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
(19954, 11056, 21661, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:06:33', '2021-07-01 14:06:33'),
(19955, 11056, 21661, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:54:33', '2021-07-09 16:54:33'),
(19956, 3040, 21661, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:55', '2021-07-30 14:55:55'),
(19957, 11056, 21661, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:57:40', '2021-08-12 14:57:40'),
(19958, 10057, 21661, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:45:42', '2021-10-08 10:45:42'),
(19959, 10057, 21661, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:27:13', '2021-11-23 17:27:13'),
(19960, 10057, 21661, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:02:16', '2021-12-03 15:02:16'),
(19961, 10057, 21661, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:14:30', '2021-12-10 13:14:30'),
(19962, 10057, 21661, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:50:51', '2021-12-17 10:50:51'),
(19963, 10057, 21661, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:42:45', '2021-12-23 10:42:45'),
(19964, 20067, 21661, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:40:24', '2022-01-11 15:40:24'),
(19965, 20067, 21661, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:42:15', '2022-01-20 10:42:15'),
(19966, 20067, 21661, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:31:44', '2022-01-28 14:31:44'),
(19967, 20067, 21661, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:58:38', '2022-02-18 13:58:38'),
(19968, 20067, 21661, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:16:30', '2022-03-08 10:16:30'),
(19969, 20067, 21661, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:30:05', '2022-03-08 14:30:05'),
(19970, 3040, 21662, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:39:57', '2021-03-16 10:39:57'),
(19971, 3040, 21662, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:57:54', '2021-05-27 12:57:54'),
(19972, 3040, 21662, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:31', '2021-06-15 14:30:31'),
(19973, 11056, 21662, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:06:45', '2021-07-01 14:06:45'),
(19974, 11056, 21662, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:54:59', '2021-07-09 16:54:59'),
(19975, 3040, 21662, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:55', '2021-07-30 14:55:55'),
(19976, 11056, 21662, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:57:31', '2021-08-12 14:57:31'),
(19977, 10057, 21662, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:45:22', '2021-10-08 10:45:22'),
(19978, 10057, 21662, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:27:07', '2021-11-23 17:27:07'),
(19979, 10057, 21662, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:02:11', '2021-12-03 15:02:11'),
(19980, 10057, 21662, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:14:24', '2021-12-10 13:14:24'),
(19981, 10057, 21662, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:50:45', '2021-12-17 10:50:45'),
(19982, 10057, 21662, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:42:38', '2021-12-23 10:42:38'),
(19983, 20067, 21662, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:40:19', '2022-01-11 15:40:19'),
(19984, 20067, 21662, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:42:10', '2022-01-20 10:42:10'),
(19985, 20067, 21662, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:31:37', '2022-01-28 14:31:37'),
(19986, 20067, 21662, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:58:32', '2022-02-18 13:58:32'),
(19987, 20067, 21662, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:16:24', '2022-03-08 10:16:24'),
(19988, 20067, 21662, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:29:59', '2022-03-08 14:29:59'),
(19989, 3040, 21663, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:40:10', '2021-03-16 10:40:10'),
(19990, 3040, 21663, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:57:58', '2021-05-27 12:57:58'),
(19991, 3040, 21663, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:26', '2021-06-15 14:30:26'),
(19992, 11056, 21663, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:06:55', '2021-07-01 14:06:55'),
(19993, 11056, 21663, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:57:51', '2021-07-09 16:57:51'),
(19994, 3040, 21663, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:55', '2021-07-30 14:55:55'),
(19995, 11056, 21663, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:57:25', '2021-08-12 14:57:25'),
(19996, 10057, 21663, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:45:09', '2021-10-08 10:45:09'),
(19997, 10057, 21663, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:27:00', '2021-11-23 17:27:00'),
(19998, 10057, 21663, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:02:05', '2021-12-03 15:02:05'),
(19999, 10057, 21663, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:14:18', '2021-12-10 13:14:18'),
(20000, 10057, 21663, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:50:40', '2021-12-17 10:50:40'),
(20001, 10057, 21663, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:42:30', '2021-12-23 10:42:30'),
(20002, 20067, 21663, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:40:12', '2022-01-11 15:40:12'),
(20003, 20067, 21663, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:42:04', '2022-01-20 10:42:04'),
(20004, 20067, 21663, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:31:30', '2022-01-28 14:31:30'),
(20005, 20067, 21663, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:58:26', '2022-02-18 13:58:26'),
(20006, 20067, 21663, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:16:17', '2022-03-08 10:16:17'),
(20007, 20067, 21663, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:29:52', '2022-03-08 14:29:52'),
(20008, 3040, 21664, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:40:22', '2021-03-16 10:40:22'),
(20009, 3040, 21664, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:58:02', '2021-05-27 12:58:02'),
(20010, 3040, 21664, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:22', '2021-06-15 14:30:22'),
(20011, 11056, 21664, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:07:11', '2021-07-01 14:07:11'),
(20012, 11056, 21664, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:56:16', '2021-07-09 16:56:16'),
(20013, 3040, 21664, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:54', '2021-07-30 14:55:54');
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
(20014, 11056, 21664, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:57:17', '2021-08-12 14:57:17'),
(20015, 10057, 21664, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:44:58', '2021-10-08 10:44:58'),
(20016, 10057, 21664, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:26:54', '2021-11-23 17:26:54'),
(20017, 10057, 21664, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:01:59', '2021-12-03 15:01:59'),
(20018, 10057, 21664, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:14:13', '2021-12-10 13:14:13'),
(20019, 10057, 21664, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:50:34', '2021-12-17 10:50:34'),
(20020, 10057, 21664, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:42:22', '2021-12-23 10:42:22'),
(20021, 20067, 21664, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:40:04', '2022-01-11 15:40:04'),
(20022, 20067, 21664, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:41:57', '2022-01-20 10:41:57'),
(20023, 20067, 21664, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:31:22', '2022-01-28 14:31:22'),
(20024, 20067, 21664, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:57:50', '2022-02-18 13:57:50'),
(20025, 20067, 21664, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:16:11', '2022-03-08 10:16:11'),
(20026, 20067, 21664, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:29:47', '2022-03-08 14:29:47'),
(20027, 3040, 21665, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:40:37', '2021-03-16 10:40:37'),
(20028, 3040, 21665, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:58:06', '2021-05-27 12:58:06'),
(20029, 3040, 21665, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:16', '2021-06-15 14:30:16'),
(20030, 11056, 21665, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:07:17', '2021-07-01 14:07:17'),
(20031, 11056, 21665, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:48:19', '2021-07-09 16:48:19'),
(20032, 3040, 21665, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:54', '2021-07-30 14:55:54'),
(20033, 11056, 21665, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:57:06', '2021-08-12 14:57:06'),
(20034, 10057, 21665, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:44:45', '2021-10-08 10:44:45'),
(20035, 10057, 21665, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:26:48', '2021-11-23 17:26:48'),
(20036, 10057, 21665, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:04:13', '2021-12-14 11:04:13'),
(20037, 10057, 21665, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:50:28', '2021-12-17 10:50:28'),
(20038, 10057, 21665, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:42:14', '2021-12-23 10:42:14'),
(20039, 20067, 21665, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:39:57', '2022-01-11 15:39:57'),
(20040, 20067, 21665, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:41:49', '2022-01-20 10:41:49'),
(20041, 20067, 21665, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:31:16', '2022-01-28 14:31:16'),
(20042, 20067, 21665, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:57:44', '2022-02-18 13:57:44'),
(20043, 20067, 21665, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:16:05', '2022-03-08 10:16:05'),
(20044, 20067, 21665, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:29:38', '2022-03-08 14:29:38'),
(20045, 3040, 21666, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:40:51', '2021-03-16 10:40:51'),
(20046, 3040, 21666, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:58:10', '2021-05-27 12:58:10'),
(20047, 3040, 21666, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:12', '2021-06-15 14:30:12'),
(20048, 11056, 21666, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:07:30', '2021-07-01 14:07:30'),
(20049, 11056, 21666, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:49:33', '2021-07-09 16:49:33'),
(20050, 3040, 21666, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:53', '2021-07-30 14:55:53'),
(20051, 11056, 21666, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:56:57', '2021-08-12 14:56:57'),
(20052, 11056, 21666, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:56:57', '2021-08-12 14:56:57'),
(20053, 10057, 21666, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:44:24', '2021-10-08 10:44:24'),
(20054, 10057, 21666, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:26:42', '2021-11-23 17:26:42'),
(20055, 10057, 21666, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:01:53', '2021-12-03 15:01:53'),
(20056, 10057, 21666, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:14:07', '2021-12-10 13:14:07'),
(20057, 10057, 21666, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:50:22', '2021-12-17 10:50:22'),
(20058, 10057, 21666, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:42:05', '2021-12-23 10:42:05'),
(20059, 20067, 21666, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:39:50', '2022-01-11 15:39:50'),
(20060, 20067, 21666, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:41:43', '2022-01-20 10:41:43'),
(20061, 20067, 21666, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:31:08', '2022-01-28 14:31:08'),
(20062, 20067, 21666, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:57:36', '2022-02-18 13:57:36'),
(20063, 20067, 21666, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:15:59', '2022-03-08 10:15:59'),
(20064, 20067, 21666, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:29:32', '2022-03-08 14:29:32'),
(20065, 3040, 21667, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:01', '2021-03-16 10:41:01'),
(20066, 1005, 21667, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:58:41', '2021-06-01 12:58:41'),
(20067, 3040, 21668, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:13', '2021-03-16 10:41:13'),
(20068, 3040, 21668, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:58:15', '2021-05-27 12:58:15'),
(20069, 3040, 21668, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:09', '2021-06-15 14:30:09'),
(20070, 11056, 21668, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:03:16', '2021-07-01 14:03:16'),
(20071, 11056, 21668, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:44:41', '2021-07-09 16:44:41'),
(20072, 3040, 21668, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:53', '2021-07-30 14:55:53');
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
(20073, 11056, 21668, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:55:38', '2021-08-12 14:55:38'),
(20074, 10057, 21668, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 10:58:59', '2021-10-14 10:58:59'),
(20075, 10057, 21668, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:26:36', '2021-11-23 17:26:36'),
(20076, 10057, 21668, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:01:46', '2021-12-03 15:01:46'),
(20077, 10057, 21668, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:14:01', '2021-12-10 13:14:01'),
(20078, 10057, 21668, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:50:16', '2021-12-17 10:50:16'),
(20079, 10057, 21668, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:41:57', '2021-12-23 10:41:57'),
(20080, 20067, 21668, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:39:44', '2022-01-11 15:39:44'),
(20081, 20067, 21668, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:41:37', '2022-01-20 10:41:37'),
(20082, 20067, 21668, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:31:03', '2022-01-28 14:31:03'),
(20083, 20067, 21668, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:57:30', '2022-02-18 13:57:30'),
(20084, 20067, 21668, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:15:54', '2022-03-08 10:15:54'),
(20085, 20067, 21668, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:29:25', '2022-03-08 14:29:25'),
(20086, 19067, 21668, NULL, '2022-04-29 00:00:00.000', 'Not Eligible', 'The provider is no longer with the group.', NULL, NULL, '2022-04-22 11:26:17', '2022-04-22 11:26:17'),
(20087, 1006, 21669, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:20', '2021-03-16 10:41:20'),
(20088, 3040, 21669, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:15:39', '2021-04-20 13:15:39'),
(20089, 1019, 21669, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:32:59', '2021-05-20 09:32:59'),
(20090, 1006, 21670, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:21', '2021-03-16 10:41:21'),
(20091, 3040, 21670, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:15:05', '2021-04-20 13:15:05'),
(20092, 1019, 21670, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:33:10', '2021-05-20 09:33:10'),
(20093, 1006, 21671, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:23', '2021-03-16 10:41:23'),
(20094, 1019, 21671, NULL, '2021-04-09 00:00:00.000', 'New/Not Initiated', 'Waiting to get enrolled with Aetna', NULL, NULL, '2021-04-02 14:59:24', '2021-04-02 14:59:24'),
(20095, 1006, 21671, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting to get enrolled with Aetna to begin Firsthealth enrollment process. ', NULL, NULL, '2021-04-22 15:54:09', '2021-04-22 15:54:09'),
(20096, 1006, 21672, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:24', '2021-03-16 10:41:24'),
(20097, 3040, 21672, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:15:47', '2021-04-20 13:15:47'),
(20098, 1019, 21672, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:33:05', '2021-05-20 09:33:05'),
(20099, 3040, 21673, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:25', '2021-03-16 10:41:25'),
(20100, 3040, 21673, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:58:21', '2021-05-27 12:58:21'),
(20101, 3040, 21673, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:05', '2021-06-15 14:30:05'),
(20102, 11056, 21673, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:03:09', '2021-07-01 14:03:09'),
(20103, 11056, 21673, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:50:34', '2021-07-09 16:50:34'),
(20104, 3040, 21673, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:53', '2021-07-30 14:55:53'),
(20105, 11056, 21673, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:55:27', '2021-08-12 14:55:27'),
(20106, 10057, 21673, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 10:59:13', '2021-10-14 10:59:13'),
(20107, 10057, 21673, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:26:29', '2021-11-23 17:26:29'),
(20108, 10057, 21673, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:01:41', '2021-12-03 15:01:41'),
(20109, 10057, 21673, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:13:56', '2021-12-10 13:13:56'),
(20110, 10057, 21673, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:50:10', '2021-12-17 10:50:10'),
(20111, 10057, 21673, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:41:49', '2021-12-23 10:41:49'),
(20112, 20067, 21673, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:39:36', '2022-01-11 15:39:36'),
(20113, 20067, 21673, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:41:31', '2022-01-20 10:41:31'),
(20114, 20067, 21673, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:30:56', '2022-01-28 14:30:56'),
(20115, 20067, 21673, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:57:24', '2022-02-18 13:57:24'),
(20116, 20067, 21673, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:15:48', '2022-03-08 10:15:48'),
(20117, 20067, 21673, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:29:19', '2022-03-08 14:29:19'),
(20118, 1006, 21674, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:25', '2021-03-16 10:41:25'),
(20119, 3040, 21674, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:16:25', '2021-04-20 13:16:25'),
(20120, 1019, 21674, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:33:25', '2021-05-20 09:33:25'),
(20121, 1019, 21674, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer with SNBCARE.', NULL, NULL, '2021-11-09 10:32:07', '2021-11-09 10:32:07'),
(20122, 1006, 21675, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:27', '2021-03-16 10:41:27'),
(20123, 3040, 21675, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:14:40', '2021-04-20 13:14:40'),
(20124, 1019, 21675, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:33:19', '2021-05-20 09:33:19'),
(20125, 1006, 21676, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:28', '2021-03-16 10:41:28'),
(20126, 3040, 21676, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:14:57', '2021-04-20 13:14:57'),
(20127, 1019, 21676, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:33:30', '2021-05-20 09:33:30'),
(20128, 1006, 21677, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:29', '2021-03-16 10:41:29'),
(20129, 3040, 21677, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:16:33', '2021-04-20 13:16:33'),
(20130, 1019, 21677, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:33:34', '2021-05-20 09:33:34'),
(20131, 1006, 21678, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:31', '2021-03-16 10:41:31'),
(20132, 3040, 21678, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:14:50', '2021-04-20 13:14:50'),
(20133, 3040, 21678, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:15:14', '2021-04-20 13:15:14'),
(20134, 1019, 21678, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:33:39', '2021-05-20 09:33:39'),
(20135, 1006, 21679, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:32', '2021-03-16 10:41:32'),
(20136, 3040, 21679, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:16:15', '2021-04-20 13:16:15'),
(20137, 1019, 21679, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:33:43', '2021-05-20 09:33:43'),
(20138, 1006, 21680, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:33', '2021-03-16 10:41:33');
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
(20139, 3040, 21680, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:15:10', '2021-04-20 13:15:10'),
(20140, 1019, 21680, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:33:47', '2021-05-20 09:33:47'),
(20141, 1006, 21681, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:35', '2021-03-16 10:41:35'),
(20142, 3040, 21681, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:16:06', '2021-04-20 13:16:06'),
(20143, 1019, 21681, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:33:52', '2021-05-20 09:33:52'),
(20144, 1019, 21681, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:43:03', '2021-10-25 10:43:03'),
(20145, 3040, 21682, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:36', '2021-03-16 10:41:36'),
(20146, 3040, 21682, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:58:25', '2021-05-27 12:58:25'),
(20147, 3040, 21682, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:00', '2021-06-15 14:30:00'),
(20148, 11056, 21682, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:03:01', '2021-07-01 14:03:01'),
(20149, 3040, 21682, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-28 12:03:23', '2021-07-28 12:03:23'),
(20150, 3040, 21682, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:52', '2021-07-30 14:55:52'),
(20151, 11056, 21682, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:55:19', '2021-08-12 14:55:19'),
(20152, 10057, 21682, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 10:59:19', '2021-10-14 10:59:19'),
(20153, 10057, 21682, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:26:23', '2021-11-23 17:26:23'),
(20154, 10057, 21682, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:01:35', '2021-12-03 15:01:35'),
(20155, 10057, 21682, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:13:50', '2021-12-10 13:13:50'),
(20156, 10057, 21682, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:50:04', '2021-12-17 10:50:04'),
(20157, 10057, 21682, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:41:42', '2021-12-23 10:41:42'),
(20158, 20067, 21682, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:39:29', '2022-01-11 15:39:29'),
(20159, 20067, 21682, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:41:25', '2022-01-20 10:41:25'),
(20160, 20067, 21682, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:30:49', '2022-01-28 14:30:49'),
(20161, 20067, 21682, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:56:50', '2022-02-18 13:56:50'),
(20162, 20067, 21682, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:15:43', '2022-03-08 10:15:43'),
(20163, 20067, 21682, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:29:12', '2022-03-08 14:29:12'),
(20164, 1006, 21683, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:37', '2021-03-16 10:41:37'),
(20165, 3040, 21683, NULL, '2021-04-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Group & Provider Status || Spectrum Neuro Behavioral Care LLC || Group & Providers || First Health ||  Hello Laura,   Please advise me the enrollment status for the below mentioned group and providers for our group with First Health under the below location. If the providers are in-network so can you please send me the welcome letter for them.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Tawakol, Katie Provider NPI# 1609222116  Provider 2: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 3: Provider Name: Hefti, Prisca Provider NPI# 1508133182  Provider 4: Provider Name: Khan, Fauzia Wali Provider NPI# 1699761965  Provider 5: Provider Name: Pionke, Peggy Provider NPI# 1699307322  Provider 6: Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  Provider 7: Provider Name: Schubert, Jonathan Provider NPI# 1235755505  Provider 8: Provider Name: Edmundson, Rodesia Sharese Provider NPI# 1124622667  Provider 9: Provider Name: Hignite, Barbara Provider NPI# 1982617262  Provider 10: Provider Name: Rozell, Carlee Provider NPI# 1225645393  Provider 11: Provider Name: Loveland, Lynnetta Provider NPI# 1598163602  Provider 12: Provider Name: Smith, Kerry R Provider NPI# 1275083230  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-04-20 13:14:30', '2021-04-20 13:14:30'),
(20166, 1019, 21683, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:33:57', '2021-05-20 09:33:57'),
(20167, 3040, 21684, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:41:46', '2021-03-16 10:41:46'),
(20168, 3040, 21684, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:58:28', '2021-05-27 12:58:28'),
(20169, 3040, 21684, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:29:56', '2021-06-15 14:29:56'),
(20170, 11056, 21684, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:02:52', '2021-07-01 14:02:52'),
(20171, 11056, 21684, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:46:30', '2021-07-09 16:46:30'),
(20172, 3040, 21684, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:52', '2021-07-30 14:55:52'),
(20173, 11056, 21684, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:55:09', '2021-08-12 14:55:09'),
(20174, 10057, 21684, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 10:59:26', '2021-10-14 10:59:26'),
(20175, 10057, 21684, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:26:15', '2021-11-23 17:26:15'),
(20176, 10057, 21684, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:01:28', '2021-12-03 15:01:28'),
(20177, 10057, 21684, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:13:45', '2021-12-10 13:13:45'),
(20178, 10057, 21684, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:49:58', '2021-12-17 10:49:58'),
(20179, 10057, 21684, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:41:34', '2021-12-23 10:41:34'),
(20180, 20067, 21684, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:39:21', '2022-01-11 15:39:21'),
(20181, 20067, 21684, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:41:18', '2022-01-20 10:41:18'),
(20182, 20067, 21684, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:30:40', '2022-01-28 14:30:40'),
(20183, 20067, 21684, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:56:45', '2022-02-18 13:56:45'),
(20184, 20067, 21684, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:15:35', '2022-03-08 10:15:35'),
(20185, 20067, 21684, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:29:06', '2022-03-08 14:29:06'),
(20186, 3040, 21685, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:42:56', '2021-03-16 10:42:56'),
(20187, 1006, 21685, NULL, '2021-05-27 00:00:00.000', 'Not Eligible', 'HealthSmart does not enroll groups separately, Anci-Care is responsible for group/facility enrollment. ', NULL, NULL, '2021-05-20 12:24:30', '2021-05-20 12:24:30'),
(20188, 3040, 21686, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:18', '2021-03-16 10:43:18'),
(20189, 3040, 21686, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Adrn) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date:  02/01/2018  Ref: 2044940', NULL, NULL, '2021-05-27 15:42:15', '2021-05-27 15:42:15'),
(20190, 3040, 21686, NULL, '2021-06-29 00:00:00.000', 'Revalidation', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-22 10:29:46', '2021-06-22 10:29:46'),
(20191, 3040, 21686, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-07-09 15:52:10', '2021-07-09 15:52:10'),
(20192, 3040, 21686, NULL, '2021-07-30 00:00:00.000', 'Revalidation', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Health Smart for our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5: Provider Name: Joseph, Molly Provider NPI# 1396380077  Waiting for your response.   Thanks', NULL, NULL, '2021-07-23 13:48:20', '2021-07-23 13:48:20'),
(20193, 11056, 21686, NULL, '2021-08-16 00:00:00.000', 'Revalidation', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status - LPMC - Health Smart  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Health Smart.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 6: Provider Name: John, Jeny Provider NPI # : 1073019493  If you have any questions please let me know. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:31:41', '2021-08-09 13:31:41'),
(20194, 3040, 21686, NULL, '2021-09-06 00:00:00.000', 'Revalidated', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status - LPMC - Health Smart  Hi,   1. Please see below providers effective date.  Providers Name                            Effective Date  PAUL, SIGI C                                     06/01/2021  STEPHEN, ANI                                  07/01/2021  RAUF, ABDUR                                   06/01/2021  ', NULL, NULL, '2021-08-30 15:18:21', '2021-08-30 15:18:21'),
(20195, 1006, 21687, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:33', '2021-03-16 10:43:33'),
(20196, 1019, 21687, NULL, '2021-04-27 00:00:00.000', 'New/Not Initiated', 'Sent the following email to : pcontracting@hne.com, blabrie3@hne.com  Hello Beverly, Attached is the Letter of intent for our group as now we have a new location in Raynham, MA, which we want to enroll with Health New England, as we have many patients in our region which have Health New England as their insurance. Please get back to me ASAP so we can move forward with our credentialing process.  Regards, Alex', NULL, NULL, '2021-04-20 09:43:58', '2021-04-20 09:43:58'),
(20197, 1006, 21687, NULL, '2021-04-28 00:00:00.000', 'Initiated', NULL, NULL, NULL, '2021-04-21 14:27:04', '2021-04-21 14:27:04'),
(20198, 1019, 21687, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Received the following email from pcontracting@hne.com  Dear Alex, Thank you for your interest in becoming an in-network provider with Health New England.  As discussed, your current locations in Massachusetts are not within the HNE service area. Given that you intend to provide telehealth services only, we recommend that you look into becoming a contracted provider with Teladoc, with whom HNE sub-contracts for telehealth services. As a contracted provider with Teladoc, you would be eligible to provide telehealth services to HNE members as well as members of other health plans that also utilize Teladoc. Provider applications can be submitted online at Teladoc: https://www.teladoc.com/providers/behavioralhealth/ Questions can be submitted to Teladoc via ProviderRelations@Teladoc.com If you should decide to open an office practice in the future, you are welcome to contact us again if you would like to contract with HNE for in-person services. Thank you and we  wish you all the best.  The Provider Contracting Team -bm Health New England pcontracting@hne.com', NULL, NULL, '2021-06-09 10:04:31', '2021-06-09 10:04:31'),
(20199, 1019, 21687, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to providerrelations@teladochealth.com  Hello, Attached is the LOI for our group. We want to enroll the following provider mentioned in the LOI under group, please get back ASAP so we can get our providers enrolled with Teledoc.   Regards, Alex', NULL, NULL, '2021-06-09 10:27:49', '2021-06-09 10:27:49'),
(20200, 1019, 21687, NULL, '2021-09-06 00:00:00.000', 'Not Eligible', 'Our servicing location are out of there coverage areas.', NULL, NULL, '2021-08-30 11:03:30', '2021-08-30 11:03:30'),
(20201, 3040, 21688, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:34', '2021-03-16 10:43:34'),
(20202, 3040, 21688, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Adrn) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date:  02/01/2020  Ref: 2044940', NULL, NULL, '2021-05-27 15:43:12', '2021-05-27 15:43:12'),
(20203, 1006, 21689, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:35', '2021-03-16 10:43:35'),
(20204, 1019, 21689, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting for response from Health New England as they don\'t credential in every city in MA.', NULL, NULL, '2021-04-22 12:39:39', '2021-04-22 12:39:39'),
(20205, 1019, 21689, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:43:33', '2021-10-25 10:43:33'),
(20206, 1006, 21690, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:36', '2021-03-16 10:43:36'),
(20207, 1019, 21690, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting for response from Health New England as they don\'t credential in every city in MA.', NULL, NULL, '2021-04-22 12:37:16', '2021-04-22 12:37:16'),
(20208, 1006, 21691, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:37', '2021-03-16 10:43:37'),
(20209, 1019, 21691, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting for response from Health New England as they don\'t credential in every city in MA.', NULL, NULL, '2021-04-22 12:40:01', '2021-04-22 12:40:01'),
(20210, 1006, 21692, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:39', '2021-03-16 10:43:39'),
(20211, 1019, 21692, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting for response from Health New England as they don\'t credential in every city in MA.', NULL, NULL, '2021-04-22 12:38:15', '2021-04-22 12:38:15'),
(20212, 1006, 21693, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:40', '2021-03-16 10:43:40'),
(20213, 1019, 21693, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting for response from Health New England as they don\'t credential in every city in MA.', NULL, NULL, '2021-04-22 12:42:37', '2021-04-22 12:42:37'),
(20214, 1006, 21694, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:42', '2021-03-16 10:43:42'),
(20215, 1019, 21694, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting for response from Health New England as they don\'t credential in every city in MA.', NULL, NULL, '2021-04-22 12:38:47', '2021-04-22 12:38:47'),
(20216, 1006, 21695, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:43', '2021-03-16 10:43:43');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(20217, 1019, 21695, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting for response from Health New England as they don\'t credential in every city in MA.', NULL, NULL, '2021-04-22 12:36:33', '2021-04-22 12:36:33'),
(20218, 1006, 21696, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:44', '2021-03-16 10:43:44'),
(20219, 1019, 21696, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting for response from Health New England as they don\'t credential in every city in MA.', NULL, NULL, '2021-04-22 12:40:42', '2021-04-22 12:40:42'),
(20220, 1019, 21696, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer with SNBCARE.', NULL, NULL, '2021-11-09 10:32:24', '2021-11-09 10:32:24'),
(20221, 1006, 21697, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:46', '2021-03-16 10:43:46'),
(20222, 1019, 21697, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting for response from Health New England as they don\'t credential in every city in MA.', NULL, NULL, '2021-04-22 12:39:12', '2021-04-22 12:39:12'),
(20223, 1006, 21698, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:48', '2021-03-16 10:43:48'),
(20224, 1019, 21698, NULL, '2021-04-09 00:00:00.000', 'Not Eligible', 'Provider cannot enroll, because New Health England doesn\'t enroll provider from Framingham. ', NULL, NULL, '2021-04-02 09:46:26', '2021-04-02 09:46:26'),
(20225, 1006, 21699, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:50', '2021-03-16 10:43:50'),
(20226, 1019, 21699, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting for response from Health New England as they don\'t credential in every city in MA.', NULL, NULL, '2021-04-22 12:34:03', '2021-04-22 12:34:03'),
(20227, 1006, 21700, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:43:52', '2021-03-16 10:43:52'),
(20228, 1019, 21700, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting for response from Health New England as they don\'t credential in every city in MA.', NULL, NULL, '2021-04-22 12:33:26', '2021-04-22 12:33:26'),
(20229, 1006, 21701, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:44:43', '2021-03-16 10:44:43'),
(20230, 1019, 21701, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex', NULL, NULL, '2021-04-16 06:56:43', '2021-04-16 06:56:43'),
(20231, 1006, 21701, NULL, '2021-04-29 00:00:00.000', 'In Process', 'We received the following information from Humana Behavioral Health on-call @ 844-291-2162:  RI Addresses and both MA addresses are updated in the system for the group as in-network. Eff: 04/01/2021  RI Plans:  Commercial Network Medicare PPO   MA-Framingham Plans:  Commercial Network  Medicare PPO GoldPlus HMO  MA-Raynham Plans:  Commercial Network  Medicare PPO  Sent the following email to behavioralhealthproviderservices@humana.com:  Sub: Executed Contract & Effective Dates - SNBCare  \"Hello,  We wanted to get copies of our group and providers executed contracts and their effective dates, the information is as follows:  Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572 TIN# 83-4482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Please get back to me on the status of these providers and their welcome letter/executed contracts as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-04-22 14:52:06', '2021-04-22 14:52:06'),
(20232, 1019, 21701, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:42:49', '2021-06-10 09:42:49'),
(20233, 11056, 21701, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:36:10', '2021-12-09 17:36:10'),
(20234, 11056, 21701, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:36:23', '2021-12-09 17:36:23'),
(20235, 19067, 21701, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:31:52', '2021-12-15 15:31:52'),
(20236, 19067, 21701, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:38:03', '2021-12-29 14:38:03'),
(20237, 19067, 21701, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:17:54', '2022-01-10 13:17:54'),
(20238, 19067, 21701, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:16:59', '2022-01-30 13:16:59'),
(20239, 19067, 21701, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:25:30', '2022-02-08 14:25:30'),
(20240, 19067, 21701, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:57:36', '2022-03-09 14:57:36'),
(20241, 19067, 21701, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:49:44', '2022-03-10 10:49:44'),
(20242, 22077, 21701, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:46:46', '2022-04-04 13:46:46'),
(20243, 1006, 21702, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:44:48', '2021-03-16 10:44:48'),
(20244, 1019, 21702, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com  Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex', NULL, NULL, '2021-04-16 06:58:04', '2021-04-16 06:58:04'),
(20245, 1019, 21702, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:49:04', '2021-06-10 09:49:04'),
(20246, 1019, 21702, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:43:09', '2021-06-11 11:43:09'),
(20247, 3040, 21703, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:44:49', '2021-03-16 10:44:49'),
(20248, 3040, 21703, NULL, '2021-06-03 00:00:00.000', 'New/Not Initiated', 'Request for participation submitted online.   Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.  ', NULL, NULL, '2021-05-27 16:05:28', '2021-05-27 16:05:28'),
(20249, 3040, 21703, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Request for participation submitted online.   Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you. ', NULL, NULL, '2021-06-02 12:08:58', '2021-06-02 12:08:58'),
(20250, 3040, 21703, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-22 10:30:07', '2021-06-22 10:30:07'),
(20251, 3040, 21703, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-07-09 15:52:11', '2021-07-09 15:52:11'),
(20252, 3040, 21703, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Health Smart for our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5: Provider Name: Joseph, Molly Provider NPI# 1396380077  Waiting for your response.   Thanks', NULL, NULL, '2021-07-23 13:48:23', '2021-07-23 13:48:23'),
(20253, 11056, 21703, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status - LPMC - Health Smart  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Health Smart.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 6: Provider Name: John, Jeny Provider NPI # : 1073019493  If you have any questions please let me know. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:32:14', '2021-08-09 13:32:14'),
(20254, 3040, 21703, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email rcvd to: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status - LPMC - Health Smart  Hi,  2. Below providers are currently in the credentialing process.  Providers Name  CHENNEMKARA, MINI P  JOSEPH, MOLLY  ', NULL, NULL, '2021-08-30 16:36:41', '2021-08-30 16:36:41'),
(20255, 10057, 21703, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : pr.south@healthsmart.com  Sub : Enrollment Status - LPMC - Health Smart  Hello,  Hope this email finds you well. I\'m writing this email to check the status for the below mentioned providers in Health Smart for our group under the below location  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Chennemkara, Mini Philip	1841755956  Please get back to me as soon as you get a chance. Waiting for your response.  Thanks & Regards,', NULL, NULL, '2021-10-14 15:07:56', '2021-10-14 15:07:56'),
(20256, 10057, 21703, NULL, '2021-11-10 00:00:00.000', 'Approved', 'Email Received From : mdiprsupport@healthsmart.com  Sub : Enrollment Status - LPMC - Health Smart  Hi,  Please see the following Providers with effective dates..  PROVIDER NAME  EFFECTIVE DATE   JOHN, JENY  05/01/2021   JOSEPH, MOLLY  05/01/2021   CHENNEMKARA, MINI P  01/01/2021   Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-11-03 09:32:50', '2021-11-03 09:32:50'),
(20257, 1006, 21704, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:44:49', '2021-03-16 10:44:49'),
(20258, 1019, 21704, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com  Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex', NULL, NULL, '2021-04-16 06:58:21', '2021-04-16 06:58:21'),
(20259, 1019, 21704, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:41:47', '2021-06-10 09:41:47'),
(20260, 1019, 21704, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:44:30', '2021-06-11 11:44:30'),
(20261, 1006, 21705, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:44:52', '2021-03-16 10:44:52'),
(20262, 1019, 21705, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com  Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex', NULL, NULL, '2021-04-16 06:58:30', '2021-04-16 06:58:30'),
(20263, 1019, 21705, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:48:57', '2021-06-10 09:48:57'),
(20264, 11056, 21705, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:36:05', '2021-12-09 17:36:05'),
(20265, 19067, 21705, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:32:00', '2021-12-15 15:32:00'),
(20266, 19067, 21705, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||    Hello,     This information can be verified on Humana website under Physician Finder, Approval letters are sent to providers upon completion, Humana preferred provider resource is AVAILALITY, you can obtain: provider demographic update, status, claims etc.,     Thanks,     Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2021-12-16 12:25:49', '2021-12-16 12:25:49'),
(20267, 19067, 21705, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:37:58', '2021-12-29 14:37:58'),
(20268, 19067, 21705, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:17:48', '2022-01-10 13:17:48'),
(20269, 19067, 21705, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:16:35', '2022-01-30 13:16:35'),
(20270, 19067, 21705, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:24:05', '2022-02-08 14:24:05'),
(20271, 19067, 21705, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:57:23', '2022-03-09 14:57:23'),
(20272, 19067, 21705, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:49:37', '2022-03-10 10:49:37'),
(20273, 22077, 21705, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:54:36', '2022-04-04 13:54:36'),
(20274, 1006, 21706, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:44:53', '2021-03-16 10:44:53'),
(20275, 1019, 21706, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com  Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex', NULL, NULL, '2021-04-16 06:58:39', '2021-04-16 06:58:39'),
(20276, 1019, 21706, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:48:51', '2021-06-10 09:48:51'),
(20277, 1019, 21706, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:45:46', '2021-06-11 11:45:46'),
(20278, 1006, 21707, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:44:54', '2021-03-16 10:44:54'),
(20279, 1019, 21707, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com  Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex', NULL, NULL, '2021-04-16 06:58:50', '2021-04-16 06:58:50'),
(20280, 1019, 21707, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:48:43', '2021-06-10 09:48:43'),
(20281, 1019, 21707, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021 Call Ref # 2000187394353. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:52:13', '2021-06-11 11:52:13'),
(20282, 1006, 21708, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:44:56', '2021-03-16 10:44:56'),
(20283, 1019, 21708, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com  Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex', NULL, NULL, '2021-04-16 06:59:00', '2021-04-16 06:59:00'),
(20284, 1019, 21708, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:48:36', '2021-06-10 09:48:36'),
(20285, 1019, 21708, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021 Call Ref # 2000187394353. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:53:15', '2021-06-11 11:53:15'),
(20286, 1006, 21709, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:44:57', '2021-03-16 10:44:57'),
(20287, 1019, 21709, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com  Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex', NULL, NULL, '2021-04-16 06:59:10', '2021-04-16 06:59:10'),
(20288, 1019, 21709, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:48:30', '2021-06-10 09:48:30'),
(20289, 1019, 21709, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021 Call Ref # 2000187394353. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:54:23', '2021-06-11 11:54:23'),
(20290, 1006, 21710, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:44:58', '2021-03-16 10:44:58'),
(20291, 1019, 21710, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com  Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex', NULL, NULL, '2021-04-16 06:59:20', '2021-04-16 06:59:20'),
(20292, 1019, 21710, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:48:23', '2021-06-10 09:48:23'),
(20293, 1019, 21710, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer with SNBCARE.', NULL, NULL, '2021-11-09 10:32:33', '2021-11-09 10:32:33'),
(20294, 1006, 21711, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:45:00', '2021-03-16 10:45:00'),
(20295, 1019, 21711, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com  Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex', NULL, NULL, '2021-04-16 06:59:29', '2021-04-16 06:59:29'),
(20296, 1019, 21711, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Sent the following email to behavioralhealthproviderservices@humana.com  Hello, As we have received the confirmation from the Network operations that our group and the following providers are In Network with effective dates 04/01/2021. They have asked us to ask you guys for the welcome letters. Can you please send us the welcome letters for the following providers, we have attached the roster for our provider. Let me know if anything else is required.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Regards, Alex', NULL, NULL, '2021-04-23 15:07:26', '2021-04-23 15:07:26'),
(20297, 1019, 21711, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:42:41', '2021-06-10 09:42:41'),
(20298, 1019, 21711, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021 Call Ref # 2000187394353. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:55:18', '2021-06-11 11:55:18'),
(20299, 1006, 21712, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:45:01', '2021-03-16 10:45:01'),
(20300, 1019, 21712, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Sent the following email to : behavioralhealthproviderservices  Sub: Enroll Provider || SNBCARE || Kerry Smith || MBHP  Hello, We wanted to enroll the below mentioned provider in Humana, under our group. Can you let us know if you do enroll these types of provider.  Group Information: Spectrum Neuro Behavioral Care LLC Tax ID: 834482753 NPI: 1356906572  Individual Provider: Kerry Smith NPI: 1275083230 Speciality: Licensed Clinical Social Worker', NULL, NULL, '2021-04-02 14:27:01', '2021-04-02 14:27:01'),
(20301, 1019, 21712, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:48:16', '2021-06-10 09:48:16'),
(20302, 11056, 21712, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:35:58', '2021-12-09 17:35:58');
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
(20303, 19067, 21712, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:32:19', '2021-12-15 15:32:19'),
(20304, 19067, 21712, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||    Hello,     This information can be verified on Humana website under Physician Finder, Approval letters are sent to providers upon completion, Humana preferred provider resource is AVAILALITY, you can obtain: provider demographic update, status, claims etc.,     Thanks,     Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2021-12-16 12:25:35', '2021-12-16 12:25:35'),
(20305, 19067, 21712, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:37:39', '2021-12-29 14:37:39'),
(20306, 19067, 21712, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:17:42', '2022-01-10 13:17:42'),
(20307, 19067, 21712, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:16:21', '2022-01-30 13:16:21'),
(20308, 19067, 21712, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:23:57', '2022-02-08 14:23:57'),
(20309, 19067, 21712, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:56:57', '2022-03-09 14:56:57'),
(20310, 19067, 21712, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:49:30', '2022-03-10 10:49:30'),
(20311, 22077, 21712, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:54:16', '2022-04-04 13:54:16'),
(20312, 1006, 21713, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:45:02', '2021-03-16 10:45:02'),
(20313, 1019, 21713, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com  Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex', NULL, NULL, '2021-04-16 06:59:39', '2021-04-16 06:59:39'),
(20314, 1019, 21713, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:48:09', '2021-06-10 09:48:09'),
(20315, 1019, 21713, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021 Call Ref # 2000187394353. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:56:34', '2021-06-11 11:56:34'),
(20316, 1006, 21714, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:45:04', '2021-03-16 10:45:04'),
(20317, 1019, 21714, NULL, '2021-04-23 00:00:00.000', 'Initiated', 'Sent the following email to mtasby2@humana.com  Hello Monica, We have attached the roster for the new Location address and the providers needed to be added under that location. Let us know if anything else is required and also if you need any further assistance let me know. Also I haven\'t heard from you about the credentialing process of our group and providers, you said that the effective date was 04/01/2021, so is it okay to start billing for our group and providers.   Group Information Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Regards, Alex', NULL, NULL, '2021-04-16 07:00:03', '2021-04-16 07:00:03'),
(20318, 1019, 21714, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to credentialinginquiries@humana.com SUB: Re: Secured: RE: Secured: RE: Welcome Letters - Providers - SNBCARE - Humana  Hello, We need the Welcome letter for the following providers and also if you can send me the copy of our Group contract with all 3 Locations on it.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Carlee Rozell NPI: 1225645393  Fauzia Wali Khan NPI: 1699761965  Jonathan Schubert NPI: 1235755505  Raveendran Pandeswari NPI: 1124247267  Melody Letoile NPI: 1942687108  Erin Oliva NPI: 1407349632  Rodesia Edmundson NPI: 1124622667  Kerry Smith NPI: 1275083230  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-06-10 09:48:01', '2021-06-10 09:48:01'),
(20319, 1019, 21714, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Spoken with Rep  Mark M as per the provider is effective 01/01/2021 Call Ref # 2000187394353. Attached is the Location Confirmation Approvals from Humana Directory for Ref.', NULL, NULL, '2021-06-11 11:57:23', '2021-06-11 11:57:23'),
(20320, 3040, 21715, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:45:21', '2021-03-16 10:45:21'),
(20321, 3040, 21715, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Adrn) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date:  09/01/2019  Ref: 2044940', NULL, NULL, '2021-05-27 15:42:52', '2021-05-27 15:42:52'),
(20322, 3040, 21716, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:45:39', '2021-03-16 10:45:39'),
(20323, 3040, 21716, NULL, '2021-06-03 00:00:00.000', 'New/Not Initiated', 'Request submitted online.   Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.  ', NULL, NULL, '2021-05-27 16:21:36', '2021-05-27 16:21:36'),
(20324, 3040, 21716, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Request submitted online.   Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you. ', NULL, NULL, '2021-06-02 12:08:49', '2021-06-02 12:08:49'),
(20325, 3040, 21716, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-22 10:29:59', '2021-06-22 10:29:59'),
(20326, 3040, 21716, NULL, '2021-07-16 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hi,  1. \" ABRAHAM, JEENA NP \" is effective date \" 07/01/2021 \".', NULL, NULL, '2021-07-09 15:50:18', '2021-07-09 15:50:18'),
(20327, 3040, 21717, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:45:49', '2021-03-16 10:45:49'),
(20328, 1005, 21717, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:58:57', '2021-06-01 12:58:57'),
(20329, 3046, 21718, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:07', '2021-03-16 10:46:07'),
(20330, 1006, 21718, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:57:46', '2021-04-06 14:57:46'),
(20331, 3046, 21719, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:09', '2021-03-16 10:46:09'),
(20332, 1006, 21719, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:57:50', '2021-04-06 14:57:50'),
(20333, 3040, 21720, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:11', '2021-03-16 10:46:11'),
(20334, 3040, 21720, NULL, '2021-06-03 00:00:00.000', 'New/Not Initiated', 'Request for participation submitted online.   Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.  ', NULL, NULL, '2021-05-27 16:17:16', '2021-05-27 16:17:16'),
(20335, 3040, 21720, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Request for participation submitted online.   Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you. ', NULL, NULL, '2021-06-02 12:09:04', '2021-06-02 12:09:04'),
(20336, 3040, 21720, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-22 10:29:56', '2021-06-22 10:29:56'),
(20337, 3040, 21720, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-07-09 15:52:09', '2021-07-09 15:52:09'),
(20338, 3040, 21720, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Health Smart for our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5: Provider Name: Joseph, Molly Provider NPI# 1396380077  Waiting for your response.   Thanks', NULL, NULL, '2021-07-23 13:48:18', '2021-07-23 13:48:18'),
(20339, 11056, 21720, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status - LPMC - Health Smart  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Health Smart.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 6: Provider Name: John, Jeny Provider NPI # : 1073019493  If you have any questions please let me know. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:32:04', '2021-08-09 13:32:04'),
(20340, 3040, 21720, NULL, '2021-09-06 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status - LPMC - Health Smart  Hi,   1. Please see below providers effective date.  Providers Name                            Effective Date  PAUL, SIGI C                                     06/01/2021  STEPHEN, ANI                                  07/01/2021  RAUF, ABDUR                                   06/01/2021  ', NULL, NULL, '2021-08-30 15:18:25', '2021-08-30 15:18:25'),
(20341, 3046, 21721, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:12', '2021-03-16 10:46:12'),
(20342, 1006, 21721, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:57:54', '2021-04-06 14:57:54'),
(20343, 3046, 21722, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:14', '2021-03-16 10:46:14'),
(20344, 1006, 21722, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:57:59', '2021-04-06 14:57:59'),
(20345, 3040, 21723, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:25', '2021-03-16 10:46:25'),
(20346, 3040, 21723, NULL, '2021-06-03 00:00:00.000', 'New/Not Initiated', 'Request for participation submitted online.  Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.', NULL, NULL, '2021-05-27 15:54:36', '2021-05-27 15:54:36'),
(20347, 3040, 21723, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Request for participation submitted online.  Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.', NULL, NULL, '2021-06-02 12:09:11', '2021-06-02 12:09:11'),
(20348, 3040, 21723, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-22 10:29:52', '2021-06-22 10:29:52'),
(20349, 3040, 21723, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-07-09 15:52:11', '2021-07-09 15:52:11'),
(20350, 3040, 21723, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Health Smart for our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5: Provider Name: Joseph, Molly Provider NPI# 1396380077  Waiting for your response.   Thanks', NULL, NULL, '2021-07-23 13:48:25', '2021-07-23 13:48:25'),
(20351, 11056, 21723, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status - LPMC - Health Smart  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Health Smart.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 6: Provider Name: John, Jeny Provider NPI # : 1073019493  If you have any questions please let me know. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:31:58', '2021-08-09 13:31:58'),
(20352, 3040, 21723, NULL, '2021-09-06 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Enrollment Status - LPMC - Health Smart  Hi,   1. Please see below providers effective date.  Providers Name                            Effective Date  PAUL, SIGI C                                     06/01/2021  STEPHEN, ANI                                  07/01/2021  RAUF, ABDUR                                   06/01/2021  ', NULL, NULL, '2021-08-30 15:18:29', '2021-08-30 15:18:29'),
(20353, 1006, 21724, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:25', '2021-03-16 10:46:25'),
(20354, 1006, 21724, NULL, '2021-04-26 00:00:00.000', 'Approved', 'We received the following approval confirmation from @ Wright, Judith JWright@magellanhealth.com:  Sub: Group Enrollment Query - SNBCare  \"Good Morning,   Your group for MA was executed 4/3/2020 and for Rhode Island 10/23/2019.  Please see the executed agreement attached.  Judy\"  Executed Contract is attached for confirmation as well.   \"Here are all of your active locations:   61 LINCOLN ST STE 203 FRAMINGHAM, MA 01702-8264  63 EDDIE DOWLING HWY STE 9 NORTH SMITHFIELD, RI 02896-7322   100 NEW STATE HWY RAYNHAM, MA 02767-5423  You can also see your active locations and manage all of your practice information right online as well.\"', NULL, NULL, '2021-04-19 13:14:06', '2021-04-19 13:14:06'),
(20355, 1006, 21725, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:26', '2021-03-16 10:46:26'),
(20356, 1019, 21725, NULL, '2021-04-13 00:00:00.000', 'Initiated', 'Initiated thru Provider Portal', NULL, NULL, '2021-04-06 16:34:03', '2021-04-06 16:34:03'),
(20357, 1019, 21725, NULL, '2021-04-19 00:00:00.000', 'In Process', 'Received the following message from Angela: ARViviano@magellanhealth.com  Outreach for CAQH: Thank you for your interest in the Magellan Health Services (Magellan)* provider network. We received a request via the web access to add the following providers to your group. 601511-661     RODESIA EDMUNDSON CAQH ID: 15091874   In order for us to begin the credentialing process, we will need to have permission to access their CAQH applications. Please have the providers verify that their information loaded to the CAQH is current and includes your group and gives Magellan permission to access. Please let me know if you have any questions.  Thank you, Magellan Contracting Team', NULL, NULL, '2021-04-12 10:53:10', '2021-04-12 10:53:10'),
(20358, 1019, 21725, NULL, '2021-04-19 00:00:00.000', 'In Process', 'Sent the following email to: ARViviano@magellanhealth.com  Hello Angela,  We have already granted permissions to Magellan Healthcare to view Rodesia Edmundson profile. Let us know if you have any issues viewing her profile on CAQH.   Regards, Alex', NULL, NULL, '2021-04-12 10:53:30', '2021-04-12 10:53:30'),
(20359, 1019, 21725, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Sent the following email to JJonesWright@magellanhealth.com  Hello Judith, We wanted to check on the enrollment status for the following providers under our group, if they are enrolled with Magellan then can you please send me a copy of executed contracts.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230  Rodesia Edmundson NPI: 1124622667  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-04-26 07:27:33', '2021-04-26 07:27:33'),
(20360, 1019, 21725, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following email from JWright@magellanhealth.com  Good Morning, Individuals aren’t contracted, they are credentialed and linked to your Tax ID. Only Spectrum is contracted.  Kerry Smith: The provider is in process NPI: 1275083230  Rodesia Edmundson: The provider is in process. NPI: 1124622667   Justin Souliere: The provider has been linked to your group effective date 4/12/2021 NPI: 1710576004  Judy', NULL, NULL, '2021-04-26 07:47:07', '2021-04-26 07:47:07'),
(20361, 1019, 21725, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to JWright@magellanhealth.com SUB: Enrollment Query || Providers || SNBCARE || Magellan  Hello Judith, Hope you\'re doing good, we need the Credentialing Status for the following providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-05-20 10:13:06', '2021-05-20 10:13:06'),
(20362, 1019, 21725, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from  JWright@magellanhealth.com Good Morning,  Kerry Smith: The provider is about 1-2 weeks from completion. NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson: Credentialing in process NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman: Has been linked to your group effective date 10/26/2020. Previously informed on 11/9/2020 NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile: Has been linked to your group effective date 12/9/2020. Previously informed on 12/21/2020. NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons: Credentialing in process. NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan: Has been linked to your group effective date 4/3/2020. NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-05-27 08:51:27', '2021-05-27 08:51:27'),
(20363, 1019, 21725, NULL, '2021-06-13 00:00:00.000', 'Approved', 'Provider is enrolled with Magellan Eff date 06/01/2024. See attachment for approval confirmation', NULL, NULL, '2021-06-06 06:51:15', '2021-06-06 06:51:15'),
(20364, 3046, 21726, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:27', '2021-03-16 10:46:27'),
(20365, 1006, 21726, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:58:03', '2021-04-06 14:58:03'),
(20366, 1006, 21727, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:27', '2021-03-16 10:46:27'),
(20367, 1019, 21727, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with 2 practices, proof of locations is attached for reference.  ', NULL, NULL, '2021-04-20 15:11:45', '2021-04-20 15:11:45'),
(20368, 1006, 21728, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:29', '2021-03-16 10:46:29'),
(20369, 1019, 21728, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with 2 practices, proof of locations is attached for reference.  ', NULL, NULL, '2021-04-20 15:35:55', '2021-04-20 15:35:55'),
(20370, 3046, 21729, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:29', '2021-03-16 10:46:29'),
(20371, 1006, 21729, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:58:07', '2021-04-06 14:58:07'),
(20372, 1006, 21730, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:30', '2021-03-16 10:46:30'),
(20373, 1006, 21730, NULL, '2021-04-23 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with 2 practices, proof of enrollment and locations is attached for reference.  ', NULL, NULL, '2021-04-16 13:46:28', '2021-04-16 13:46:28'),
(20374, 1006, 21731, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:31', '2021-03-16 10:46:31'),
(20375, 1019, 21731, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with 2 practices, proof of locations is attached for reference.  ', NULL, NULL, '2021-04-20 16:01:42', '2021-04-20 16:01:42'),
(20376, 3046, 21732, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:31', '2021-03-16 10:46:31'),
(20377, 1006, 21732, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:58:11', '2021-04-06 14:58:11'),
(20378, 1006, 21733, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:32', '2021-03-16 10:46:32'),
(20379, 1006, 21733, NULL, '2021-04-23 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with all 3 practices, proof of enrollment and locations is attached for reference.  ', NULL, NULL, '2021-04-16 14:18:44', '2021-04-16 14:18:44'),
(20380, 1006, 21734, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:34', '2021-03-16 10:46:34'),
(20381, 1006, 21734, NULL, '2021-04-23 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with all 3 practices, proof of enrollment and locations is attached for reference. ', NULL, NULL, '2021-04-16 13:24:24', '2021-04-16 13:24:24'),
(20382, 1006, 21735, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:36', '2021-03-16 10:46:36'),
(20383, 3040, 21735, NULL, '2021-04-27 00:00:00.000', 'Rejected', 'Received the following email from Judith: \"Good Morning,   The credentialing department has indicated that this provider does not meet credentialing requirements. Please see letter attached.   Judy   Judith Jones-Wright Network Management Specialist, PA/DE/MA Field Network Department Magellan Healthcare, Commercial Network Management\"  Provider cannot be enrolled due to not being behavioral health provider.', NULL, NULL, '2021-04-20 14:00:59', '2021-04-20 14:00:59'),
(20384, 1006, 21736, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:37', '2021-03-16 10:46:37'),
(20385, 1019, 21736, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with 2 practices, proof of locations is attached for reference.  ', NULL, NULL, '2021-04-20 15:29:05', '2021-04-20 15:29:05'),
(20386, 3046, 21737, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:38', '2021-03-16 10:46:38'),
(20387, 1006, 21737, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:58:18', '2021-04-06 14:58:18'),
(20388, 3040, 21738, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:38', '2021-03-16 10:46:38'),
(20389, 3040, 21738, NULL, '2021-06-03 00:00:00.000', 'New/Not Initiated', 'Request for participation submitted online.   Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.  ', NULL, NULL, '2021-05-27 16:11:44', '2021-05-27 16:11:44'),
(20390, 3040, 21738, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Request for participation submitted online.   Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you. ', NULL, NULL, '2021-06-02 12:09:17', '2021-06-02 12:09:17'),
(20391, 3040, 21738, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-22 10:29:49', '2021-06-22 10:29:49'),
(20392, 3040, 21738, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Enrollment Status || Longpoint Medical Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Health Smart for our group under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-07-09 15:52:12', '2021-07-09 15:52:12'),
(20393, 3040, 21738, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,  Please see below providers effective date.  Providers Name	Effective Date JACOB, JAYA 01/01/2021 STEPHEN, ANI 01/01/2021', NULL, NULL, '2021-07-12 08:54:16', '2021-07-12 08:54:16'),
(20394, 1006, 21739, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:38', '2021-03-16 10:46:38'),
(20395, 1019, 21739, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted enrollment request via online portal. ', NULL, NULL, '2021-03-25 11:31:54', '2021-03-25 11:31:54'),
(20396, 1006, 21739, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Sent a f/u email @ \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com:  Sub: Enrollment Query - SNBCare - Magellan  \"Hello Judith,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers:   Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Provider Name: Justin Souliere NPI# 1710576004  Provider Name: Kerry Smith NPI# 1275083230  Please get back to me as soon as you\'re able.   Thank you.\"', NULL, NULL, '2021-04-16 13:01:54', '2021-04-16 13:01:54'),
(20397, 1006, 21739, NULL, '2021-04-23 00:00:00.000', 'In Process', 'I received the following update from Judy:  \"Good Afternoon,  Provider Name: Justin Souliere: Almost there. The provider is at the end of the process, but has not yet been made active. I anticipate by the end of next week. NPI# 1710576004  Provider Name: Kerry Smith: The provider is in process. NPI# 1275083230  Judy\"', NULL, NULL, '2021-04-16 13:09:58', '2021-04-16 13:09:58'),
(20398, 1019, 21739, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Sent the following email to JJonesWright@magellanhealth.com  Hello Judith, We wanted to check on the enrollment status for the following providers under our group, if they are enrolled with Magellan then can you please send me a copy of executed contracts.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230  Rodesia Edmundson NPI: 1124622667  Justin Souliere NPI: 1710576004  Regards, Alex', NULL, NULL, '2021-04-26 07:26:45', '2021-04-26 07:26:45'),
(20399, 1019, 21739, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following email from JWright@magellanhealth.com  Good Morning, Individuals aren’t contracted, they are credentialed and linked to your Tax ID. Only Spectrum is contracted.  Kerry Smith: The provider is in process NPI: 1275083230  Rodesia Edmundson: The provider is in process. NPI: 1124622667   Justin Souliere: The provider has been linked to your group effective date 4/12/2021 NPI: 1710576004  Judy', NULL, NULL, '2021-04-26 07:47:59', '2021-04-26 07:47:59'),
(20400, 1019, 21739, NULL, '2021-05-15 00:00:00.000', 'In Process', 'Received the following email from ADRose@magellanhealth.com Good Morning, MIS# 601509645 Magellan is in the process of Kerry Smith’s credentialing. We need the following information to be returned to complete your credentialing. Verification of her degree. The information on her CAQH application reflects MSN. Magellan requires a degree in social work for all social workers. Verification of her degree, what college/university she attended to obtain it and the year of graduation is required in order to complete her credentialing. This information can be faxed back to Magellan at 888-656-1121, within 7 days of receiving this notice. *Here is our provider services number 1-800-788-4005. Keep the number handy in case you have questions regarding credentialing or claims. Thank you, Autumn Rose-Gonda', NULL, NULL, '2021-05-07 10:32:25', '2021-05-07 10:32:25'),
(20401, 1019, 21739, NULL, '2021-05-15 00:00:00.000', 'In Process', 'Sent the following email to ADRose@magellanhealth.com Hello Autumn, Hope you\'re doing well, we have faxed her MSW Degree to you, can you please see if you have received it or not. Regards, Alex', NULL, NULL, '2021-05-07 10:34:32', '2021-05-07 10:34:32'),
(20402, 1019, 21739, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Received the following email from ADRose@magellanhealth.com Good Morning Alex,  Kerry Smith’s diploma has been received and Magellan will continue to process her application for credentialing.  Thank you, Autumn', NULL, NULL, '2021-05-12 11:20:37', '2021-05-12 11:20:37'),
(20403, 1019, 21739, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to JWright@magellanhealth.com SUB: Enrollment Query || Providers || SNBCARE || Magellan  Hello Judith, Hope you\'re doing good, we need the Credentialing Status for the following providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-05-20 10:13:53', '2021-05-20 10:13:53');
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
(20404, 1019, 21739, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from  JWright@magellanhealth.com Good Morning,  Kerry Smith: The provider is about 1-2 weeks from completion. NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson: Credentialing in process NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman: Has been linked to your group effective date 10/26/2020. Previously informed on 11/9/2020 NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile: Has been linked to your group effective date 12/9/2020. Previously informed on 12/21/2020. NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons: Credentialing in process. NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan: Has been linked to your group effective date 4/3/2020. NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-05-27 08:46:56', '2021-05-27 08:46:56'),
(20405, 1019, 21739, NULL, '2021-06-13 00:00:00.000', 'Approved', 'Provider is enrolled with Magellan Eff date 05/17/2021. See attachment for approval confirmation', NULL, NULL, '2021-06-06 07:01:28', '2021-06-06 07:01:28'),
(20406, 1006, 21740, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:46:40', '2021-03-16 10:46:40'),
(20407, 1019, 21740, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with 2 practices, proof of enrollment and locations is attached for reference.  ', NULL, NULL, '2021-04-20 14:59:46', '2021-04-20 14:59:46'),
(20408, 3046, 21741, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:49:18', '2021-03-16 10:49:18'),
(20409, 1006, 21741, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 09:03:14', '2021-04-08 09:03:14'),
(20410, 3046, 21742, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:49:19', '2021-03-16 10:49:19'),
(20411, 1006, 21742, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 09:03:25', '2021-04-08 09:03:25'),
(20412, 3046, 21743, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:49:21', '2021-03-16 10:49:21'),
(20413, 1006, 21743, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 09:03:33', '2021-04-08 09:03:33'),
(20414, 3046, 21744, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:49:22', '2021-03-16 10:49:22'),
(20415, 1006, 21744, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 09:03:41', '2021-04-08 09:03:41'),
(20416, 3046, 21745, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:49:24', '2021-03-16 10:49:24'),
(20417, 1006, 21745, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 09:03:50', '2021-04-08 09:03:50'),
(20418, 3046, 21746, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:49:25', '2021-03-16 10:49:25'),
(20419, 1006, 21746, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 09:03:58', '2021-04-08 09:03:58'),
(20420, 3046, 21747, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:49:27', '2021-03-16 10:49:27'),
(20421, 1006, 21747, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 09:04:06', '2021-04-08 09:04:06'),
(20422, 3046, 21748, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:49:29', '2021-03-16 10:49:29'),
(20423, 1006, 21748, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 09:04:17', '2021-04-08 09:04:17'),
(20424, 1006, 21749, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:51:47', '2021-03-16 10:51:47'),
(20425, 1019, 21749, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Magellan with 2 practices, proof of locations is attached for reference.  ', NULL, NULL, '2021-04-20 15:23:55', '2021-04-20 15:23:55'),
(20426, 3046, 21750, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:52:52', '2021-03-16 10:52:52'),
(20427, 1006, 21750, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted LOI & W9 for addition location to Urgentcare contract. Sent email @ pdsdallas@aetna.com ', NULL, NULL, '2021-03-25 17:32:42', '2021-03-25 17:32:42'),
(20428, 9057, 21750, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to: pdsdallas@aetna.com Sub: Additional location status request - RHC - First Health  Hello, We submitted a request for additional location to our urgent care contract under the following group  and providers.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provide Details Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415     Provider 3: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 4: Provider Name: Trevino, Rose Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :5 Provider Name: Ayarzagoitia, Patrick  Provider NPI#   1649568239 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :6 Provider Name: Mason, Traci Provider NPI#   1497127831 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :7 Provider Name: Svatek, Maegan Provider NPI#   1639670250 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider:8 Provider Name: Capupus, Mari Provider NPI#   NPI: 1740517945 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider:9 Provider Name: Rogers, Petina Provider NPI#   1801443916 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Kindly provide the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-26 13:09:12', '2021-05-26 13:09:12'),
(20429, 3040, 21750, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com  Subject: Additional location status request - RHC - First Health  Hello,   I wanted to get an update on the status of this request, please get back to me as soon as possible.  Thank you! ', NULL, NULL, '2021-06-15 16:29:59', '2021-06-15 16:29:59'),
(20430, 11056, 21750, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email received from : BharathB@aetna.com  Sub : Additional location status request - RHC - First Health  Hi Brad,  Please share practice location phone and Fax numbers so that we can proceed further.  Regards, Bharath  Email sent to : BharathB@aetna.com  Sub : Additional location status request - RHC - First Health  Hi Bharath,  Hope you are doing well. Here is the information you asked for about the practice.  Practice Detail: Practice Name : Statcare Minor Emergency Clinic Practice Phone : 361-516-0800 Practice Fax : 361-516-0855   If you need any further information feel free to contact me. Waiting to hear from you soon. Thank you! ', NULL, NULL, '2021-07-01 14:57:15', '2021-07-01 14:57:15'),
(20431, 1006, 21750, NULL, '2021-07-14 00:00:00.000', 'In Process', 'We received the following reply from Bharath, Bollu BharathB@aetna.com:  Sub: Additional location status request - RHC - First Health  \"Hi Brad,  Following up on the below email. Please assist  Regards, Bharath\"  Replied:   \"Hello Bollu,   Sure thing, here\'s the information: Address: 500 E CAESAR, KINGSVILLE, TX 78363   Phone# 361-516-0800 Fax# 361-516-0855  Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone#  361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-07-07 08:51:12', '2021-07-07 08:51:12'),
(20432, 1006, 21750, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & pdsdallas@aetna.com:  Sub: Additional location status request - RHC - First Health  \"Hello Bollu,   I appreciate the update, from what I can see from the First Health directory there seems to have been some confusion.   We want all of the following mentioned practice addresses listed under all of the given providers:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Name: Rose Trevino NPI# 1437174794  Provider Name: Katherine Rabagos NPI# 1134415631  Provider Name: Mary Gonzalez NPI# 1952713083  Provider Name: William Francis NPI# 1457994436  Provider Name: Juan Capupus NPI# 1891168597  Provider Name: Maegan Svatek NPI# 1639670250  Provider Name: Petina Rogers NPI# 1801443916  Provider Name: Traci Mason NPI# 1497127831  Provider Name: Mari Capupus NPI# 1740517945  Provider Name: Patrick Ayarzagoitia NPI# 1649568239  Please let me know if you need anything to get these updated.  Thank you.\"', NULL, NULL, '2021-08-17 17:28:29', '2021-08-17 17:28:29'),
(20433, 11056, 21750, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : pdsdallas@aetna.com>  Sub : Fwd: Additional location status request - RHC - First Health  Good evening!  Hope all is well with you. I want all of the following mentioned practice addresses listed under all of the given providers. Please update me with the latest credentialing status of these providers too.  Practice Details: Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Details: Provider Name: Rose Trevino NPI# 1437174794  Provider Name: Katherine Rabagos NPI# 1134415631  Provider Name: Mary Gonzalez NPI# 1952713083  Provider Name: William Francis NPI# 1457994436  Provider Name: Juan Capupus NPI# 1891168597  Provider Name: Maegan Svatek NPI# 1639670250  Provider Name: Petina Rogers NPI# 1801443916  Provider Name: Traci Mason NPI# 1497127831  Provider Name: Mari Capupus NPI# 1740517945  Provider Name: Patrick Ayarzagoitia NPI# 1649568239  If you have any questions or concerns or require any documents or information, please contact me without any hesitation. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:26:59', '2021-09-21 16:26:59'),
(20434, 11056, 21750, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com  Sub : Fwd: Additional location status request - RHC - First Health  Hi,  All the Providers has been added with the given locations.   Thank You,  Phani ', NULL, NULL, '2021-10-01 14:41:43', '2021-10-01 14:41:43'),
(20435, 11056, 21750, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub  : Fwd: Additional location status request - RHC - First Health  Good morning!  Hope you are doing great. Please provide the approval letters and executed contract for the facility & providers as soon as possible. I will be eagerly waiting for it.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-10-13 16:50:16', '2021-10-13 16:50:16'),
(20436, 11056, 21750, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : Fwd: Additional location status request - RHC - First Health  Hello Ahmed,    I hope that this email finds you well!  Please see attached copy of the contract on file for the practice. The practices group ID when submitting updates to the Data Team is 1067518.   I personally did not send out the welcome letter so I do not have the file to send over. The welcome letters during that time are outdated now so the information would be different than what we currently use. Any of the welcome letters that I have recently sent have the updated information to reference. Please make sure to always list the group ID number so that the Data Team can locate the file easier and your requests process faster.  I hope that this helps!  Take care,  Jeanette Sidley Network Relations Consultant', NULL, NULL, '2021-10-20 14:34:07', '2021-10-20 14:34:07'),
(20437, 11056, 21750, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : RE: [SEND SECURE] RE: [EXTERNAL] Re: Additional location status request - RHC - First Health Fwd: Additional location status request - RHC - First Health  Good morning!     Hope you are doing great. We have four locations under the facility tax I.D. Two of them are already listed under the providers and facility but the other highlighted ones were remaining. Miss Phani informed us that the all locations are loaded, therefore, we need the effective dates and some kind of letter for proof for our providers.     Kindly do us a favor. Confirm with the Effective Dates soon.     Thank you!  Have a wonderful day!     Practice Name: Statcare Minor Emergency Clinic  NPI# 1689924904  TIN# 46-0575924     Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363  Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413  Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415', NULL, NULL, '2021-11-10 17:39:24', '2021-11-10 17:39:24'),
(20438, 11056, 21750, NULL, '2021-11-25 00:00:00.000', 'Approved', 'Rep: Teresita D  Status: Approved Eff date: 6/1/21  Refcode: 111821teresitad', NULL, NULL, '2021-11-18 16:36:33', '2021-11-18 16:36:33'),
(20439, 3040, 21751, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:52:54', '2021-03-16 10:52:54'),
(20440, 3040, 21751, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract with effective date: 06/20/2019  Contract attached', NULL, NULL, '2021-05-28 12:29:29', '2021-05-28 12:29:29'),
(20441, 1006, 21752, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:52:58', '2021-03-16 10:52:58'),
(20442, 1006, 21752, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'We received the following update regarding LCSW/LICSW enrollment guidelines of Mass Health @ Rippstein, Kyle KyleRippstein@maximus.com:   Sub: Enrollment || Providers || SNBCARE || MassHealth  \"Hi Alex,  We do not enroll LCSWs at this time.  We DO enroll LICSWs, but in a non-billing capacity (they would not “link” to the Group as would a Physician or NP, for example).  I have attached the proper applications for LICSWs. Let us know if you need any further assistance.  Thanks,  Kyle Rippstein Supervisor, Provider Enrollment and Credentialing MassHealth MAXIMUS , Inc 55 Summer St, 8th floor Boston, MA 02110 Office (617)948-5537 Fax (617)988-8904\"  Non-billing capacity implies that we aren\'t able to submit claims under those providers, so there is no point with that process either.  ', NULL, NULL, '2021-04-21 15:23:43', '2021-04-21 15:23:43'),
(20443, 1006, 21753, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:00', '2021-03-16 10:53:00'),
(20444, 1019, 21753, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Enrollment form submitted with new location address and providers need to be linked under that address. SS attached for ref (ATN) is 206630. Submitted thru POSC ', NULL, NULL, '2021-04-21 11:20:27', '2021-04-21 11:20:27'),
(20445, 1019, 21753, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  Hello Yen, Hope you are doing well, I have attached the completed and signed documents. Let me know the time frame for location addition for our Group and Providers. Let me know if you need further information.    Regards, Alex', NULL, NULL, '2021-04-28 11:08:20', '2021-04-28 11:08:20'),
(20446, 1019, 21753, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  SUB: MassHealth Application ATN206630  Good Afternoon Yen, Hope you\'re doing good, can you please let me know the Status of our application, and how much more time it will take to process our application.  Regards, Alex ', NULL, NULL, '2021-06-03 16:27:33', '2021-06-03 16:27:33'),
(20447, 1019, 21753, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from YenLengChow@maximus.com  Hi Alex, Yes, the group has been enrolled under the PID/SL 110159328B effective 6/17/2021. You should be receiving a welcome letter in the next few weeks.  ', NULL, NULL, '2021-06-22 13:29:43', '2021-06-22 13:29:43'),
(20448, 1019, 21753, NULL, '2021-08-17 00:00:00.000', 'Approved', 'Received the following email from YenLengChow@maximus.com  The providers listed on section 2.2 of the application were linked to the group: Eff Date: 06/17/2021. I have attached the Group Roster for RNM Location for ref.  ', NULL, NULL, '2021-08-10 22:47:17', '2021-08-10 22:47:17'),
(20449, 1006, 21754, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:02', '2021-03-16 10:53:02'),
(20450, 1019, 21754, NULL, '2021-04-10 00:00:00.000', 'New/Not Initiated', 'Mass Health doesn\'t enroll LCSW.', NULL, NULL, '2021-04-03 14:01:28', '2021-04-03 14:01:28'),
(20451, 1006, 21754, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'We received the following update regarding LCSW/LICSW enrollment guidelines of Mass Health @ Rippstein, Kyle KyleRippstein@maximus.com:   Sub: Enrollment || Providers || SNBCARE || MassHealth  \"Hi Alex,  We do not enroll LCSWs at this time.  We DO enroll LICSWs, but in a non-billing capacity (they would not “link” to the Group as would a Physician or NP, for example).  I have attached the proper applications for LICSWs. Let us know if you need any further assistance.  Thanks,  Kyle Rippstein Supervisor, Provider Enrollment and Credentialing MassHealth MAXIMUS , Inc 55 Summer St, 8th floor Boston, MA 02110 Office (617)948-5537 Fax (617)988-8904\"  Non-billing capacity implies that we aren\'t able to submit claims under those providers, so there is no point with that process either.  ', NULL, NULL, '2021-04-21 15:23:05', '2021-04-21 15:23:05'),
(20452, 1006, 21755, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:04', '2021-03-16 10:53:04'),
(20453, 1006, 21755, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'We received the following update regarding LCSW/LICSW enrollment guidelines of Mass Health @ Rippstein, Kyle KyleRippstein@maximus.com:   Sub: Enrollment || Providers || SNBCARE || MassHealth  \"Hi Alex,  We do not enroll LCSWs at this time.  We DO enroll LICSWs, but in a non-billing capacity (they would not “link” to the Group as would a Physician or NP, for example).  I have attached the proper applications for LICSWs. Let us know if you need any further assistance.  Thanks,  Kyle Rippstein Supervisor, Provider Enrollment and Credentialing MassHealth MAXIMUS , Inc 55 Summer St, 8th floor Boston, MA 02110 Office (617)948-5537 Fax (617)988-8904\"  Non-billing capacity implies that we aren\'t able to submit claims under those providers, so there is no point with that process either.  ', NULL, NULL, '2021-04-21 15:23:19', '2021-04-21 15:23:19'),
(20454, 1006, 21756, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:05', '2021-03-16 10:53:05'),
(20455, 1019, 21756, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Enrollment form submitted with new location address and providers need to be linked under that address. SS attached for ref (ATN) is 206630. Submitted thru POSC ', NULL, NULL, '2021-04-21 11:25:03', '2021-04-21 11:25:03'),
(20456, 1019, 21756, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  Hello Yen, Hope you are doing well, I have attached the completed and signed documents. Let me know the time frame for location addition for our Group and Providers. Let me know if you need further information.    Regards, Alex', NULL, NULL, '2021-04-28 11:07:35', '2021-04-28 11:07:35'),
(20457, 1019, 21756, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  SUB: MassHealth Application ATN206630  Good Afternoon Yen, Hope you\'re doing good, can you please let me know the Status of our application, and how much more time it will take to process our application.  Regards, Alex ', NULL, NULL, '2021-06-03 16:27:25', '2021-06-03 16:27:25'),
(20458, 1019, 21756, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from YenLengChow@maximus.com  Hi Alex, Yes, the group has been enrolled under the PID/SL 110159328B effective 6/17/2021. You should be receiving a welcome letter in the next few weeks.  ', NULL, NULL, '2021-06-22 13:29:27', '2021-06-22 13:29:27'),
(20459, 1019, 21756, NULL, '2021-08-17 00:00:00.000', 'Approved', 'Received the following email from YenLengChow@maximus.com  The providers listed on section 2.2 of the application were linked to the group: Eff Date: 06/17/2021. I have attached the Group Roster for RNM Location for ref.  ', NULL, NULL, '2021-08-10 22:49:15', '2021-08-10 22:49:15'),
(20460, 3046, 21757, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:07', '2021-03-16 10:53:07'),
(20461, 1006, 21757, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted LOI & W9 for addition location to Urgentcare contract. Sent email @ pdsdallas@aetna.com ', NULL, NULL, '2021-03-25 17:33:19', '2021-03-25 17:33:19'),
(20462, 9057, 21757, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to: pdsdallas@aetna.com Sub: Additional location status request - RHC - First Health  Hello, We submitted a request for additional location to our urgent care contract under the following group  and providers.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provide Details Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415     Provider 3: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 4: Provider Name: Trevino, Rose Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :5 Provider Name: Ayarzagoitia, Patrick  Provider NPI#   1649568239 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :6 Provider Name: Mason, Traci Provider NPI#   1497127831 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :7 Provider Name: Svatek, Maegan Provider NPI#   1639670250 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider:8 Provider Name: Capupus, Mari Provider NPI#   NPI: 1740517945 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider:9 Provider Name: Rogers, Petina Provider NPI#   1801443916 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Kindly provide the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-26 13:09:22', '2021-05-26 13:09:22'),
(20463, 3040, 21757, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com  Subject: Additional location status request - RHC - First Health  Hello,   I wanted to get an update on the status of this request, please get back to me as soon as possible.  Thank you! ', NULL, NULL, '2021-06-15 16:31:20', '2021-06-15 16:31:20'),
(20464, 11056, 21757, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email received from : BharathB@aetna.com  Sub : Additional location status request - RHC - First Health  Hi Brad,  Please share practice location phone and Fax numbers so that we can proceed further.  Regards, Bharath  Email sent to : BharathB@aetna.com  Sub : Additional location status request - RHC - First Health  Hi Bharath,  Hope you are doing well. Here is the information you asked for about the practice.  Practice Detail: Practice Name : Statcare Minor Emergency Clinic Practice Phone : 361-516-0800 Practice Fax : 361-516-0855   If you need any further information feel free to contact me. Waiting to hear from you soon. Thank you! ', NULL, NULL, '2021-07-01 14:57:26', '2021-07-01 14:57:26'),
(20465, 1006, 21757, NULL, '2021-07-14 00:00:00.000', 'In Process', 'We received the following reply from Bharath, Bollu BharathB@aetna.com:  Sub: Additional location status request - RHC - First Health  \"Hi Brad,  Following up on the below email. Please assist  Regards, Bharath\"  Replied:   \"Hello Bollu,   Sure thing, here\'s the information: Address: 500 E CAESAR, KINGSVILLE, TX 78363   Phone# 361-516-0800 Fax# 361-516-0855  Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone#  361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-07-07 08:51:27', '2021-07-07 08:51:27'),
(20466, 1006, 21757, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & pdsdallas@aetna.com:  Sub: Additional location status request - RHC - First Health  \"Hello Bollu,   I appreciate the update, from what I can see from the First Health directory there seems to have been some confusion.   We want all of the following mentioned practice addresses listed under all of the given providers:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Name: Rose Trevino NPI# 1437174794  Provider Name: Katherine Rabagos NPI# 1134415631  Provider Name: Mary Gonzalez NPI# 1952713083  Provider Name: William Francis NPI# 1457994436  Provider Name: Juan Capupus NPI# 1891168597  Provider Name: Maegan Svatek NPI# 1639670250  Provider Name: Petina Rogers NPI# 1801443916  Provider Name: Traci Mason NPI# 1497127831  Provider Name: Mari Capupus NPI# 1740517945  Provider Name: Patrick Ayarzagoitia NPI# 1649568239  Please let me know if you need anything to get these updated.  Thank you.\"', NULL, NULL, '2021-08-17 17:28:25', '2021-08-17 17:28:25'),
(20467, 11056, 21757, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : pdsdallas@aetna.com>  Sub : Fwd: Additional location status request - RHC - First Health  Good evening!  Hope all is well with you. I want all of the following mentioned practice addresses listed under all of the given providers. Please update me with the latest credentialing status of these providers too.  Practice Details: Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Details: Provider Name: Rose Trevino NPI# 1437174794  Provider Name: Katherine Rabagos NPI# 1134415631  Provider Name: Mary Gonzalez NPI# 1952713083  Provider Name: William Francis NPI# 1457994436  Provider Name: Juan Capupus NPI# 1891168597  Provider Name: Maegan Svatek NPI# 1639670250  Provider Name: Petina Rogers NPI# 1801443916  Provider Name: Traci Mason NPI# 1497127831  Provider Name: Mari Capupus NPI# 1740517945  Provider Name: Patrick Ayarzagoitia NPI# 1649568239  If you have any questions or concerns or require any documents or information, please contact me without any hesitation. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:26:54', '2021-09-21 16:26:54'),
(20468, 11056, 21757, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com  Sub : Fwd: Additional location status request - RHC - First Health  Hi,  All the Providers has been added with the given locations.   Thank You,  Phani ', NULL, NULL, '2021-10-01 14:41:36', '2021-10-01 14:41:36'),
(20469, 11056, 21757, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub  : Fwd: Additional location status request - RHC - First Health  Good morning!  Hope you are doing great. Please provide the approval letters and executed contract for the facility & providers as soon as possible. I will be eagerly waiting for it.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-10-13 16:50:10', '2021-10-13 16:50:10'),
(20470, 11056, 21757, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : Fwd: Additional location status request - RHC - First Health  Hello Ahmed,    I hope that this email finds you well!  Please see attached copy of the contract on file for the practice. The practices group ID when submitting updates to the Data Team is 1067518.   I personally did not send out the welcome letter so I do not have the file to send over. The welcome letters during that time are outdated now so the information would be different than what we currently use. Any of the welcome letters that I have recently sent have the updated information to reference. Please make sure to always list the group ID number so that the Data Team can locate the file easier and your requests process faster.  I hope that this helps!  Take care,  Jeanette Sidley Network Relations Consultant', NULL, NULL, '2021-10-20 14:33:59', '2021-10-20 14:33:59'),
(20471, 11056, 21757, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : RE: [SEND SECURE] RE: [EXTERNAL] Re: Additional location status request - RHC - First Health Fwd: Additional location status request - RHC - First Health  Good morning!     Hope you are doing great. We have four locations under the facility tax I.D. Two of them are already listed under the providers and facility but the other highlighted ones were remaining. Miss Phani informed us that the all locations are loaded, therefore, we need the effective dates and some kind of letter for proof for our providers.     Kindly do us a favor. Confirm with the Effective Dates soon.     Thank you!  Have a wonderful day!     Practice Name: Statcare Minor Emergency Clinic  NPI# 1689924904  TIN# 46-0575924     Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363  Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413  Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415', NULL, NULL, '2021-11-10 17:39:18', '2021-11-10 17:39:18'),
(20472, 11056, 21757, NULL, '2021-11-25 00:00:00.000', 'Approved', 'Rep: Cris S  Status: Approved  Eff date: 6/1/21  Refcode : 11182021', NULL, NULL, '2021-11-18 15:11:09', '2021-11-18 15:11:09'),
(20473, 1006, 21758, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:07', '2021-03-16 10:53:07'),
(20474, 1019, 21758, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Enrollment form submitted with new location address and providers need to be linked under that address. SS attached for ref (ATN) is 206630. Submitted thru POSC ', NULL, NULL, '2021-04-21 11:21:29', '2021-04-21 11:21:29'),
(20475, 1019, 21758, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  Hello Yen, Hope you are doing well, I have attached the completed and signed documents. Let me know the time frame for location addition for our Group and Providers. Let me know if you need further information.    Regards, Alex', NULL, NULL, '2021-04-28 11:07:22', '2021-04-28 11:07:22'),
(20476, 1019, 21758, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  SUB: MassHealth Application ATN206630  Good Afternoon Yen, Hope you\'re doing good, can you please let me know the Status of our application, and how much more time it will take to process our application.  Regards, Alex ', NULL, NULL, '2021-06-03 16:27:15', '2021-06-03 16:27:15'),
(20477, 1019, 21758, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from YenLengChow@maximus.com  Hi Alex, Yes, the group has been enrolled under the PID/SL 110159328B effective 6/17/2021. You should be receiving a welcome letter in the next few weeks.  ', NULL, NULL, '2021-06-22 13:29:13', '2021-06-22 13:29:13'),
(20478, 1019, 21758, NULL, '2021-08-17 00:00:00.000', 'Approved', 'Received the following email from YenLengChow@maximus.com  The providers listed on section 2.2 of the application were linked to the group: Eff Date: 06/17/2021. I have attached the Group Roster for RNM Location for ref.  ', NULL, NULL, '2021-08-10 22:48:49', '2021-08-10 22:48:49'),
(20479, 1006, 21759, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:08', '2021-03-16 10:53:08'),
(20480, 1006, 21759, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'We received the following update regarding LCSW/LICSW enrollment guidelines of Mass Health @ Rippstein, Kyle KyleRippstein@maximus.com:   Sub: Enrollment || Providers || SNBCARE || MassHealth  \"Hi Alex,  We do not enroll LCSWs at this time.  We DO enroll LICSWs, but in a non-billing capacity (they would not “link” to the Group as would a Physician or NP, for example).  I have attached the proper applications for LICSWs. Let us know if you need any further assistance.  Thanks,  Kyle Rippstein Supervisor, Provider Enrollment and Credentialing MassHealth MAXIMUS , Inc 55 Summer St, 8th floor Boston, MA 02110 Office (617)948-5537 Fax (617)988-8904\"  Non-billing capacity implies that we aren\'t able to submit claims under those providers, so there is no point with that process either.  ', NULL, NULL, '2021-04-21 15:23:25', '2021-04-21 15:23:25'),
(20481, 3040, 21761, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:09', '2021-03-16 10:53:09'),
(20482, 3040, 21761, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.   For group contract please see group task. ', NULL, NULL, '2021-05-28 12:30:44', '2021-05-28 12:30:44'),
(20483, 3046, 21762, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:25', '2021-03-16 10:53:25'),
(20484, 1006, 21762, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted LOI & W9 for addition location to Urgentcare contract. Sent email @ pdsdallas@aetna.com ', NULL, NULL, '2021-03-25 17:33:23', '2021-03-25 17:33:23'),
(20485, 9057, 21762, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to: pdsdallas@aetna.com Sub: Additional location status request - RHC - First Health  Hello, We submitted a request for additional location to our urgent care contract under the following group  and providers.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provide Details Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415     Provider 3: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 4: Provider Name: Trevino, Rose Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :5 Provider Name: Ayarzagoitia, Patrick  Provider NPI#   1649568239 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :6 Provider Name: Mason, Traci Provider NPI#   1497127831 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :7 Provider Name: Svatek, Maegan Provider NPI#   1639670250 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider:8 Provider Name: Capupus, Mari Provider NPI#   NPI: 1740517945 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider:9 Provider Name: Rogers, Petina Provider NPI#   1801443916 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Kindly provide the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-26 13:09:46', '2021-05-26 13:09:46'),
(20486, 3040, 21762, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com  Subject: Additional location status request - RHC - First Health  Hello,   I wanted to get an update on the status of this request, please get back to me as soon as possible.  Thank you! ', NULL, NULL, '2021-06-15 16:31:14', '2021-06-15 16:31:14'),
(20487, 11056, 21762, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email received from : BharathB@aetna.com  Sub : Additional location status request - RHC - First Health  Hi Brad,  Please share practice location phone and Fax numbers so that we can proceed further.  Regards, Bharath  Email sent to : BharathB@aetna.com  Sub : Additional location status request - RHC - First Health  Hi Bharath,  Hope you are doing well. Here is the information you asked for about the practice.  Practice Detail: Practice Name : Statcare Minor Emergency Clinic Practice Phone : 361-516-0800 Practice Fax : 361-516-0855   If you need any further information feel free to contact me. Waiting to hear from you soon. Thank you! ', NULL, NULL, '2021-07-01 14:57:34', '2021-07-01 14:57:34'),
(20488, 1006, 21762, NULL, '2021-07-14 00:00:00.000', 'In Process', 'We received the following reply from Bharath, Bollu BharathB@aetna.com:  Sub: Additional location status request - RHC - First Health  \"Hi Brad,  Following up on the below email. Please assist  Regards, Bharath\"  Replied:   \"Hello Bollu,   Sure thing, here\'s the information: Address: 500 E CAESAR, KINGSVILLE, TX 78363   Phone# 361-516-0800 Fax# 361-516-0855  Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone#  361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-07-07 08:51:31', '2021-07-07 08:51:31'),
(20489, 1006, 21762, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & pdsdallas@aetna.com:  Sub: Additional location status request - RHC - First Health  \"Hello Bollu,   I appreciate the update, from what I can see from the First Health directory there seems to have been some confusion.   We want all of the following mentioned practice addresses listed under all of the given providers:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Name: Rose Trevino NPI# 1437174794  Provider Name: Katherine Rabagos NPI# 1134415631  Provider Name: Mary Gonzalez NPI# 1952713083  Provider Name: William Francis NPI# 1457994436  Provider Name: Juan Capupus NPI# 1891168597  Provider Name: Maegan Svatek NPI# 1639670250  Provider Name: Petina Rogers NPI# 1801443916  Provider Name: Traci Mason NPI# 1497127831  Provider Name: Mari Capupus NPI# 1740517945  Provider Name: Patrick Ayarzagoitia NPI# 1649568239  Please let me know if you need anything to get these updated.  Thank you.\"', NULL, NULL, '2021-08-17 17:28:21', '2021-08-17 17:28:21'),
(20490, 11056, 21762, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : pdsdallas@aetna.com>  Sub : Fwd: Additional location status request - RHC - First Health  Good evening!  Hope all is well with you. I want all of the following mentioned practice addresses listed under all of the given providers. Please update me with the latest credentialing status of these providers too.  Practice Details: Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Details: Provider Name: Rose Trevino NPI# 1437174794  Provider Name: Katherine Rabagos NPI# 1134415631  Provider Name: Mary Gonzalez NPI# 1952713083  Provider Name: William Francis NPI# 1457994436  Provider Name: Juan Capupus NPI# 1891168597  Provider Name: Maegan Svatek NPI# 1639670250  Provider Name: Petina Rogers NPI# 1801443916  Provider Name: Traci Mason NPI# 1497127831  Provider Name: Mari Capupus NPI# 1740517945  Provider Name: Patrick Ayarzagoitia NPI# 1649568239  If you have any questions or concerns or require any documents or information, please contact me without any hesitation. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:26:49', '2021-09-21 16:26:49'),
(20491, 11056, 21762, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com  Sub : Fwd: Additional location status request - RHC - First Health  Hi,  All the Providers has been added with the given locations.   Thank You,  Phani ', NULL, NULL, '2021-10-01 14:41:30', '2021-10-01 14:41:30'),
(20492, 11056, 21762, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub  : Fwd: Additional location status request - RHC - First Health  Good morning!  Hope you are doing great. Please provide the approval letters and executed contract for the facility & providers as soon as possible. I will be eagerly waiting for it.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-10-13 16:50:04', '2021-10-13 16:50:04'),
(20493, 11056, 21762, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : Fwd: Additional location status request - RHC - First Health  Hello Ahmed,    I hope that this email finds you well!  Please see attached copy of the contract on file for the practice. The practices group ID when submitting updates to the Data Team is 1067518.   I personally did not send out the welcome letter so I do not have the file to send over. The welcome letters during that time are outdated now so the information would be different than what we currently use. Any of the welcome letters that I have recently sent have the updated information to reference. Please make sure to always list the group ID number so that the Data Team can locate the file easier and your requests process faster.  I hope that this helps!  Take care,  Jeanette Sidley Network Relations Consultant', NULL, NULL, '2021-10-20 14:33:51', '2021-10-20 14:33:51'),
(20494, 11056, 21762, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : RE: [SEND SECURE] RE: [EXTERNAL] Re: Additional location status request - RHC - First Health Fwd: Additional location status request - RHC - First Health  Good morning!     Hope you are doing great. We have four locations under the facility tax I.D. Two of them are already listed under the providers and facility but the other highlighted ones were remaining. Miss Phani informed us that the all locations are loaded, therefore, we need the effective dates and some kind of letter for proof for our providers.     Kindly do us a favor. Confirm with the Effective Dates soon.     Thank you!  Have a wonderful day!     Practice Name: Statcare Minor Emergency Clinic  NPI# 1689924904  TIN# 46-0575924     Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363  Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413  Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415', NULL, NULL, '2021-11-10 17:39:13', '2021-11-10 17:39:13'),
(20495, 11056, 21762, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : RE: [SEND SECURE] RE: [EXTERNAL] Re: Additional location status request - RHC - First Health Fwd: Additional location status request - RHC - First Health  Good morning!     Hope you are doing great. We have four locations under the facility tax I.D. Two of them are already listed under the providers and facility but the other highlighted ones were remaining. Miss Phani informed us that the all locations are loaded, therefore, we need the effective dates and some kind of letter for proof for our providers.     Kindly do us a favor. Confirm with the Effective Dates soon.     Thank you!  Have a wonderful day!     Practice Name: Statcare Minor Emergency Clinic  NPI# 1689924904  TIN# 46-0575924     Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363  Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413  Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415', NULL, NULL, '2021-11-10 17:39:13', '2021-11-10 17:39:13'),
(20496, 11056, 21762, NULL, '2021-11-25 00:00:00.000', 'Approved', 'Rep: Cris S  Status: Approved Eff date: 11/1/2019  Refcode : 11182021', NULL, NULL, '2021-11-18 15:01:24', '2021-11-18 15:01:24'),
(20497, 3040, 21763, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:32', '2021-03-16 10:53:32'),
(20498, 3040, 21763, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.   For group contract please see group task. ', NULL, NULL, '2021-05-28 12:31:05', '2021-05-28 12:31:05'),
(20499, 1006, 21764, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:35', '2021-03-16 10:53:35'),
(20500, 1019, 21764, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Enrollment form submitted with new location address and providers need to be linked under that address. SS attached for ref (ATN) is 206630. Submitted thru POSC ', NULL, NULL, '2021-04-21 11:25:56', '2021-04-21 11:25:56');
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
(20501, 1019, 21764, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  Hello Yen, Hope you are doing well, I have attached the completed and signed documents. Let me know the time frame for location addition for our Group and Providers. Let me know if you need further information.    Regards, Alex', NULL, NULL, '2021-04-28 11:06:39', '2021-04-28 11:06:39'),
(20502, 1019, 21764, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  SUB: MassHealth Application ATN206630  Good Afternoon Yen, Hope you\'re doing good, can you please let me know the Status of our application, and how much more time it will take to process our application.  Regards, Alex ', NULL, NULL, '2021-06-03 16:26:38', '2021-06-03 16:26:38'),
(20503, 1019, 21764, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from YenLengChow@maximus.com  Hi Alex, Yes, the group has been enrolled under the PID/SL 110159328B effective 6/17/2021. You should be receiving a welcome letter in the next few weeks.  ', NULL, NULL, '2021-06-22 13:28:51', '2021-06-22 13:28:51'),
(20504, 1019, 21764, NULL, '2021-08-17 00:00:00.000', 'Approved', 'Received the following email from YenLengChow@maximus.com  The providers listed on section 2.2 of the application were linked to the group: Eff Date: 06/17/2021. I have attached the Group Roster for RNM Location for ref.  ', NULL, NULL, '2021-08-10 22:50:28', '2021-08-10 22:50:28'),
(20505, 1006, 21765, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:37', '2021-03-16 10:53:37'),
(20506, 1019, 21765, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Enrollment form submitted with new location address and providers need to be linked under that address. SS attached for ref (ATN) is 206630. Submitted thru POSC ', NULL, NULL, '2021-04-21 11:22:48', '2021-04-21 11:22:48'),
(20507, 1019, 21765, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  Hello Yen, Hope you are doing well, I have attached the completed and signed documents. Let me know the time frame for location addition for our Group and Providers. Let me know if you need further information.    Regards, Alex', NULL, NULL, '2021-04-28 11:06:09', '2021-04-28 11:06:09'),
(20508, 1019, 21765, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  SUB: MassHealth Application ATN206630  Good Afternoon Yen, Hope you\'re doing good, can you please let me know the Status of our application, and how much more time it will take to process our application.  Regards, Alex ', NULL, NULL, '2021-06-03 16:26:10', '2021-06-03 16:26:10'),
(20509, 1019, 21765, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from YenLengChow@maximus.com  Hi Alex, Yes, the group has been enrolled under the PID/SL 110159328B effective 6/17/2021. You should be receiving a welcome letter in the next few weeks.  ', NULL, NULL, '2021-06-22 13:28:44', '2021-06-22 13:28:44'),
(20510, 1019, 21765, NULL, '2021-08-17 00:00:00.000', 'Approved', 'Received the following email from YenLengChow@maximus.com  The providers listed on section 2.2 of the application were linked to the group: Eff Date: 06/17/2021. I have attached the Group Roster for RNM Location.  ', NULL, NULL, '2021-08-10 22:46:13', '2021-08-10 22:46:13'),
(20511, 1006, 21766, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:38', '2021-03-16 10:53:38'),
(20512, 1019, 21766, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Enrollment form submitted with new location address and providers need to be linked under that address. SS attached for ref (ATN) is 206630. Submitted thru POSC ', NULL, NULL, '2021-04-21 11:24:26', '2021-04-21 11:24:26'),
(20513, 1019, 21766, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  Hello Yen, Hope you are doing well, I have attached the completed and signed documents. Let me know the time frame for location addition for our Group and Providers. Let me know if you need further information.    Regards, Alex', NULL, NULL, '2021-04-28 11:05:30', '2021-04-28 11:05:30'),
(20514, 1019, 21766, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  SUB: MassHealth Application ATN206630  Good Afternoon Yen, Hope you\'re doing good, can you please let me know the Status of our application, and how much more time it will take to process our application.  Regards, Alex ', NULL, NULL, '2021-06-03 16:26:02', '2021-06-03 16:26:02'),
(20515, 1019, 21766, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from YenLengChow@maximus.com  Hi Alex, Yes, the group has been enrolled under the PID/SL 110159328B effective 6/17/2021. You should be receiving a welcome letter in the next few weeks.  ', NULL, NULL, '2021-06-22 13:28:27', '2021-06-22 13:28:27'),
(20516, 1019, 21766, NULL, '2021-08-17 00:00:00.000', 'Approved', 'Received the following email from YenLengChow@maximus.com  The providers listed on section 2.2 of the application were linked to the group: Eff Date: 06/17/2021. I have attached the Group Roster for RNM Location for ref.  ', NULL, NULL, '2021-08-10 22:50:55', '2021-08-10 22:50:55'),
(20517, 1006, 21767, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:40', '2021-03-16 10:53:40'),
(20518, 1006, 21767, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'We received the following update regarding LCSW/LICSW enrollment guidelines of Mass Health @ Rippstein, Kyle KyleRippstein@maximus.com:   Sub: Enrollment || Providers || SNBCARE || MassHealth  \"Hi Alex,  We do not enroll LCSWs at this time.  We DO enroll LICSWs, but in a non-billing capacity (they would not “link” to the Group as would a Physician or NP, for example).  I have attached the proper applications for LICSWs. Let us know if you need any further assistance.  Thanks,  Kyle Rippstein Supervisor, Provider Enrollment and Credentialing MassHealth MAXIMUS , Inc 55 Summer St, 8th floor Boston, MA 02110 Office (617)948-5537 Fax (617)988-8904\"  Non-billing capacity implies that we aren\'t able to submit claims under those providers, so there is no point with that process either.  ', NULL, NULL, '2021-04-21 15:23:33', '2021-04-21 15:23:33'),
(20519, 1006, 21768, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:42', '2021-03-16 10:53:42'),
(20520, 1019, 21768, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Enrollment form submitted with new location address and providers need to be linked under that address. SS attached for ref (ATN) is 206630. Submitted thru POSC ', NULL, NULL, '2021-04-21 11:23:30', '2021-04-21 11:23:30'),
(20521, 1019, 21768, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  Hello Yen, Hope you are doing well, I have attached the completed and signed documents. Let me know the time frame for location addition for our Group and Providers. Let me know if you need further information.    Regards, Alex', NULL, NULL, '2021-04-28 11:04:57', '2021-04-28 11:04:57'),
(20522, 1019, 21768, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  SUB: MassHealth Application ATN206630  Good Afternoon Yen, Hope you\'re doing good, can you please let me know the Status of our application, and how much more time it will take to process our application.  Regards, Alex ', NULL, NULL, '2021-06-03 16:25:49', '2021-06-03 16:25:49'),
(20523, 1019, 21768, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from YenLengChow@maximus.com  Hi Alex, Yes, the group has been enrolled under the PID/SL 110159328B effective 6/17/2021. You should be receiving a welcome letter in the next few weeks.  ', NULL, NULL, '2021-06-22 13:27:50', '2021-06-22 13:27:50'),
(20524, 1019, 21768, NULL, '2021-08-17 00:00:00.000', 'Approved', 'Received the following email from YenLengChow@maximus.com  The providers listed on section 2.2 of the application were linked to the group: Eff Date: 06/17/2021. I have attached the Group Roster for RNM Location for ref.  ', NULL, NULL, '2021-08-10 22:49:43', '2021-08-10 22:49:43'),
(20525, 3046, 21769, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:45', '2021-03-16 10:53:45'),
(20526, 1006, 21769, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted LOI & W9 for addition location to Urgentcare contract. Sent email @ pdsdallas@aetna.com ', NULL, NULL, '2021-03-25 17:33:27', '2021-03-25 17:33:27'),
(20527, 9057, 21769, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to: pdsdallas@aetna.com Sub: Additional location status request - RHC - First Health  Hello, We submitted a request for additional location to our urgent care contract under the following group  and providers.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provide Details Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415     Provider 3: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 4: Provider Name: Trevino, Rose Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :5 Provider Name: Ayarzagoitia, Patrick  Provider NPI#   1649568239 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :6 Provider Name: Mason, Traci Provider NPI#   1497127831 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :7 Provider Name: Svatek, Maegan Provider NPI#   1639670250 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider:8 Provider Name: Capupus, Mari Provider NPI#   NPI: 1740517945 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider:9 Provider Name: Rogers, Petina Provider NPI#   1801443916 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Kindly provide the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-26 13:09:56', '2021-05-26 13:09:56'),
(20528, 3040, 21769, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com  Subject: Additional location status request - RHC - First Health  Hello,   I wanted to get an update on the status of this request, please get back to me as soon as possible.  Thank you! ', NULL, NULL, '2021-06-15 16:31:09', '2021-06-15 16:31:09'),
(20529, 11056, 21769, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email received from : BharathB@aetna.com  Sub : Additional location status request - RHC - First Health  Hi Brad,  Please share practice location phone and Fax numbers so that we can proceed further.  Regards, Bharath  Email sent to : BharathB@aetna.com  Sub : Additional location status request - RHC - First Health  Hi Bharath,  Hope you are doing well. Here is the information you asked for about the practice.  Practice Detail: Practice Name : Statcare Minor Emergency Clinic Practice Phone : 361-516-0800 Practice Fax : 361-516-0855   If you need any further information feel free to contact me. Waiting to hear from you soon. Thank you! ', NULL, NULL, '2021-07-01 14:57:41', '2021-07-01 14:57:41'),
(20530, 1006, 21769, NULL, '2021-07-14 00:00:00.000', 'In Process', 'We received the following reply from Bharath, Bollu BharathB@aetna.com:  Sub: Additional location status request - RHC - First Health  \"Hi Brad,  Following up on the below email. Please assist  Regards, Bharath\"  Replied:   \"Hello Bollu,   Sure thing, here\'s the information: Address: 500 E CAESAR, KINGSVILLE, TX 78363   Phone# 361-516-0800 Fax# 361-516-0855  Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone#  361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-07-07 08:51:34', '2021-07-07 08:51:34'),
(20531, 1006, 21769, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & pdsdallas@aetna.com:  Sub: Additional location status request - RHC - First Health  \"Hello Bollu,   I appreciate the update, from what I can see from the First Health directory there seems to have been some confusion.   We want all of the following mentioned practice addresses listed under all of the given providers:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Name: Rose Trevino NPI# 1437174794  Provider Name: Katherine Rabagos NPI# 1134415631  Provider Name: Mary Gonzalez NPI# 1952713083  Provider Name: William Francis NPI# 1457994436  Provider Name: Juan Capupus NPI# 1891168597  Provider Name: Maegan Svatek NPI# 1639670250  Provider Name: Petina Rogers NPI# 1801443916  Provider Name: Traci Mason NPI# 1497127831  Provider Name: Mari Capupus NPI# 1740517945  Provider Name: Patrick Ayarzagoitia NPI# 1649568239  Please let me know if you need anything to get these updated.  Thank you.\"', NULL, NULL, '2021-08-17 17:28:18', '2021-08-17 17:28:18'),
(20532, 11056, 21769, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : pdsdallas@aetna.com>  Sub : Fwd: Additional location status request - RHC - First Health  Good evening!  Hope all is well with you. I want all of the following mentioned practice addresses listed under all of the given providers. Please update me with the latest credentialing status of these providers too.  Practice Details: Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Details: Provider Name: Rose Trevino NPI# 1437174794  Provider Name: Katherine Rabagos NPI# 1134415631  Provider Name: Mary Gonzalez NPI# 1952713083  Provider Name: William Francis NPI# 1457994436  Provider Name: Juan Capupus NPI# 1891168597  Provider Name: Maegan Svatek NPI# 1639670250  Provider Name: Petina Rogers NPI# 1801443916  Provider Name: Traci Mason NPI# 1497127831  Provider Name: Mari Capupus NPI# 1740517945  Provider Name: Patrick Ayarzagoitia NPI# 1649568239  If you have any questions or concerns or require any documents or information, please contact me without any hesitation. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:26:41', '2021-09-21 16:26:41'),
(20533, 11056, 21769, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com  Sub : Fwd: Additional location status request - RHC - First Health  Hi,  All the Providers has been added with the given locations.   Thank You,  Phani ', NULL, NULL, '2021-10-01 14:41:22', '2021-10-01 14:41:22'),
(20534, 11056, 21769, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub  : Fwd: Additional location status request - RHC - First Health  Good morning!  Hope you are doing great. Please provide the approval letters and executed contract for the facility & providers as soon as possible. I will be eagerly waiting for it.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-10-13 16:49:56', '2021-10-13 16:49:56'),
(20535, 11056, 21769, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : Fwd: Additional location status request - RHC - First Health  Hello Ahmed,    I hope that this email finds you well!  Please see attached copy of the contract on file for the practice. The practices group ID when submitting updates to the Data Team is 1067518.   I personally did not send out the welcome letter so I do not have the file to send over. The welcome letters during that time are outdated now so the information would be different than what we currently use. Any of the welcome letters that I have recently sent have the updated information to reference. Please make sure to always list the group ID number so that the Data Team can locate the file easier and your requests process faster.  I hope that this helps!  Take care,  Jeanette Sidley Network Relations Consultant', NULL, NULL, '2021-10-20 14:33:44', '2021-10-20 14:33:44'),
(20536, 11056, 21769, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : RE: [SEND SECURE] RE: [EXTERNAL] Re: Additional location status request - RHC - First Health Fwd: Additional location status request - RHC - First Health  Good morning!     Hope you are doing great. We have four locations under the facility tax I.D. Two of them are already listed under the providers and facility but the other highlighted ones were remaining. Miss Phani informed us that the all locations are loaded, therefore, we need the effective dates and some kind of letter for proof for our providers.     Kindly do us a favor. Confirm with the Effective Dates soon.     Thank you!  Have a wonderful day!     Practice Name: Statcare Minor Emergency Clinic  NPI# 1689924904  TIN# 46-0575924     Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363  Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413  Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415', NULL, NULL, '2021-11-10 17:39:08', '2021-11-10 17:39:08'),
(20537, 11056, 21769, NULL, '2021-11-25 00:00:00.000', 'Approved', 'Rep:  Cris S  Eff date: 6/1/2021  Refcode: 6052218700  Please see the attachment.', NULL, NULL, '2021-11-18 14:51:53', '2021-11-18 14:51:53'),
(20538, 1006, 21770, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:53:48', '2021-03-16 10:53:48'),
(20539, 1019, 21770, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Enrollment form submitted with new location address and providers need to be linked under that address. SS attached for ref (ATN) is 206630. Submitted thru POSC', NULL, NULL, '2021-04-21 11:17:59', '2021-04-21 11:17:59'),
(20540, 1019, 21770, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following email from YenLengChow@maximus.com Good afternoon,  My name is Yen and I’m the provider enrollment and credentialing specialist working on Spectrum Neuro Behavioral Care LLC DBA SNBCARE. We have received the online application, however, in order to enroll this application, we need the complete paper application as well as the other required documents. From what I see, are you trying to add another service location?  Application sections 1.4, 1.7, 2.8, 2.9, 1.10, 2 Contract Disclosures form for entities W9 EFT Bank attachment Trading Partner Agreement   We can’t reuse the documents sent in for the previous location as the signatures have to be within a year. Please fill out the attached documents and email them back to me, feel free to reach out if you have any questions. Thanks, Yen Leng Chow', NULL, NULL, '2021-04-26 06:43:31', '2021-04-26 06:43:31'),
(20541, 1019, 21770, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  Hello Yen, Hope you are doing well, I have attached the completed and signed documents. Let me know the time frame for location addition for our Group and Providers. Let me know if you need further information.    Regards, Alex', NULL, NULL, '2021-04-28 11:02:13', '2021-04-28 11:02:13'),
(20542, 1019, 21770, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Received the follwoing email from YenLengChow@maximus.com  Good afternoon,     We have only received an online application for this entity, can you please email me the EFT? Sorry I meant sections 1.8 and 1.9 on the application  Please get back ASAP so I resubmit this request. ', NULL, NULL, '2021-05-04 14:03:55', '2021-05-04 14:03:55'),
(20543, 1019, 21770, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com Hello Yen Leng,  I have attached the completed application now with all additional information. Let me know if you need anything else.  Thank you,', NULL, NULL, '2021-05-04 14:04:48', '2021-05-04 14:04:48'),
(20544, 1019, 21770, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from YenLengChow@maximus.com Hi Alex,   Per our phone call, I have attached page 1 of the EFT to this email. Please sign it and email it back to me.  Thanks!', NULL, NULL, '2021-05-27 13:12:46', '2021-05-27 13:12:46'),
(20545, 1019, 21770, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  Hello Yen, It was nice speaking with you, I have attached the Signed copy of EFT, let me know if you have any questions.  Regards, Alex', NULL, NULL, '2021-05-27 13:13:44', '2021-05-27 13:13:44'),
(20546, 1019, 21770, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to YenLengChow@maximus.com  SUB: MassHealth Application ATN206630  Good Afternoon Yen, Hope you\'re doing good, can you please let me know the Status of our application, and how much more time it will take to process our application.  Regards, Alex ', NULL, NULL, '2021-06-03 16:25:21', '2021-06-03 16:25:21'),
(20547, 1019, 21770, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from YenLengChow@maximus.com  Hi Alex,  Yes, the group has been enrolled under the PID/SL 110159328B effective 6/17/2021. You should be receiving a welcome letter in the next few weeks.  ', NULL, NULL, '2021-06-22 13:27:08', '2021-06-22 13:27:08'),
(20548, 1019, 21770, NULL, '2021-08-17 00:00:00.000', 'Approved', 'Received the following email from YenLengChow@maximus.com  The providers listed on section 2.2 of the application were linked to the group: Eff Date: 06/17/2021. I have attached the Group Roster for RNM Location for ref.  ', NULL, NULL, '2021-08-10 22:51:19', '2021-08-10 22:51:19'),
(20549, 3040, 21771, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:54:17', '2021-03-16 10:54:17'),
(20550, 3040, 21771, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.   For group contract please see group task. ', NULL, NULL, '2021-05-28 12:31:26', '2021-05-28 12:31:26'),
(20551, 3040, 21772, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:54:36', '2021-03-16 10:54:36'),
(20552, 3040, 21772, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.   For group contract please see group task. ', NULL, NULL, '2021-05-28 12:31:29', '2021-05-28 12:31:29'),
(20553, 3040, 21773, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:54:50', '2021-03-16 10:54:50'),
(20554, 3040, 21773, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.   For group contract please see group task. ', NULL, NULL, '2021-05-28 12:31:33', '2021-05-28 12:31:33'),
(20555, 1006, 21774, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:54:55', '2021-03-16 10:54:55'),
(20556, 1019, 21774, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Submitted Location Addition request thru MBHP website. see attachment for ref', NULL, NULL, '2021-04-21 11:38:39', '2021-04-21 11:38:39'),
(20557, 1019, 21774, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to MBHPnetworkoperations@beaconhealthoption.com SUB: Enrollment Query || Providers || MBHP || SNBCARE  Good Afternoon, We need the enrollment status for the following providers under our group.  Group Information:  Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Providers:  Jennifer Ullrich NPI: 1710489760 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Katie Tawakol NPI: 1609222116 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Mahreen Rashid NPI: 1396393146 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Prisca Hefti NPI: 1508133182 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Peggy Pionke NPI: 1699307322 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Regards,', NULL, NULL, '2021-06-05 11:27:38', '2021-06-05 11:27:38'),
(20558, 1019, 21774, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Spoken with Rep Ashley M, regarding enrolling issue as MBHP wasn\'t getting back to us, so she sent a request from her side to enroll the following providers with MBHP. Waiting for MBHP email now. Call Ref # Ashley M 06/16/2021 - 6765376', NULL, NULL, '2021-06-23 10:49:04', '2021-06-23 10:49:04'),
(20559, 19067, 21774, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Provider Enrollment Status  Hi,  Hope you\'re having a productive day.  I want to know Credentialing status for providers below:  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Primary Location	61 Lincoln St., Suite 203, Framingham, MA 01702. Secondary Location	100 New State Hwy. Raynham, MA 02767 Provider Name	NPI Jennifer Ullrich	1710489760 Katie Tawakol 1609222116 Mehreen Rashid 1396393146 Prisca Hefti 1508133182                                  Peggy Pionke	1699307322  Kindly get back to me as soon as possible.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-13 15:02:24', '2021-12-13 15:02:24'),
(20560, 19067, 21774, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Hello!  Hope you\'re doing well.  I would like to know the enrollment status of the following Providers and Group as well as with MBHP.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Peggy Pionke	1699307322	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Katie Tawakol	1609222116	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Mahreen Rashid	1396393146	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Mahreen Rashid	1396393146	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Prisca Hefti	1508133182	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	61 Lincoln St., Suite 203, Framingham, MA 01702-8264   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 13:45:05', '2021-12-29 13:45:05'),
(20561, 19067, 21774, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Hello!  Hope you\'re doing well.  I would like to know the enrollment status of the following Providers and Group as well as with MBHP.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Peggy Pionke	1699307322	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Katie Tawakol	1609222116	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Mahreen Rashid	1396393146	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Mahreen Rashid	1396393146	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Prisca Hefti	1508133182	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	61 Lincoln St., Suite 203, Framingham, MA 01702-8264   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 13:47:29', '2021-12-29 13:47:29'),
(20562, 19067, 21774, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Greetings!  Any updates on the previously mentioned request?   Kindly get back to us once you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:05:27', '2022-01-10 14:05:27'),
(20563, 19067, 21774, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hello,  I would like to know the enrollment status of the previously mentioned request.   Regards.', NULL, NULL, '2022-02-11 10:45:41', '2022-02-11 10:45:41'),
(20564, 19067, 21774, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||    Hello,  Hope this email finds you well.  Any updates on the enrollment of the provider, Lauren Powell?   Regards, Hammad Ahmed', NULL, NULL, '2022-03-16 17:16:56', '2022-03-16 17:16:56'),
(20565, 22077, 21774, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Fwd: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Good Morning,  Kindly see the attached file as requested  Thanks', NULL, NULL, '2022-04-05 08:06:48', '2022-04-05 08:06:48'),
(20566, 22077, 21774, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Received, thank you.     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159  Please note my last day with company is 4/8/2022  Please direct any questions to mbhp_pr@beaconhealthoptions.com ', NULL, NULL, '2022-04-05 10:18:49', '2022-04-05 10:18:49'),
(20567, 1006, 21775, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:54:57', '2021-03-16 10:54:57'),
(20568, 3040, 21775, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:18:21', '2021-04-21 08:18:21'),
(20569, 1019, 21775, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:44:04', '2021-10-25 10:44:04'),
(20570, 1006, 21776, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:54:58', '2021-03-16 10:54:58'),
(20571, 3040, 21776, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:19:47', '2021-04-21 08:19:47'),
(20572, 3040, 21776, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Waiting for location addition once the location added in the group contract after that we can request for provider to add in the additional location. ', NULL, NULL, '2021-04-21 08:24:00', '2021-04-21 08:24:00'),
(20573, 1019, 21776, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to MBHPnetworkoperations@beaconhealthoption.com SUB: Enrollment Query || Providers || MBHP || SNBCARE  Good Afternoon, We need the enrollment status for the following providers under our group.  Group Information:  Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Providers:  Jennifer Ullrich NPI: 1710489760 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Katie Tawakol NPI: 1609222116 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Mahreen Rashid NPI: 1396393146 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Prisca Hefti NPI: 1508133182 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Peggy Pionke NPI: 1699307322 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Regards,', NULL, NULL, '2021-06-04 15:33:01', '2021-06-04 15:33:01'),
(20574, 1019, 21776, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Spoken with Rep Ashley M, regarding enrolling issue as MBHP wasn\'t getting back to us, so she sent a request from her side to enroll the following providers with MBHP. Waiting for MBHP email now. Call Ref # Ashley M 06/16/2021 - 6765376', NULL, NULL, '2021-06-23 10:48:56', '2021-06-23 10:48:56'),
(20575, 19067, 21776, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Provider Enrollment Status  Hi,  Hope you\'re having a productive day.  I want to know Credentialing status for providers below:  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Primary Location	61 Lincoln St., Suite 203, Framingham, MA 01702. Secondary Location	100 New State Hwy. Raynham, MA 02767 Provider Name	NPI Jennifer Ullrich	1710489760 Katie Tawakol 1609222116 Mehreen Rashid 1396393146 Prisca Hefti 1508133182                                  Peggy Pionke	1699307322  Kindly get back to me as soon as possible.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-13 15:02:18', '2021-12-13 15:02:18'),
(20576, 19067, 21776, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Hello!  Hope you\'re doing well.  I would like to know the enrollment status of the following Providers and Group as well as with MBHP.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Peggy Pionke	1699307322	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Katie Tawakol	1609222116	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Mahreen Rashid	1396393146	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Mahreen Rashid	1396393146	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Prisca Hefti	1508133182	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	61 Lincoln St., Suite 203, Framingham, MA 01702-8264   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 13:44:51', '2021-12-29 13:44:51'),
(20577, 19067, 21776, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Hello!  Hope you\'re doing well.  I would like to know the enrollment status of the following Providers and Group as well as with MBHP.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Peggy Pionke	1699307322	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Katie Tawakol	1609222116	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Mahreen Rashid	1396393146	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Mahreen Rashid	1396393146	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Prisca Hefti	1508133182	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	61 Lincoln St., Suite 203, Framingham, MA 01702-8264   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 13:46:37', '2021-12-29 13:46:37'),
(20578, 19067, 21776, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Hello!  Hope you\'re doing well.  I would like to know the enrollment status of the following Providers and Group as well as with MBHP.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Peggy Pionke	1699307322	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Katie Tawakol	1609222116	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Mahreen Rashid	1396393146	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Mahreen Rashid	1396393146	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Prisca Hefti	1508133182	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	61 Lincoln St., Suite 203, Framingham, MA 01702-8264   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 13:46:37', '2021-12-29 13:46:37'),
(20579, 19067, 21776, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Greetings!  Any updates on the previously mentioned request?   Kindly get back to us once you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:05:22', '2022-01-10 14:05:22'),
(20580, 19067, 21776, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hello,  I would like to know the enrollment status of the previously mentioned request.   Regards.', NULL, NULL, '2022-02-11 10:45:31', '2022-02-11 10:45:31'),
(20581, 19067, 21776, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: 	RE: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hi Ahmed,     The below providers that will need to complete the form, please indicate in the service section they want to add MBHP line of insurance.     Peggy Pionke – Complete the attached form  Katie Tawakolv – Already in network  Mahreen Rashid – Complete the attached form  Prisca Hefti – Already in network  Jennifer Ullrich – Complete the attached form     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159', NULL, NULL, '2022-02-15 09:48:25', '2022-02-15 09:48:25'),
(20582, 19067, 21776, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hi Randy,  Please provide an effective date and approval letter for the providers who are now in-network with MBHP.   Thanks, Hammad Ahmed', NULL, NULL, '2022-03-16 17:12:18', '2022-03-16 17:12:18'),
(20583, 22077, 21776, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Fwd: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Good Morning,  Kindly see the attached file as requested  Thanks', NULL, NULL, '2022-04-05 08:11:39', '2022-04-05 08:11:39'),
(20584, 22077, 21776, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Received, thank you.     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159  Please note my last day with company is 4/8/2022  Please direct any questions to mbhp_pr@beaconhealthoptions.com ', NULL, NULL, '2022-04-05 10:20:54', '2022-04-05 10:20:54'),
(20585, 1006, 21777, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:00', '2021-03-16 10:55:00'),
(20586, 3040, 21777, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:18:35', '2021-04-21 08:18:35'),
(20587, 1006, 21778, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:01', '2021-03-16 10:55:01'),
(20588, 3040, 21778, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:20:58', '2021-04-21 08:20:58'),
(20589, 1006, 21779, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:02', '2021-03-16 10:55:02'),
(20590, 3040, 21779, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:19:03', '2021-04-21 08:19:03'),
(20591, 1006, 21780, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:04', '2021-03-16 10:55:04'),
(20592, 3040, 21780, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:21:13', '2021-04-21 08:21:13'),
(20593, 1006, 21781, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:05', '2021-03-16 10:55:05'),
(20594, 3040, 21781, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Email sent to: MNHPnetworkoperations@beaconhealthoption.com  Subject: Enroll Providers || Spectrum Neuro Behavioral Care LLC || Rashid, Mahreen & Ullrich, Jennifer Lee || MBHP ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers for our group   Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 2:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-21 08:16:08', '2021-04-21 08:16:08'),
(20595, 1019, 21781, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to MBHPnetworkoperations@beaconhealthoption.com SUB: Enrollment Query || Providers || MBHP || SNBCARE  Good Afternoon, We need the enrollment status for the following providers under our group.  Group Information:  Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Providers:  Jennifer Ullrich NPI: 1710489760 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Katie Tawakol NPI: 1609222116 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Mahreen Rashid NPI: 1396393146 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Prisca Hefti NPI: 1508133182 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Peggy Pionke NPI: 1699307322 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Regards,', NULL, NULL, '2021-06-04 15:32:53', '2021-06-04 15:32:53'),
(20596, 1019, 21781, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Spoken with Rep Ashley M, regarding enrolling issue as MBHP wasn\'t getting back to us, so she sent a request from her side to enroll the following providers with MBHP. Waiting for MBHP email now. Call Ref # Ashley M 06/16/2021 - 6765376', NULL, NULL, '2021-06-23 10:48:47', '2021-06-23 10:48:47'),
(20597, 19067, 21781, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Provider Enrollment Status  Hi,  Hope you\'re having a productive day.  I want to know Credentialing status for providers below:  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Primary Location	61 Lincoln St., Suite 203, Framingham, MA 01702. Secondary Location	100 New State Hwy. Raynham, MA 02767 Provider Name	NPI Jennifer Ullrich	1710489760 Katie Tawakol 1609222116 Mehreen Rashid 1396393146 Prisca Hefti 1508133182                                  Peggy Pionke	1699307322  Kindly get back to me as soon as possible.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-13 15:02:09', '2021-12-13 15:02:09'),
(20598, 19067, 21781, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Hello!  Hope you\'re doing well.  I would like to know the enrollment status of the following Providers and Group as well as with MBHP.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Peggy Pionke	1699307322	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Katie Tawakol	1609222116	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Mahreen Rashid	1396393146	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Mahreen Rashid	1396393146	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Prisca Hefti	1508133182	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	61 Lincoln St., Suite 203, Framingham, MA 01702-8264   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 13:44:41', '2021-12-29 13:44:41'),
(20599, 19067, 21781, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Greetings!  Any updates on the previously mentioned request?   Kindly get back to us once you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:04:57', '2022-01-10 14:04:57'),
(20600, 19067, 21781, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hello,  I would like to know the enrollment status of the previously mentioned request.   Regards.', NULL, NULL, '2022-02-11 10:45:24', '2022-02-11 10:45:24'),
(20601, 19067, 21781, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: 	RE: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hi Ahmed,     The below providers that will need to complete the form, please indicate in the service section they want to add MBHP line of insurance.     Peggy Pionke – Complete the attached form  Katie Tawakolv – Already in network  Mahreen Rashid – Complete the attached form  Prisca Hefti – Already in network  Jennifer Ullrich – Complete the attached form     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159', NULL, NULL, '2022-02-15 09:48:21', '2022-02-15 09:48:21'),
(20602, 19067, 21781, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hi Randy,  Please provide an effective date and approval letter for the providers who are now in-network with MBHP.   Thanks, Hammad Ahmed', NULL, NULL, '2022-03-16 17:12:23', '2022-03-16 17:12:23'),
(20603, 22077, 21781, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Fwd: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Good Morning,  Kindly see the attached file as requested  Thanks', NULL, NULL, '2022-04-05 08:13:26', '2022-04-05 08:13:26');
