01 12:54:37'),
(33452, 3040, 25533, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:17', '2021-06-18 16:22:17'),
(33453, 3040, 25533, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:11', '2021-07-20 11:18:11'),
(33454, 3040, 25533, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  We have completed the request for the following providers:  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 6: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 7: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let us know if you have any questions.  Thanks   Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-07-27 14:13:16', '2021-07-27 14:13:16'),
(33455, 3040, 25534, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:50', '2021-04-26 14:17:50'),
(33456, 1006, 25534, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:50:24', '2021-04-30 15:50:24'),
(33457, 3040, 25534, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:48:28', '2021-06-01 09:48:28'),
(33458, 11056, 25534, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:45:52', '2021-06-18 16:45:52'),
(33459, 3040, 25534, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:47:57', '2021-07-05 14:47:57'),
(33460, 3040, 25534, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:32:02', '2021-07-15 11:32:02'),
(33461, 3040, 25535, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:50', '2021-04-26 14:17:50'),
(33462, 3040, 25535, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:45:20', '2021-05-03 07:45:20'),
(33463, 3040, 25535, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:47:31', '2021-05-27 10:47:31'),
(33464, 3040, 25535, NULL, '2021-06-22 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, '2021-06-15 13:25:47', '2021-06-15 13:25:47'),
(33465, 11056, 25535, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:32:20', '2021-07-01 13:32:20'),
(33466, 3040, 25535, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:46', '2021-07-08 16:56:46'),
(33467, 3040, 25536, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:50', '2021-04-26 14:17:50'),
(33468, 3040, 25536, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:15', '2021-05-05 14:14:15'),
(33469, 3040, 25536, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:48', '2021-06-01 09:31:48'),
(33470, 3040, 25536, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:18', '2021-06-18 15:40:18'),
(33471, 3040, 25536, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:06', '2021-07-16 11:35:06'),
(33472, 3040, 25537, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:51', '2021-04-26 14:17:51'),
(33473, 3040, 25537, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:17', '2021-04-30 09:16:17'),
(33474, 3040, 25542, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:51', '2021-04-26 14:17:51'),
(33475, 1006, 25542, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, 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, '2021-04-30 13:59:10', '2021-04-30 13:59:10'),
(33476, 3040, 25543, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:51', '2021-04-26 14:17:51'),
(33477, 3040, 25543, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:24:30', '2021-04-30 10:24:30'),
(33478, 3040, 25543, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:16:43', '2021-05-03 11:16:43'),
(33479, 3040, 25544, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:51', '2021-04-26 14:17:51'),
(33480, 3040, 25544, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:38', '2021-04-29 16:04:38'),
(33481, 3040, 25545, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:51', '2021-04-26 14:17:51'),
(33482, 3040, 25545, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 15:00:42', '2021-04-26 15:00:42'),
(33483, 3040, 25546, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:51', '2021-04-26 14:17:51'),
(33484, 3040, 25546, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:17:35', '2021-04-29 09:17:35'),
(33485, 3040, 25547, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:51', '2021-04-26 14:17:51'),
(33486, 3040, 25547, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:56:03', '2021-04-30 08:56:03'),
(33487, 3040, 25547, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.   If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:11:28', '2021-05-28 11:11:28'),
(33488, 3040, 25547, 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 16:22:34', '2021-06-16 16:22:34'),
(33489, 3040, 25547, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks Thanks', NULL, NULL, '2021-07-20 11:30:15', '2021-07-20 11:30:15'),
(33490, 3040, 25547, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:18:58', '2021-07-27 16:18:58'),
(33491, 3040, 25549, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:51', '2021-04-26 14:17:51'),
(33492, 1006, 25549, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:13:15', '2021-04-30 16:13:15'),
(33493, 3040, 25549, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:41', '2021-06-01 12:54:41'),
(33494, 3040, 25549, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:14', '2021-06-18 16:22:14'),
(33495, 3040, 25549, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:11', '2021-07-20 11:18:11'),
(33496, 3040, 25549, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,    Hope you are doing well. Please advise the enrollment status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.      Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations)  Practice Tax-ID# 81-5123542  Practice NPI# 1518404631  Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider 1:  Provider Name: Garcia, Homero  Provider NPI# 1730564857     Provider 2:  Provider Name: Lira, Arturo Alejandro  Provider NPI# 1245789502     Provider 3:  Provider Name: Lopez, Mayra Alejandra  Provider NPI# 1265945125    Provider 4:  Provider Name: Hernandez, Juan  Provider NPI# 1225617558    If you need any additional information please let me know. Waiting to hear from you soon.     Thank you   ', NULL, NULL, '2021-09-07 13:57:06', '2021-09-07 13:57:06'),
(33497, 10057, 25549, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lira, Arturo Alejandro	1245789502 Lopez, Mayra Alejandra	1265945125 Hernandez, Juan	1225617558  Please get back to me as soon as you get a chance. Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 13:25:14', '2021-10-19 13:25:14'),
(33498, 10057, 25549, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Dear Provider:  Thank you for your interest in joining the Wellcare network.  Please allow us 30 calendar days to review your request.  A Centene contracting representative will reach out to you within 30 calendar days.  Please note:  In response to your request to join the Wellcare network, you may receive correspondence from a Superior Health Plan email address.   Thank you once again for your interest.  Sincerely, Network Management', NULL, NULL, '2021-11-17 10:12:31', '2021-11-17 10:12:31');
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
(33499, 10057, 25549, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  I have submitted the remaining below mentioned provider forms via your website, let me know the update.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Garcia, Homero	1730564857 Juan Hernandez	1225617558 Lopez, Mayra	1265945125  Please find the attached forms for your reference as well.  Thanks & Regards,', NULL, NULL, '2021-11-30 16:10:44', '2021-11-30 16:10:44'),
(33500, 10057, 25549, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned providers request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 15:39:53', '2021-12-07 15:39:53'),
(33501, 10057, 25549, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:30:44', '2021-12-17 15:30:44'),
(33502, 10057, 25549, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Thank you for reaching out. Can I get the welcome packets of mentioned providers?  Looking forward to hearing from you soon.  Regards,', NULL, NULL, '2021-12-27 12:57:26', '2021-12-27 12:57:26'),
(33503, 10057, 25549, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,  Here is a list of par providers for your contract, and the welcome letter.  Please see attachment.  Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-30 14:27:30', '2021-12-30 14:27:30'),
(33504, 20067, 25549, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || WellCare ||   Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Juan Hernandez	1225617558 Homero garcia	1730564857 Mayra Lopez	1265945125  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:54:14', '2022-01-05 17:54:14'),
(33505, 20067, 25549, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon!  Hope you had a great weekend. Any updates on the below-mentioned request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 14:23:18', '2022-01-18 14:23:18'),
(33506, 20067, 25549, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Received the effective date but not confirm for which location, Will approve the task next week after the confirmation.', NULL, NULL, '2022-01-31 09:49:56', '2022-01-31 09:49:56'),
(33507, 20067, 25549, NULL, '2022-02-10 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Fwd: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,   The request to add Mayra Lopez NP to Valley Med Urgent Care PLLC TIN 815123542 is complete. Please see welcome letter attached.  Sincerely,', NULL, NULL, '2022-02-03 09:58:40', '2022-02-03 09:58:40'),
(33508, 3040, 25550, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:51', '2021-04-26 14:17:51'),
(33509, 1006, 25550, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:50:21', '2021-04-30 15:50:21'),
(33510, 3040, 25550, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:48:33', '2021-06-01 09:48:33'),
(33511, 11056, 25550, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:45:27', '2021-06-18 16:45:27'),
(33512, 3040, 25550, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:47:56', '2021-07-05 14:47:56'),
(33513, 3040, 25550, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:21:55', '2021-07-15 11:21:55'),
(33514, 3040, 25551, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:51', '2021-04-26 14:17:51'),
(33515, 3040, 25551, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:25', '2021-05-05 14:14:25'),
(33516, 3040, 25551, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:51', '2021-06-01 09:31:51'),
(33517, 3040, 25551, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:15', '2021-06-18 15:40:15'),
(33518, 3040, 25551, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:05', '2021-07-16 11:35:05'),
(33519, 3040, 25552, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:51', '2021-04-26 14:17:51'),
(33520, 3040, 25552, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:29', '2021-04-30 09:16:29'),
(33521, 3040, 25557, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:52', '2021-04-26 14:17:52'),
(33522, 1006, 25557, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, 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, '2021-04-30 13:59:05', '2021-04-30 13:59:05'),
(33523, 3040, 25558, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:52', '2021-04-26 14:17:52'),
(33524, 3040, 25558, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:25:33', '2021-04-30 10:25:33'),
(33525, 3040, 25558, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:18:39', '2021-05-03 11:18:39'),
(33526, 3040, 25559, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:52', '2021-04-26 14:17:52'),
(33527, 3040, 25559, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:28', '2021-04-29 16:04:28'),
(33528, 3040, 25560, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:52', '2021-04-26 14:17:52'),
(33529, 3040, 25560, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 14:59:49', '2021-04-26 14:59:49'),
(33530, 3040, 25561, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:52', '2021-04-26 14:17:52'),
(33531, 3040, 25561, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:16:32', '2021-04-29 09:16:32'),
(33532, 3040, 25562, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:52', '2021-04-26 14:17:52'),
(33533, 3040, 25562, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:55:46', '2021-04-30 08:55:46'),
(33534, 3040, 25562, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.   If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:11:44', '2021-05-28 11:11:44'),
(33535, 3040, 25562, 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 16:22:31', '2021-06-16 16:22:31'),
(33536, 3040, 25562, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:15', '2021-07-20 11:30:15'),
(33537, 3040, 25562, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:18:57', '2021-07-27 16:18:57'),
(33538, 3040, 25564, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:52', '2021-04-26 14:17:52'),
(33539, 1006, 25564, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:13:12', '2021-04-30 16:13:12'),
(33540, 3040, 25564, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:43', '2021-06-01 12:54:43'),
(33541, 3040, 25564, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:11', '2021-06-18 16:22:11'),
(33542, 3040, 25564, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:10', '2021-07-20 11:18:10'),
(33543, 3040, 25564, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  We have completed the request for the following providers:  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 6: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 7: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let us know if you have any questions.  Thanks   Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-07-27 14:13:17', '2021-07-27 14:13:17'),
(33544, 3040, 25565, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:52', '2021-04-26 14:17:52'),
(33545, 1006, 25565, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:50:18', '2021-04-30 15:50:18'),
(33546, 3040, 25565, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:49:00', '2021-06-01 09:49:00'),
(33547, 11056, 25565, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:45:05', '2021-06-18 16:45:05'),
(33548, 3040, 25565, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:47:55', '2021-07-05 14:47:55'),
(33549, 3040, 25565, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:16:22', '2021-07-15 11:16:22'),
(33550, 3040, 25566, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:52', '2021-04-26 14:17:52'),
(33551, 3040, 25566, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:45:32', '2021-05-03 07:45:32'),
(33552, 3040, 25566, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:47:37', '2021-05-27 10:47:37'),
(33553, 3040, 25566, NULL, '2021-06-22 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, '2021-06-15 13:25:43', '2021-06-15 13:25:43'),
(33554, 11056, 25566, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:32:12', '2021-07-01 13:32:12'),
(33555, 3040, 25566, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:46', '2021-07-08 16:56:46'),
(33556, 3040, 25567, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:52', '2021-04-26 14:17:52'),
(33557, 3040, 25567, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:17', '2021-05-05 14:14:17'),
(33558, 3040, 25567, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:54', '2021-06-01 09:31:54'),
(33559, 3040, 25567, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:12', '2021-06-18 15:40:12'),
(33560, 3040, 25567, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:05', '2021-07-16 11:35:05'),
(33561, 3040, 25568, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:52', '2021-04-26 14:17:52'),
(33562, 3040, 25568, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:21', '2021-04-30 09:16:21'),
(33563, 3040, 25573, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:53', '2021-04-26 14:17:53'),
(33564, 1006, 25573, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, 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, '2021-04-30 13:59:00', '2021-04-30 13:59:00'),
(33565, 3040, 25574, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:53', '2021-04-26 14:17:53'),
(33566, 3040, 25574, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:24:45', '2021-04-30 10:24:45'),
(33567, 3040, 25574, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:17:03', '2021-05-03 11:17:03'),
(33568, 3040, 25575, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:53', '2021-04-26 14:17:53'),
(33569, 3040, 25575, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:48', '2021-04-29 16:04:48'),
(33570, 3040, 25576, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:53', '2021-04-26 14:17:53'),
(33571, 3040, 25576, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 15:01:36', '2021-04-26 15:01:36'),
(33572, 3040, 25577, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:53', '2021-04-26 14:17:53');
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
(33573, 3040, 25577, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 10:08:27', '2021-04-29 10:08:27'),
(33574, 3040, 25578, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:53', '2021-04-26 14:17:53'),
(33575, 3040, 25578, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:56:16', '2021-04-30 08:56:16'),
(33576, 3040, 25578, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.   If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:11:49', '2021-05-28 11:11:49'),
(33577, 3040, 25578, 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 16:22:28', '2021-06-16 16:22:28'),
(33578, 3040, 25578, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:14', '2021-07-20 11:30:14'),
(33579, 3040, 25578, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:18:57', '2021-07-27 16:18:57'),
(33580, 3040, 25580, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:53', '2021-04-26 14:17:53'),
(33581, 1006, 25580, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:50:15', '2021-04-30 15:50:15'),
(33582, 3040, 25580, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:49:09', '2021-06-01 09:49:09'),
(33583, 11056, 25580, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:44:25', '2021-06-18 16:44:25'),
(33584, 3040, 25580, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:47:55', '2021-07-05 14:47:55'),
(33585, 3040, 25580, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:11:07', '2021-07-15 11:11:07'),
(33586, 3040, 25581, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:53', '2021-04-26 14:17:53'),
(33587, 3040, 25581, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:47:14', '2021-05-03 07:47:14'),
(33588, 3040, 25581, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:47:41', '2021-05-27 10:47:41'),
(33589, 3040, 25581, NULL, '2021-06-22 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, '2021-06-15 13:25:39', '2021-06-15 13:25:39'),
(33590, 11056, 25581, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:31:53', '2021-07-01 13:31:53'),
(33591, 3040, 25581, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:45', '2021-07-08 16:56:45'),
(33592, 3040, 25582, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:53', '2021-04-26 14:17:53'),
(33593, 3040, 25582, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:45', '2021-05-05 14:14:45'),
(33594, 3040, 25582, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:58', '2021-06-01 09:31:58'),
(33595, 3040, 25582, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:40:09', '2021-06-18 15:40:09'),
(33596, 3040, 25582, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:35:04', '2021-07-16 11:35:04'),
(33597, 3040, 25583, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:53', '2021-04-26 14:17:53'),
(33598, 3040, 25583, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:38', '2021-04-30 09:16:38'),
(33599, 3040, 25588, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:54', '2021-04-26 14:17:54'),
(33600, 1006, 25588, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, 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, '2021-04-30 13:58:55', '2021-04-30 13:58:55'),
(33601, 3040, 25589, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:54', '2021-04-26 14:17:54'),
(33602, 3040, 25589, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:26:26', '2021-04-30 10:26:26'),
(33603, 3040, 25589, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-05-03 11:19:39', '2021-05-03 11:19:39'),
(33604, 3040, 25590, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:54', '2021-04-26 14:17:54'),
(33605, 3040, 25590, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:04:40', '2021-04-29 16:04:40'),
(33606, 3040, 25591, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:54', '2021-04-26 14:17:54'),
(33607, 3040, 25591, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 15:00:55', '2021-04-26 15:00:55'),
(33608, 3040, 25592, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:54', '2021-04-26 14:17:54'),
(33609, 3040, 25592, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-04-29 09:17:50', '2021-04-29 09:17:50'),
(33610, 3040, 25593, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:54', '2021-04-26 14:17:54'),
(33611, 3040, 25593, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:56:07', '2021-04-30 08:56:07'),
(33612, 3040, 25593, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.   If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:11:53', '2021-05-28 11:11:53'),
(33613, 3040, 25593, 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 16:22:25', '2021-06-16 16:22:25'),
(33614, 3040, 25593, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:14', '2021-07-20 11:30:14'),
(33615, 3040, 25593, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:18:56', '2021-07-27 16:18:56'),
(33616, 3040, 25595, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:54', '2021-04-26 14:17:54'),
(33617, 1006, 25595, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:13:08', '2021-04-30 16:13:08'),
(33618, 3040, 25595, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:46', '2021-06-01 12:54:46'),
(33619, 3040, 25595, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:22:09', '2021-06-18 16:22:09'),
(33620, 3040, 25595, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:10', '2021-07-20 11:18:10'),
(33621, 3040, 25595, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  We have completed the request for the following providers:  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 6: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 7: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let us know if you have any questions.  Thanks   Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-07-27 14:13:19', '2021-07-27 14:13:19'),
(33622, 3040, 25596, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:54', '2021-04-26 14:17:54'),
(33623, 1006, 25596, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:50:13', '2021-04-30 15:50:13'),
(33624, 3040, 25596, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:49:12', '2021-06-01 09:49:12'),
(33625, 11056, 25596, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:43:40', '2021-06-18 16:43:40'),
(33626, 3040, 25596, 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,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:47:54', '2021-07-05 14:47:54'),
(33627, 3040, 25596, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  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 trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-15 11:04:56', '2021-07-15 11:04:56'),
(33628, 3040, 25597, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:54', '2021-04-26 14:17:54'),
(33629, 3040, 25597, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || 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 Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:46:36', '2021-05-03 07:46:36'),
(33630, 3040, 25597, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:47:46', '2021-05-27 10:47:46'),
(33631, 3040, 25597, NULL, '2021-06-22 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, '2021-06-15 13:25:35', '2021-06-15 13:25:35'),
(33632, 11056, 25597, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:31:45', '2021-07-01 13:31:45'),
(33633, 3040, 25597, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:45', '2021-07-08 16:56:45'),
(33634, 3040, 25598, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:17:54', '2021-04-26 14:17:54'),
(33635, 3040, 25598, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:14:29', '2021-05-05 14:14:29'),
(33636, 3040, 25598, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:32:01', '2021-06-01 09:32:01');
