Enrollment Tracking Information Applicant Name: PATRICK AYARZAGOITIA   Tracking ID: T072920200004799  Submitted Date: WED - JULY 29 2020 06:53:49 PM EST  Submitted By: Patrick Ayarzagoitia  Contact Email(s): KALONZO@WELLMED.NET ANNISSA.GOINS@EMCARE.COM PAYARZAGOITIA@GMAIL.COM RHC@CLAIMSMEDINC.COM TENNA.BEHM@EMCARE.COM ABOSMANS@WELLMED.NET Reason(s) for submission: A Medicare Part B practitioner is currently enrolled in Medicare and is reassigning his/her benefits to a Part B supplier, Part B practitioner or Part A provider currently enrolled in Medicare.