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
(45709, 10057, 31240, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:32:04', '2021-10-18 16:32:04'),
(45710, 10057, 31240, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Hello,  Hope this email finds you in good health. Could you please let me know the updated status for the below mentioned updated status.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 15:53:11', '2021-11-23 15:53:11'),
(45711, 10057, 31240, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org vicki.guerra@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good afternoon,  Hope this email finds you well. I\'m writing this email to check the status for the below mentioned request.  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:32:13', '2021-12-03 14:32:13'),
(45712, 10057, 31240, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-13 10:59:46', '2021-12-13 10:59:46'),
(45713, 10057, 31240, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 10:06:28', '2021-12-20 10:06:28'),
(45714, 10057, 31240, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 12:01:56', '2021-12-28 12:01:56'),
(45715, 20067, 31240, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good afternoon, Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers, if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Joseph Molly	1396380077 Mini Channamakara	1841755956 Odette Kourouma	1134525868 Jeena Abraham	1467901587 SIGI PAUL	1033623616 Glory Abraham	1194206490 James Piccione JR	1356321509 Limy Fernandus	1972005189 Vibitha Joseph	1952931560 Brittany Brown	1275163537 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238 Jeemol George	1497219067 Julie Jose	1447883061 Jaya Jacob	1194336149 Jeny John	1073019493  Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well. Your earliest response would be greatly appreciated.  Eagerly waiting to hear from you,  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-10 13:23:09', '2022-01-10 13:23:09'),
(45716, 20067, 31240, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST - LPMC - CHRISTUS HEALTH PLAN  Good Afternoon! Hope this email finds you in good health. I sent the email 9 days ago but I haven\'t received any response yet. Kindly respond to the previous request.  Eager to hear from you. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-19 15:24:04', '2022-01-19 15:24:04'),
(45717, 20067, 31240, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good afternoon!  Hope this email finds you in good health. Kindly respond to the Urgent request.  Eagerly waiting to hear from you. Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-28 13:16:03', '2022-01-28 13:16:03'),
(45718, 20067, 31240, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Afternoon  Facility has been processed contract effective date 01/01/22  Thank you', NULL, NULL, '2022-02-08 13:44:12', '2022-02-08 13:44:12'),
(45719, 20067, 31240, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Morning!  Kindly send me a copy of the facility contract. I emailed you on 02/03/2022 and I haven\'t received any response from you yet.  Kindly respond promptly this is my SECOND reminder.  Thank you, ', NULL, NULL, '2022-02-18 09:50:40', '2022-02-18 09:50:40'),
(45720, 20067, 31240, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Evening!  Kindly send me the copy of the Facility contract. This is my THIRD REMINDER.  Kindly respond promptly.  Thank you,', NULL, NULL, '2022-03-04 15:34:07', '2022-03-04 15:34:07'),
(45721, 20067, 31240, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jrbrunin@christushealth.org  Sub:  Facility Contract Request || Longpoint Medical Center || Christus Health Plan   Hello Jackie!  This is Syed. I was trying to reach you but you were unavailable over the call. I want a copy of Facility Contract as it is effective from 01/01/2022. Also please confirm to me that all of the 17 providers have been linked to this group.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Sigi paul	1033623616 Mini Chennemkara	1841755956 Jeena Abraham	1467901587 Odette Kourouma	1134525868 James Piccione	1356321509 Glory Abraham	1194206490 Limy Fernandus	1972005189 Cini Thomas	1134777238 Ani Stephen	1588959118 Jeemol George	1497219067 Julie Jose	1447883061 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Abdur Rauf	1497726202  Thank you,', NULL, NULL, '2022-03-17 10:43:22', '2022-03-17 10:43:22'),
(45722, 1006, 31241, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:48', '2021-05-14 15:13:48'),
(45723, 3040, 31241, NULL, '2021-06-04 00:00:00.000', 'In Process', ' Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  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, '2021-05-28 13:05:43', '2021-05-28 13:05:43'),
(45724, 3040, 31241, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann |  Greetings,  Hope you are doing well. Please find the attached ancillary contract request for the below mentioned 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-16 16:56:52', '2021-06-16 16:56:52'),
(45725, 3040, 31241, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-05 16:20:11', '2021-07-05 16:20:11'),
(45726, 3040, 31241, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email rcvd from: MHHPContracting@memorialhermann.org  Subject: RE: [EXTERNAL] Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann ||  Good morning. This group will be presented to our committee on Friday. I will have an update for you on Monday.  Thank you.  Camilla  ----------------------------------------------------------------------------------------------------------------------------------  Good morning. If during the tele-health call it is determined that the patient needs to be seen in an office, where would you refer the patient to? Please advise.  Thank you.  Camilla  ----------------------------------------------------------------------------------------------------------------------------------  ', NULL, NULL, '2021-07-23 14:54:50', '2021-07-23 14:54:50'),
(45727, 3040, 31241, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: MHHPContracting@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann ||  Hello Camilla,   Thank you for the update. Please find below the information that you requested in your previous email. We can refer the patient to the below hospital.   Hospital Name: Memorial Hermann Memorial City Medical Center Address: 921 Gessner Rd, Houston, TX 77024  If you need further information please let me know. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-23 14:55:27', '2021-07-23 14:55:27'),
(45728, 3040, 31241, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Email rcvd from: MHHPContracting@memorialhermann.org  Subject: RE: [EXTERNAL] Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann ||  July 27, 2021 Longpoint Medical Center 9504 Long Point Rd, Ste E Houston, TX 77055 Dear Longpoint Medical Center: We would like to thank you for your interest in participating in the Memorial Hermann Health Plan network; however, we do not currently have a network need for the specialty and/or services which you provide. We will keep your Request for Participation on file and notify you if our needs change in the future. Should you have questions or need additional assistance, please contact our Provider Relations Department at 713.338.4801 or you can send an email to: Providerservices@memorialhermann.org. Thank you again for your interest in Memorial Hermann Health Plan Provider Network.  Kind regards,  Memorial Hermann Health Plan Provider Relations', NULL, NULL, '2021-07-27 16:12:28', '2021-07-27 16:12:28'),
(45729, 1006, 31242, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:48', '2021-05-14 15:13:48'),
(45730, 1006, 31242, NULL, '2021-05-28 00:00:00.000', 'Initiated', 'Group enrollment request submitted via Wellcare online form, attached in group task for reference.', NULL, NULL, '2021-05-20 21:30:48', '2021-05-20 21:30:48'),
(45731, 3040, 31242, NULL, '2021-06-16 00:00:00.000', 'In Process', 'I had a word with (Mary J) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: MXJINANG ', NULL, NULL, '2021-06-09 10:03:33', '2021-06-09 10:03:33'),
(45732, 3040, 31242, NULL, '2021-07-05 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-06-28 13:15:44', '2021-06-28 13:15:44'),
(45733, 3040, 31242, NULL, '2021-07-23 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-16 16:44:52', '2021-07-16 16:44:52'),
(45734, 11056, 31242, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:53:41', '2021-08-11 13:53:41'),
(45735, 3040, 31242, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:27:54', '2021-09-07 16:27:54'),
(45736, 10057, 31242, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:47:25', '2021-10-19 11:47:25'),
(45737, 10057, 31242, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  The providers below are PAR effective 5/1/2021. Any provider that is not on this list may need to be submitted to be added via our website or you will need to submit a roster with all pertinent information to have the providers added. If you need to add a location or make demographic changes to a provider please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-11-23 16:17:09', '2021-11-23 16:17:09'),
(45738, 10057, 31242, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-12-02 15:18:57', '2021-12-02 15:18:57'),
(45739, 10057, 31242, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:21:47', '2021-12-09 13:21:47'),
(45740, 10057, 31242, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:01:03', '2021-12-17 14:01:03'),
(45741, 10057, 31242, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:25:12', '2021-12-23 11:25:12'),
(45742, 10057, 31242, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:56:35', '2021-12-30 13:56:35'),
(45743, 20067, 31242, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email Received From: Ashley.Stevens@wellcare.com  Subject: : RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  May I please get the W-9 for :  Longpoint Medical Center  76-0612416    The providers are in the process of being loaded.  Thanks  Ashley Stevens  Contracts Coordinator, Contracting & Network Development   ', NULL, NULL, '2022-01-06 10:51:59', '2022-01-06 10:51:59'),
(45744, 20067, 31242, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Subject: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC    Good morning Ashley,  Kindly see the attachment for Longpoint Medical Center\'s W9.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-06 11:01:14', '2022-01-06 11:01:14'),
(45745, 20067, 31242, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email received from: ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good Afternoon,     All providers are still in progress for all 3 contract, however our credentialing department is asking for a Collaborative form to credential Jeny John 1073019493. Can you provide that for us?     Thanks     Ashley Stevens  Contracts Coordinator, Contracting & Network Development ', NULL, NULL, '2022-01-14 16:58:59', '2022-01-14 16:58:59'),
(45746, 20067, 31242, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good morning Ashley,  Hope you are doing great. Any updates on the previous request?  Thank you, Syed Ahad.', NULL, NULL, '2022-01-25 10:19:09', '2022-01-25 10:19:09'),
(45747, 20067, 31242, NULL, '2022-02-10 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good morning, I Hope this email finds you well. Kindly see the attachment for Jeny John 1073019493.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-02-03 14:44:28', '2022-02-03 14:44:28'),
(45748, 20067, 31242, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good morning!  Hope this email finds you in good health. Any updates for Jeny John?  Thank you.', NULL, NULL, '2022-02-08 12:04:16', '2022-02-08 12:04:16'),
(45749, 20067, 31242, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good Morning!  Hope all is well with you. Can you please send me the group contract for Longpoint Medical Center?  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Thank you,', NULL, NULL, '2022-02-18 10:21:58', '2022-02-18 10:21:58'),
(45750, 20067, 31242, NULL, '2022-02-25 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - LPMC - Wellcare  Good Morning,   Please see attached contract for Longpoint Medical Center. This covers WellCare HMO line of business through the affiliate language of the Superior HealthPlan contract.  Sincerely,', NULL, NULL, '2022-02-18 12:36:17', '2022-02-18 12:36:17'),
(45751, 1006, 31243, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:48', '2021-05-14 15:13:48'),
(45752, 1006, 31243, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent following enrollment request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - LPMC - Christus Spohn   \"Hello,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416  Primary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-05-31 16:25:28', '2021-05-31 16:25:28'),
(45753, 3040, 31243, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-18 11:46:14', '2021-06-18 11:46:14'),
(45754, 3040, 31243, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  Greetings,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416 Primary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226     Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:57:39', '2021-07-06 14:57:39'),
(45755, 3040, 31243, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  \"Hello,   We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416 Primary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you ', NULL, NULL, '2021-07-27 16:48:42', '2021-07-27 16:48:42'),
(45756, 3040, 31243, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Email rcvd from: vicki.guerra@christushealth.org  Subject: Christus Spohn Health Network - Counties  Hi Adil,  Happy Thursday!  Thank you for speaking with me. The email address CSHNproviderrelations@christushealth.org is not a working email. I apologize for the delay and we are updating our website.  Please click on the website below. It will give you the map of our services areas based on county.  https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area  Vicki Ann Guerra  Provider Relations Representative  CHRISTUS Spohn Health Network  613 Elizabeth St Ste 604  Corpus Christi, TX 78404  O: 361-881-3167  F: 361-881-3745', NULL, NULL, '2021-07-28 11:11:46', '2021-07-28 11:11:46'),
(45757, 1006, 31244, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:48', '2021-05-14 15:13:48'),
(45758, 3040, 31244, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com  Subject: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Greetings,   Hope you are doing well. Please find the attached Facility/Ancillary network interest form to enroll in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 10:51:41', '2021-06-02 10:51:41'),
(45759, 3040, 31244, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-06-22 11:17:46', '2021-06-22 11:17:46'),
(45760, 3040, 31244, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Waiting for your response.   Thanks ', NULL, NULL, '2021-07-12 14:18:36', '2021-07-12 14:18:36'),
(45761, 11056, 31244, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring |  Adil,  I’ve also forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 09:56:44', '2021-08-09 09:56:44'),
(45762, 3040, 31244, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I didn\'t get any email from anyone regarding the enrollment. Can you please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 11:31:51', '2021-08-17 11:31:51'),
(45763, 10057, 31244, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com  Sub : Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon,  Hope this email finds you well, Please be informed that I have not yet received any email from any one, you are therefore requested to please update me about the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 15:19:40', '2021-10-06 15:19:40'),
(45764, 10057, 31244, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : JENNIFER.PEREZ@cigna.com  Sub : [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello,  May you reach out to the email listed on the letter of interest? The correct representative will be able to assist you further.  Thank you,  Jennifer Perez', NULL, NULL, '2021-11-09 16:08:59', '2021-11-09 16:08:59'),
(45765, 10057, 31244, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hey,  Can you please share with me the email address of the relevant person.  I truly appreciate your support.  Thanks & Regards,', NULL, NULL, '2021-11-23 17:00:42', '2021-11-23 17:00:42'),
(45766, 10057, 31244, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Received From : JENNIFER.PEREZ@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hi,  Please see below email address.  TXMAContracting@cigna.com  Jennifer Perez Network Operations Senior Analyst | Cigna-Medicare', NULL, NULL, '2021-12-03 14:41:16', '2021-12-03 14:41:16'),
(45767, 10057, 31244, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Morning,  Hope this email finds you well. I\'m writing this email to check the updated status for the below mentioned providers under the TIN.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-12-10 11:29:20', '2021-12-10 11:29:20'),
(45768, 10057, 31244, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Greetings!  Any update on the below request. This is my second reminder. Please get back to me as soon as possible.  Thanks & Regards, Steve Albert ', NULL, NULL, '2021-12-17 10:36:58', '2021-12-17 10:36:58'),
(45769, 10057, 31244, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good morning,  I\'m still waiting to get an update from your side?  Your earliest response would be appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-23 10:27:58', '2021-12-23 10:27:58'),
(45770, 10057, 31244, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request, the process is getting deley day by day.  Kindly revert back to me with the latest update.  Regards,', NULL, NULL, '2021-12-29 17:41:47', '2021-12-29 17:41:47'),
(45771, 20067, 31244, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from:  TXMAContracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||   Please fully complete the network interest form for consideration follow the website link below to download the form. Complete for each provider and send it back in and the review process will begin.        1.     TX/OK Cigna Medicare Network  a.     If interested in joining the Cigna Medicare network in the Texas/Oklahoma market, please fill out a Network Interest Form at one of the below links:                                            i.    Practitioner Network Interest Form (Physician/Medical Clinics) – https://medicareproviders.cigna.com/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-tx.pdf     ii. Facility/Ancillary Network Interest Form – https://medicareproviders.cigna.com/static/medicareproviders-cigna-com/docs/facility-network-interest-form-tx.pdf     *** Please ensure all sections are filled out correctly on the forms to prevent any delays on review. ***     2.   Network Interest Form  a.     All network interest forms submitted for the current month will be reviewed by the Network Interest Committee the first week of the following month.                                            i.    Example – If we receive an interest form sent on 11/05/2021, the Committee will review the first week of December.  *** Unless a holiday falls within the first week, it will then be reviewed the following week. ***  b.   Please avoid sending in duplicate requests to prevent any issues during the review process.     3.   Status Update  a.     Once the committee has reviewed the forms, you will receive one of the below responses:                                            i.    Approvals – A representative will reach out to initiate contracting and credentialing.                                           ii.    Denials – A letter will be sent to the contact email listed on the Network Interest Form.                                           iii.    Pendings – A representative will reach out if any additional information is needed.        Thank you,  Cigna Medicare', NULL, NULL, '2022-01-11 14:49:16', '2022-01-11 14:49:16'),
(45772, 20067, 31244, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Kindly see the attachments below  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:10:10', '2022-01-11 15:10:10'),
(45773, 20067, 31244, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon! Hope you are doing well.Haven\'t heard anything from you in the previous email. Kindly respond Promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 15:35:13', '2022-01-19 15:35:13'),
(45774, 20067, 31244, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longmont Medical Center || Group || Cigna Healthspring ||  Good afternoon!  Hope you are doing well, This is my MY SECOND REMINDER Kindly do the needful.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-28 13:45:03', '2022-01-28 13:45:03'),
(45775, 20067, 31244, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon!  I haven\'t heard from your side yet. Kindly respond to the request it\'s really very urgent.  Thank You.', NULL, NULL, '2022-02-08 13:57:47', '2022-02-08 13:57:47');
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
(45776, 20067, 31244, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: txmacontracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Syed,     The corrected forms were received by you on 1/11/2022. The committee meeting has not met yet for the month, as they are reviewed the following month from when they’re received. Once a decision is made you will be contacted for the next steps.     2.   Network Interest Form  a.     All network interest forms submitted for the current month will be reviewed by the Network Interest Committee the first week of the following month.                                            i.    Example – If we receive an interest form sent on 11/05/2021, the Committee will review the first week of December.  *** Unless a holiday falls within the first week, it will then be reviewed the following week. ***  b.   Please avoid sending in duplicate requests to prevent any issues during the review process.     3.   Status Update  a.     Once the committee has reviewed the forms, you will receive one of the below responses:                                            i.    Approvals – A representative will reach out to initiate contracting and credentialing.                                           ii.    Denials – A letter will be sent to the contact email listed on the Network Interest Form.                                           iii.    Pending’s – A representative will reach out if any additional information is needed.           Thank you,', NULL, NULL, '2022-02-16 15:42:01', '2022-02-16 15:42:01'),
(45777, 20067, 31244, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||   Good Evening!  Any updates on the request? Has the committee meeting met?  Kindly update me.  Thank you', NULL, NULL, '2022-03-04 15:55:16', '2022-03-04 15:55:16'),
(45778, 20067, 31244, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Morning!  I have sent the network interest forms on 01/11/2022. Kindly update me on the request.   Thank you,', NULL, NULL, '2022-03-17 10:55:28', '2022-03-17 10:55:28'),
(45779, 1006, 31245, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:48', '2021-05-14 15:13:48'),
(45780, 3040, 31245, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Triwest ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Triwest in 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: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:05:24', '2021-05-31 15:05:24'),
(45781, 11056, 31245, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Group Participating for Triwest form has been submitted. Waiting for the contract. Please see the attachments.', NULL, NULL, '2021-06-18 10:28:32', '2021-06-18 10:28:32'),
(45782, 11056, 31245, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Request Id: 151162; Request was successfully sent.', NULL, NULL, '2021-06-18 10:51:50', '2021-06-18 10:51:50'),
(45783, 3040, 31245, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Re: Enroll Providers || Longpoint Medical Center || Providers || Triwest ||  Hello Jess,   Hope you are doing well. Can you please advise how to enroll the below mentioned group in Triwest. I already submitted the online application for the group.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-08 10:00:17', '2021-07-08 10:00:17'),
(45784, 3040, 31245, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Email rcvd from: providerservices@triwest.com  Subject: TriWest Healthcare Alliance Provider Agreement 121TW75178  Dear Provider,  Thank you for joining the Department of Veterans Affairs (VA) Community Care Network (CCN) through TriWest Healthcare Alliance (TriWest). This letter confirms that your TriWest CCN contract has been signed and executed.', NULL, NULL, '2021-07-22 13:27:16', '2021-07-22 13:27:16'),
(45785, 1006, 31246, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:48', '2021-05-14 15:13:48'),
(45786, 3040, 31246, NULL, '2021-05-27 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes ', NULL, NULL, '2021-05-20 16:37:51', '2021-05-20 16:37:51'),
(45787, 1006, 31251, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:48', '2021-05-14 15:13:48'),
(45788, 3040, 31251, NULL, '2021-06-04 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-05-28 14:29:34', '2021-05-28 14:29:34'),
(45789, 10057, 31251, NULL, '2022-01-05 00:00:00.000', 'Approved', 'Call Details: (855) 322-4080   Rep: Ramiah  Reference # SF 21535469  Effective Date: 07/15/2020', NULL, NULL, '2021-12-29 10:22:57', '2021-12-29 10:22:57'),
(45790, 1006, 31252, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:48', '2021-05-14 15:13:48'),
(45791, 3040, 31252, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll || Longpoint Medical Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below location.   Practice Details: Practice Name: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, '2021-05-25 12:47:09', '2021-05-25 12:47:09'),
(45792, 3040, 31252, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Re: Need to Enroll || Longpoint Medical Center || Group & Providers || CHRISTUS HEALTH PLAN||  Hello, Michal,   Hope you are doing well. Can you please advise how to enroll the group and providers in Christus Health Plan. We need to do the group contract.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-14 08:35:48', '2021-06-14 08:35:48'),
(45793, 3040, 31252, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Health Plan ||  Greetings,  Hope you are doing well. I wanted to add the additional location in Christus Health Plan for our group under the below locations.   Practice Details:  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice 2:   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice 3:   Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Tertiary Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-14 15:02:50', '2021-06-14 15:02:50'),
(45794, 11056, 31252, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enrollment Status || Longpoint Medical Center || CHRISTUS HEALTH PLAN ||  Greetings,  Hope you are doing well. I wanted to inquire about the enrollment status of  the below mentioned group and providers in Christus Health Plan.  Practice  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-06-29 13:08:11', '2021-06-29 13:08:11'),
(45795, 3040, 31252, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN   We cannot contract with an Urgent Care Center with a group contract, the only way the center can become in network is with an Ancillary contract and only the group NPI will show up as in network and can only bill as the group NPI.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, ', NULL, NULL, '2021-07-19 09:15:10', '2021-07-19 09:15:10'),
(45796, 3040, 31252, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Can you please send the ancillary contract so we can start the process for the below mentioned groups. We have 3 different locations under the same Tax ID and NPI number. For your reference I mentioned all the locations below.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-19 09:17:53', '2021-07-19 09:17:53'),
(45797, 3040, 31252, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information please let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:07', '2021-07-28 11:39:07'),
(45798, 11056, 31252, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:00:06', '2021-08-11 17:00:06'),
(45799, 3040, 31252, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:41', '2021-08-17 15:02:41'),
(45800, 3040, 31252, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:39', '2021-09-14 16:14:39'),
(45801, 12062, 31252, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:15:00', '2021-09-22 13:15:00'),
(45802, 10057, 31252, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:31:56', '2021-10-18 16:31:56'),
(45803, 10057, 31252, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Hello,  Hope this email finds you in good health. Could you please let me know the updated status for the below mentioned updated status.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 15:53:04', '2021-11-23 15:53:04'),
(45804, 10057, 31252, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org vicki.guerra@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good afternoon,  Hope this email finds you well. I\'m writing this email to check the status for the below mentioned request.  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:32:03', '2021-12-03 14:32:03'),
(45805, 10057, 31252, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-13 10:59:40', '2021-12-13 10:59:40'),
(45806, 10057, 31252, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 10:05:12', '2021-12-20 10:05:12'),
(45807, 10057, 31252, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 12:01:49', '2021-12-28 12:01:49'),
(45808, 20067, 31252, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good afternoon, Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers, if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Joseph Molly	1396380077 Mini Channamakara	1841755956 Odette Kourouma	1134525868 Jeena Abraham	1467901587 SIGI PAUL	1033623616 Glory Abraham	1194206490 James Piccione JR	1356321509 Limy Fernandus	1972005189 Vibitha Joseph	1952931560 Brittany Brown	1275163537 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238 Jeemol George	1497219067 Julie Jose	1447883061 Jaya Jacob	1194336149 Jeny John	1073019493  Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well. Your earliest response would be greatly appreciated.  Eagerly waiting to hear from you,  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-10 13:22:24', '2022-01-10 13:22:24'),
(45809, 20067, 31252, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST - LPMC - CHRISTUS HEALTH PLAN  Good Afternoon! Hope this email finds you in good health. I sent the email 9 days ago but I haven\'t received any response yet. Kindly respond to the previous request.  Eager to hear from you. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-19 15:23:54', '2022-01-19 15:23:54'),
(45810, 20067, 31252, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good afternoon!  Hope this email finds you in good health. Kindly respond to the Urgent request.  Eagerly waiting to hear from you. Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-28 13:15:56', '2022-01-28 13:15:56'),
(45811, 20067, 31252, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Afternoon  Facility has been processed contract effective date 01/01/22  Thank you', NULL, NULL, '2022-02-08 13:46:13', '2022-02-08 13:46:13'),
(45812, 20067, 31252, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Morning!  Kindly send me a copy of the facility contract. I emailed you on 02/03/2022 and I haven\'t received any response from you yet.  Kindly respond promptly this is my SECOND reminder.  Thank you, ', NULL, NULL, '2022-02-18 09:50:33', '2022-02-18 09:50:33'),
(45813, 20067, 31252, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Evening!  Kindly send me the copy of the Facility contract. This is my THIRD REMINDER.  Kindly respond promptly.  Thank you,', NULL, NULL, '2022-03-04 15:34:00', '2022-03-04 15:34:00'),
(45814, 20067, 31252, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jrbrunin@christushealth.org  Sub:  Facility Contract Request || Longpoint Medical Center || Christus Health Plan   Hello Jackie!  This is Syed. I was trying to reach you but you were unavailable over the call. I want a copy of Facility Contract as it is effective from 01/01/2022. Also please confirm to me that all of the 17 providers have been linked to this group.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Sigi paul	1033623616 Mini Chennemkara	1841755956 Jeena Abraham	1467901587 Odette Kourouma	1134525868 James Piccione	1356321509 Glory Abraham	1194206490 Limy Fernandus	1972005189 Cini Thomas	1134777238 Ani Stephen	1588959118 Jeemol George	1497219067 Julie Jose	1447883061 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Abdur Rauf	1497726202  Thank you,', NULL, NULL, '2022-03-17 10:42:54', '2022-03-17 10:42:54'),
(45815, 1006, 31253, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-17 13:16:15', '2021-05-17 13:16:15'),
(45816, 1006, 31253, NULL, '2021-05-24 00:00:00.000', 'Initiated', 'Enrollment request submitted via the online portal.   Reference Number :	21137001297 ', NULL, NULL, '2021-05-17 15:15:26', '2021-05-17 15:15:26'),
(45817, 3040, 31253, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare Railroad.', NULL, NULL, '2021-06-07 17:43:03', '2021-06-07 17:43:03'),
(45818, 1006, 31267, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-28 15:41:20', '2021-05-28 15:41:20'),
(45819, 1006, 31267, NULL, '2021-06-04 00:00:00.000', 'Initiated', 'Sent following email @ trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Enrollment Request - BHUCC - TRPN  \"Hello,  We wish to enroll the following providers and group with TRPN, their information is as follows: Group Name: Best Health Urgent Care & ClinicNPI# 1013540962TIN# 84-4737737 Provider Name: Stephane Cyriaque NPI# 1780192633Enroll as: Specialist Provider Name: Shametria Tann NPI# 1124615612Enroll as: PCP Please let me know what else is required to process this request.  Thank you. \"', NULL, NULL, '2021-05-28 16:08:00', '2021-05-28 16:08:00'),
(45820, 3040, 31267, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: AVasquez@trpnppo.com  Subject: TRPN - Best Health Urgent Care & Clinic Hi Brad,   It was a pleasure speaking with you today.  Per our conversation, I am attaching a copy of our standard agreement for review and completion, please contact me directly with any questions and/or requests. I look forward to working with you.  Best regards,  Alex Vasquez Contract Coordinator 6970 O’Bannon Drive Las Vegas, Nevada 89117 Phone: (619) 271-2708 Fax: (619) 271-2587 avasquez@trpnppo.com www.trpnppo.com ', NULL, NULL, '2021-06-09 16:08:26', '2021-06-09 16:08:26'),
(45821, 1006, 31267, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Replied to Alejandro with the agreement @ Alejandro Vasquez AVasquez@trpnppo.com:  Sub: FW: TRPN - Best Health Urgent Care & Clinic  \"Hello Alejandro,  Appreciate the reply, here\'s the filled-out agreement. Please let me know what else might be needed to proceed further with this process.  Thank you. \"  Agreement is attached in group task for reference as it is an ancillary contract request. ', NULL, NULL, '2021-06-09 16:25:00', '2021-06-09 16:25:00'),
(45822, 11056, 31267, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email received from : AVasquez@trpnppo.com  Sub : TRPN - Best Health Urgent Care & Clinic  Hi Brad,   I will have the agreement executed and a countersigned copy will be sent to you for your records, the time frame for completion is three to four weeks, but feel free to follow up with me at any time.   Thank you and have a great weekend!', NULL, NULL, '2021-06-28 12:58:45', '2021-06-28 12:58:45'),
(45823, 11056, 31267, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to : AVasquez@trpnppo.com  Sub : Enrollment Status Update - Best Health Urgent Care & Clinic - TRPN  Greetings,  Hope you are doing well. This is a follow-up email for the agreement which you were going to send us in 3-4 weeks but the time frame has been completed and we haven\'t got the agreement yet. Kindly respond to us soon. We are eagerly waiting for your response and agreement.   Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Stephane Cyriaque Provider  NPI # : 1780192633  Provider Name : Shametria Tann Provider  NPI # : 1124615612  If you need any information or documents feel free to reach out to us. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-12 12:57:46', '2021-07-12 12:57:46'),
(45824, 11056, 31267, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to : AVasquez@trpnppo.com  Sub : AGREEMENT DEMAND - BHUCC - TRPN  Greetings,  Hope you are doing well. This is a follow-up email for the agreement which you were going to send us in 4-5 weeks ago but the time frame has been completed and we haven\'t got the agreement yet. Kindly respond to us soon. We are eagerly waiting for your response and agreement.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Stephane Cyriaque Provider  NPI # : 1780192633  Provider Name : Shametria Tann Provider  NPI # : 1124615612  If you need any information or documents feel free to reach out to us. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 10:47:22', '2021-07-19 10:47:22'),
(45825, 11056, 31267, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email received from : AVasquez@trpnppo.com via trpnppo.onmicrosoft.com   Sub : Automatic reply: AGREEMENT DEMAND - BHUCC - TRPN  I will be out of the office starting Mondy, July 19 and I will return all calls/emails upon my return on Wednesday, July 21. Thank you! ', NULL, NULL, '2021-07-30 12:44:32', '2021-07-30 12:44:32'),
(45826, 11056, 31267, NULL, '2021-08-11 00:00:00.000', 'Approved', 'Approval Email received from : kfry@trpnppo.com  &  avasquez@trpnppo.com  Sub : Welcome to Three Rivers Provider Network.  Welcome to Three Rivers Provider Network.  Please see your attached welcome letter and executed agreement.  Please reach out if you need anything else.  Thank you  Kellyn Fry Data Entry Coordinator/Office Assistant 6970 O’ Bannon Drive Las Vegas, NV 89117 Phone:(619) 600-4808 Fax: (619) 271-2658 Primary Email: kfry@trpnppo.com', NULL, NULL, '2021-08-04 13:27:09', '2021-08-04 13:27:09'),
(45827, 1006, 31268, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-28 16:29:48', '2021-05-28 16:29:48'),
(45828, 1006, 31268, NULL, '2021-06-04 00:00:00.000', 'Initiated', 'Sent following email @ trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Enrollment Request - BHUCC - TRPN  \"Hello,  We wish to enroll the following providers and group with TRPN, their information is as follows: Group Name: Best Health Urgent Care & ClinicNPI# 1013540962TIN# 84-4737737 Provider Name: Stephane Cyriaque NPI# 1780192633Enroll as: Specialist Provider Name: Shametria Tann NPI# 1124615612Enroll as: PCP Please let me know what else is required to process this request.  Thank you. \"', NULL, NULL, '2021-05-28 16:30:41', '2021-05-28 16:30:41'),
(45829, 3040, 31268, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: AVasquez@trpnppo.com  Subject: TRPN - Best Health Urgent Care & Clinic Hi Brad,   It was a pleasure speaking with you today.  Per our conversation, I am attaching a copy of our standard agreement for review and completion, please contact me directly with any questions and/or requests. I look forward to working with you.  Best regards,  Alex Vasquez Contract Coordinator 6970 O’Bannon Drive Las Vegas, Nevada 89117 Phone: (619) 271-2708 Fax: (619) 271-2587 avasquez@trpnppo.com www.trpnppo.com ', NULL, NULL, '2021-06-09 16:08:29', '2021-06-09 16:08:29'),
(45830, 1006, 31268, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Replied to Alejandro with the agreement @ Alejandro Vasquez AVasquez@trpnppo.com:  Sub: FW: TRPN - Best Health Urgent Care & Clinic  \"Hello Alejandro,  Appreciate the reply, here\'s the filled-out agreement. Please let me know what else might be needed to proceed further with this process.  Thank you. \"  Agreement is attached in group task for reference as it is an ancillary contract request. ', NULL, NULL, '2021-06-09 16:24:55', '2021-06-09 16:24:55'),
(45831, 11056, 31268, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email received from : AVasquez@trpnppo.com  Sub : TRPN - Best Health Urgent Care & Clinic  Hi Brad,   I will have the agreement executed and a countersigned copy will be sent to you for your records, the time frame for completion is three to four weeks, but feel free to follow up with me at any time.   Thank you and have a great weekend!', NULL, NULL, '2021-06-28 12:58:09', '2021-06-28 12:58:09'),
(45832, 11056, 31268, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to : AVasquez@trpnppo.com  Sub : Enrollment Status Update - Best Health Urgent Care & Clinic - TRPN  Greetings,  Hope you are doing well. This is a follow-up email for the agreement which you were going to send us in 3-4 weeks but the time frame has been completed and we haven\'t got the agreement yet. Kindly respond to us soon. We are eagerly waiting for your response and agreement.   Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Stephane Cyriaque Provider  NPI # : 1780192633  Provider Name : Shametria Tann Provider  NPI # : 1124615612  If you need any information or documents feel free to reach out to us. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-12 12:57:12', '2021-07-12 12:57:12'),
(45833, 11056, 31268, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to : AVasquez@trpnppo.com  Sub : AGREEMENT DEMAND - BHUCC - TRPN  Greetings,  Hope you are doing well. This is a follow-up email for the agreement which you were going to send us in 4-5 weeks ago but the time frame has been completed and we haven\'t got the agreement yet. Kindly respond to us soon. We are eagerly waiting for your response and agreement.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Stephane Cyriaque Provider  NPI # : 1780192633  Provider Name : Shametria Tann Provider  NPI # : 1124615612  If you need any information or documents feel free to reach out to us. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 10:46:53', '2021-07-19 10:46:53'),
(45834, 11056, 31268, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email received from : AVasquez@trpnppo.com via trpnppo.onmicrosoft.com   Sub : Automatic reply: AGREEMENT DEMAND - BHUCC - TRPN  I will be out of the office starting Mondy, July 19 and I will return all calls/emails upon my return on Wednesday, July 21. Thank you!', NULL, NULL, '2021-07-30 12:42:00', '2021-07-30 12:42:00'),
(45835, 11056, 31268, NULL, '2021-08-11 00:00:00.000', 'Approved', 'Approval Email received from : kfry@trpnppo.com  &  avasquez@trpnppo.com  Sub : Welcome to Three Rivers Provider Network.  Welcome to Three Rivers Provider Network.  Please see your attached welcome letter and executed agreement.  Please reach out if you need anything else.  Thank you  Kellyn Fry Data Entry Coordinator/Office Assistant 6970 O’ Bannon Drive Las Vegas, NV 89117 Phone:(619) 600-4808 Fax: (619) 271-2658 Primary Email: kfry@trpnppo.com', NULL, NULL, '2021-08-04 13:26:18', '2021-08-04 13:26:18'),
(45836, 1006, 31269, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-28 17:02:59', '2021-05-28 17:02:59'),
(45837, 1006, 31269, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment and f/u request @ credentialing@anci-care.com:  Sub: Enrollment Request/Status - BHUCC - Anci-Care  \"Hello,  I wanted to know what is required to get the following group and providers enrolled with Anci-Care, their information is as follows:  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962 TIN# 84-4737737  Provider Name: Stephane Cyriaque NPI# 1780192633  Provider Name: Shametria Tann NPI# 1124615612  Please get back to me as soon as possible regarding this. Thank you. \"', NULL, NULL, '2021-06-07 10:30:56', '2021-06-07 10:30:56'),
(45838, 1006, 31269, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent following reply to Patti DavidsonACS pdavidson@anci-care.com:  Sub; New Provider Agreement - per request  \"Hello Patti,  Please find the attached information as requested, do let me know if anything else is required to proceed with this process.  Thank you!\"  Documents are attached for reference in main group task. ', NULL, NULL, '2021-06-24 13:40:39', '2021-06-24 13:40:39'),
(45839, 11056, 31269, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email received from :  pdavidson@anci-care.com  Sub : New Provider Agreement - per request  Hi.  Thank you!  I have submitted all documents on for credentialing approval.  Once approved you will receive a welcome letter and signed provider agreement from Jennifer Maligaya- Sr. PR Rep.  Thank you,  Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-07-06 16:23:49', '2021-07-06 16:23:49'),
(45840, 11056, 31269, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub :  New Provider Agreement - per request  Good Afternoon Patti,    Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and group in Anci care. When will you gonna provide the letter welcome letter and signed provider agreement.    Practice Details:  Practice Name: Best Health Urgent Care & Clinic Practice NPI# 1013540962  Practice TIN# 84-4737737     Providers:   Provider Name: Stephane Cyriaque NPI# 1780192633     Provider Name: Shametria Tann NPI# 1124615612     Please get back to me as soon as possible regarding this.Feel free to reach out to me if you have any questions.     Thank you!', NULL, NULL, '2021-07-15 14:05:19', '2021-07-15 14:05:19'),
(45841, 11056, 31269, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email received from : Jennifer.Maligaya@healthsmart.com  Sub : New Provider Agreement - per request  Good Morning,  BEST HEALTH URGENT CARE & CLINIC, TIN 844737737 is contracted with ACS. Please note, ACS credentials/recredentials the location, not individuals. Therefore, if the providers invoice with the same TIN, they are considered in network with ACS.  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-07-23 10:20:08', '2021-07-23 10:20:08'),
(45842, 11056, 31269, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to : Jennifer.Maligaya@healthsmart.com  Sub : New Provider Agreement - per request  Greetings,  Hope all is well. Yeah the provider invoice with the same TIN of the practice BEST HEALTH URGENT CARE & CLINIC. Thank you for the clarification.  Thank you! Have a great day!', NULL, NULL, '2021-07-26 11:30:48', '2021-07-26 11:30:48'),
(45843, 11056, 31269, NULL, '2021-08-05 00:00:00.000', 'Approved', '	 APPROVAL Email received from : 	\'Jennifer Maligaya\' via Best Health Urgent Care & Clinic, PLLC   Jennifer.Maligaya@healthsmart.com  Sub : Welcome to ACS, Best Health Urgent Care & Clinic  Good Afternoon,     Congratulations and welcome to the Ancillary Care Services (ACS) network. Please see the attachments. My name is Jennifer Maligaya and I am the Sr. Provider Relations Representative to the ACS Providers.     My contact information is listed below my signature. Please do not hesitate to reach out to me with any questions or concerns. Thank you!     Best Regards,     Jennifer Maligaya | Sr. Provider Relations Representative  HealthSmart | Network Solutions  Office: 405 241 4811 | Fax: 214 574 1121  Jennifer.maligaya@healthsmart.com | www.HealthSmart.com   The agreement is attached .Please see the attachment.', NULL, NULL, '2021-07-28 14:38:43', '2021-07-28 14:38:43'),
(45844, 1006, 31270, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-28 17:03:08', '2021-05-28 17:03:08'),
(45845, 1006, 31270, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment and f/u request @ credentialing@anci-care.com:  Sub: Enrollment Request/Status - BHUCC - Anci-Care  \"Hello,  I wanted to know what is required to get the following group and providers enrolled with Anci-Care, their information is as follows:  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962 TIN# 84-4737737  Provider Name: Stephane Cyriaque NPI# 1780192633  Provider Name: Shametria Tann NPI# 1124615612  Please get back to me as soon as possible regarding this. Thank you. \"', NULL, NULL, '2021-06-07 10:30:50', '2021-06-07 10:30:50'),
(45846, 1006, 31270, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent following reply to Patti DavidsonACS pdavidson@anci-care.com:  Sub; New Provider Agreement - per request  \"Hello Patti,  Please find the attached information as requested, do let me know if anything else is required to proceed with this process.  Thank you!\"  Documents are attached for reference in main group task. ', NULL, NULL, '2021-06-24 13:40:28', '2021-06-24 13:40:28'),
(45847, 11056, 31270, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to :   Sub :  Hi.  Thank you!  I have submitted all documents on for credentialing approval.  Once approved you will receive a welcome letter and signed provider agreement from Jennifer Maligaya- Sr. PR Rep.  Thank you,  Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-07-06 16:22:25', '2021-07-06 16:22:25'),
(45848, 11056, 31270, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email received from :  pdavidson@anci-care.com  Sub : New Provider Agreement - per request  Hi.  Thank you!  I have submitted all documents on for credentialing approval.  Once approved you will receive a welcome letter and signed provider agreement from Jennifer Maligaya- Sr. PR Rep.  Thank you,  Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-07-06 16:23:30', '2021-07-06 16:23:30'),
(45849, 11056, 31270, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub :  New Provider Agreement - per request  Good Afternoon Patti,    Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and group in Anci care. When will you gonna provide the letter welcome letter and signed provider agreement.    Practice Details:  Practice Name: Best Health Urgent Care & Clinic Practice NPI# 1013540962  Practice TIN# 84-4737737     Providers:   Provider Name: Stephane Cyriaque NPI# 1780192633     Provider Name: Shametria Tann NPI# 1124615612     Please get back to me as soon as possible regarding this.Feel free to reach out to me if you have any questions.     Thank you! ', NULL, NULL, '2021-07-15 14:05:46', '2021-07-15 14:05:46'),
(45850, 11056, 31270, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email received from : Jennifer.Maligaya@healthsmart.com  Sub : New Provider Agreement - per request  Good Morning,  BEST HEALTH URGENT CARE & CLINIC, TIN 844737737 is contracted with ACS. Please note, ACS credentials/recredentials the location, not individuals. Therefore, if the providers invoice with the same TIN, they are considered in network with ACS.  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-07-23 10:19:55', '2021-07-23 10:19:55'),
(45851, 11056, 31270, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to : Jennifer.Maligaya@healthsmart.com  Sub : New Provider Agreement - per request  Greetings,  Hope all is well. Yeah the provider invoice with the same TIN of the practice BEST HEALTH URGENT CARE & CLINIC. Thank you for the clarification.  Thank you! Have a great day!', NULL, NULL, '2021-07-26 11:30:11', '2021-07-26 11:30:11'),
(45852, 11056, 31270, NULL, '2021-08-05 00:00:00.000', 'Approved', 'APPROVAL Email received from : 	\'Jennifer Maligaya\' via Best Health Urgent Care & Clinic, PLLC   Jennifer.Maligaya@healthsmart.com  Sub : Welcome to ACS, Best Health Urgent Care & Clinic  Good Afternoon,     Congratulations and welcome to the Ancillary Care Services (ACS) network. Please see the attachments. My name is Jennifer Maligaya and I am the Sr. Provider Relations Representative to the ACS Providers.     My contact information is listed below my signature. Please do not hesitate to reach out to me with any questions or concerns. Thank you!     Best Regards,     Jennifer Maligaya | Sr. Provider Relations Representative  HealthSmart | Network Solutions  Office: 405 241 4811 | Fax: 214 574 1121  Jennifer.maligaya@healthsmart.com | www.HealthSmart.com  The agreement is attached .Please see the attachment.', NULL, NULL, '2021-07-28 14:38:15', '2021-07-28 14:38:15'),
(45853, 1006, 31271, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45854, 3040, 31271, NULL, '2021-06-11 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 310023', NULL, NULL, '2021-06-04 16:03:02', '2021-06-04 16:03:02');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(45855, 3040, 31271, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 310023 || Valley Med Urgent Care PLLC || Hernandez, Juan || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in BCBS for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address:  2534 Boca Chica Blvd. Brownsville, TX 78521-3496   Secondary Address:  101 E. Expy 83 Ste. 170 McAllen, TX 78501-1166 Tertiary Address:  800 E. Alton Gloor Ave. Brownsville, TX 78521-3496  Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-22 11:33:26', '2021-06-22 11:33:26'),
(45856, 3040, 31271, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email rcvd from: TXProviderUpdateSubmission@bcbstx.com  Subject: Application ID: 310023 || Valley Med Urgent Care PLLC || Hernandez, Juan || BCBS || : Case Number - 02567289  Good afternoon,  I have located your application the provider’s record number for your group has been set up.  Juan A Hernandez Provider record # 8PR463  For any questions regarding network contracting, credentialing, network effective dates or status requests, please reach out to your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number), fax, and email contact methods.   Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-07-12 14:28:49', '2021-07-12 14:28:49'),
(45857, 10057, 31271, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email Sent To : Noemi_Diaz@bcbstx.com  Sub : BCBS - Enrollment Query  Good Afternoon,  Hope you are doing well. I am writing this email to get the latest update on the credentialing applications of below mentioned providers.  Group Name	Valley Med Urgent Care PLLC (Two locations) Tax ID	81-3237149 Group NPI	1821542432 Primary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Provider Name	NPI Wert, Jeniece K	1659919702 - Case # 02552862 Luyando, Mariana	1518404631 - Application # 334796  Please feel free to call or email me. Waiting to hear from you soon  Thanks & Regards,', NULL, NULL, '2021-10-05 14:48:52', '2021-10-05 14:48:52'),
(45858, 10057, 31271, NULL, '2021-11-01 00:00:00.000', 'Approved', 'Email Received From : txintaketeampiermailbox@bcbstx.com  Sub : BCBSTX New Provider Information  Group Name : VALLEY MED URGENT CARE PLLC Group Record Id : H000Q9Z701  Provider Name : JUAN A HERNANDEZ Provider Record Number : H08PR46301 Specialty : Physician Assistant  Networks : Network Name	Network Effective Date BAV - Blue Advantage HMO	10/19/2021 HMO - Blue Essentials	10/19/2021 BCA - BlueChoice PPO	10/19/2021 CHP - CHIP (Medicaid)	10/19/2021 HME - Health Select	10/19/2021 PMC - Medicare Advantage PPO	10/19/2021 STR - STAR (Medicaid)	10/19/2021 STK - STAR Kids (Medicaid)	10/19/2021', NULL, NULL, '2021-10-25 09:40:08', '2021-10-25 09:40:08'),
(45859, 1006, 31272, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45860, 3040, 31272, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-06-04 11:01:02', '2021-06-04 11:01:02'),
(45861, 1006, 31273, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45862, 1005, 31273, NULL, '2021-06-12 00:00:00.000', 'Initiated', 'CAQH Provider ID:  15160227 CAQH account created and Spoke with Cigna Rep they asked to wait for 24 hour for CAQH to verify the information and attest it so Cigna may extract the details from there.', NULL, NULL, '2021-06-04 15:06:04', '2021-06-04 15:06:04'),
(45863, 3040, 31273, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Provider ID: 3567367 Application no: 12638455', NULL, NULL, '2021-06-09 16:57:20', '2021-06-09 16:57:20'),
(45864, 3040, 31273, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email rcvd from: discovercigna@information.cigna.com  Subject: Cigna Credentialing Status Update: Application Received  Re:	Reference number 12638455 Application to participate in the Cigna medical network Dear JUAN HERNANDEZ,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.', NULL, NULL, '2021-06-28 14:31:54', '2021-06-28 14:31:54'),
(45865, 3040, 31273, NULL, '2021-07-26 00:00:00.000', 'In Process', 'I had a word (Luis)  Cigna representative and he advised that application is still in reviewing process and will take up 90-120 days    Ref: Luis A 07/19/2021', NULL, NULL, '2021-07-19 08:36:52', '2021-07-19 08:36:52'),
(45866, 3040, 31273, NULL, '2021-09-17 00:00:00.000', 'Approved', 'I had a word with (Maurice) With Cigna representative  and he said the provider is effective 08/02/2021.  ', NULL, NULL, '2021-09-10 13:51:40', '2021-09-10 13:51:40'),
(45867, 1006, 31274, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45868, 3040, 31274, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || UHC ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and provider in UHC for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-04 15:36:32', '2021-06-04 15:36:32'),
(45869, 3040, 31274, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com   Subject: Re: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || UHC ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in UHC for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 11:40:58', '2021-06-22 11:40:58'),
(45870, 3040, 31274, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject:  Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || UHC ||  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned provider in UHC for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-12 14:26:59', '2021-07-12 14:26:59'),
(45871, 3040, 31274, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || UHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in UHC for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-08-30 11:48:00', '2021-08-30 11:48:00'),
(45872, 3040, 31274, NULL, '2021-09-21 00:00:00.000', 'Approved', 'Provider is participating with UHC. For more details please see attachment. ', NULL, NULL, '2021-09-14 13:27:57', '2021-09-14 13:27:57'),
(45873, 1006, 31275, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45874, 1005, 31275, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:39:12', '2021-06-04 09:39:12'),
(45875, 3040, 31275, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'TCHP does not cover Hidalgo or Cameron County for VMUC. ', NULL, NULL, '2021-06-04 11:28:42', '2021-06-04 11:28:42'),
(45876, 1006, 31276, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45877, 3040, 31276, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Effective Date: 11/01/2017  Group has an ancillary contract.', NULL, NULL, '2021-06-04 14:01:01', '2021-06-04 14:01:01'),
(45878, 1006, 31277, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45879, 1005, 31277, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:37:12', '2021-06-04 09:37:12'),
(45880, 3040, 31277, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html ', NULL, NULL, '2021-06-04 11:25:44', '2021-06-04 11:25:44'),
(45881, 1006, 31278, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45882, 1005, 31278, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:37:28', '2021-06-04 09:37:28'),
(45883, 3040, 31278, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference. ', NULL, NULL, '2021-06-04 11:24:18', '2021-06-04 11:24:18'),
(45884, 1006, 31279, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45885, 1005, 31279, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Aetna\'s approval.', NULL, NULL, '2021-06-04 09:14:20', '2021-06-04 09:14:20'),
(45886, 11056, 31279, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Talked to Chris for enrollment procedure for First Health at Aetna. Form has been submitted. Waiting for enrollment. Please see attachments. Ref no. of call is : 6026518636 Ref code for form is : MEDICAL', NULL, NULL, '2021-06-24 15:40:53', '2021-06-24 15:40:53'),
(45887, 3040, 31279, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-07-13 13:25:10', '2021-07-13 13:25:10'),
(45888, 1006, 31280, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45889, 3040, 31280, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Service Case Number:	7630381 Details have been emailed to you at: vmuc@claimsmedinc.com', NULL, NULL, '2021-06-04 14:19:44', '2021-06-04 14:19:44'),
(45890, 3040, 31280, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Service Case Number:	7647780 Details have been emailed to you at: vmuc@claimsmedinc.com', NULL, NULL, '2021-06-22 13:24:25', '2021-06-22 13:24:25'),
(45891, 3040, 31280, NULL, '2021-07-19 00:00:00.000', 'In Process', 'I had a word with PAM B Multiplan representative and she advise provider is in-network with both Multiplan & PHCS but provider is not showing on directory. After discussion with Brad he said we can\'t rely on the effective provider need to show up on directory. ', NULL, NULL, '2021-07-12 14:45:58', '2021-07-12 14:45:58'),
(45892, 3040, 31280, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-07-13 13:32:52', '2021-07-13 13:32:52'),
(45893, 1006, 31281, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45894, 1005, 31281, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:26:11', '2021-06-04 09:26:11'),
(45895, 3040, 31281, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-06-04 14:05:34', '2021-06-04 14:05:34'),
(45896, 1006, 31282, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45897, 1005, 31282, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:24:23', '2021-06-04 09:24:23'),
(45898, 3040, 31282, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Application Status            Submitted PEP Ticket Number          17843821 		 ', NULL, NULL, '2021-06-11 17:23:32', '2021-06-11 17:23:32'),
(45899, 1005, 31282, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Checked online and the application is currently \"In Progress\".', NULL, NULL, '2021-06-29 11:44:18', '2021-06-29 11:44:18'),
(45900, 3040, 31282, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Provider is participating with Medicaid. Please see attachment. ', NULL, NULL, '2021-07-12 10:07:48', '2021-07-12 10:07:48'),
(45901, 1006, 31283, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45902, 1005, 31283, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:26:26', '2021-06-04 09:26:26'),
(45903, 3040, 31283, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and provider in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-04 14:12:19', '2021-06-04 14:12:19'),
(45904, 3040, 31283, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task. ', NULL, NULL, '2021-06-16 16:21:27', '2021-06-16 16:21:27'),
(45905, 3040, 31283, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:08', '2021-07-20 11:30:08'),
(45906, 3040, 31283, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:18:47', '2021-07-27 16:18:47'),
(45907, 1006, 31285, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45908, 1005, 31285, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-04 09:19:28', '2021-06-04 09:19:28'),
(45909, 3040, 31285, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com  ', NULL, NULL, '2021-06-04 11:18:53', '2021-06-04 11:18:53'),
(45910, 1006, 31286, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45911, 1005, 31286, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:38:54', '2021-06-04 09:38:54'),
(45912, 3040, 31286, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Superior Health ||   Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Healthplan in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-12 10:47:47', '2021-07-12 10:47:47'),
(45913, 3040, 31286, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject: Re: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Superior Health ||  Hello,  Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Healthplan in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-08-27 13:19:17', '2021-08-27 13:19:17'),
(45914, 3040, 31286, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: RE: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Superior Health ||  Good Afternoon Adil,  To request network participation, please follow the enrollment process: Add a Provider to an Existing Group Contract  Upon completion, you should receive an email within a minimum of two weeks. Please make sure to review your Spam folder and respond within a timely manner.  If I may be of assistance, please do not hesitate to contact me.  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA', NULL, NULL, '2021-09-01 09:59:34', '2021-09-01 09:59:34'),
(45915, 12062, 31286, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email received from : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  & replied to SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Fwd: [SECURE] Add a provider- JUAN ALONSO HERNANDEZ   Dear Provider,  We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.             Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com  for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.          To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/     For Re-Credentialing, please email your information to credentialing@centene.com.     Samantha Cazares Superior Health Plan | Network Operations  I have replied to this email with a completed add provide application form   Attached form for your reference.', NULL, NULL, '2021-09-09 13:53:52', '2021-09-09 13:53:52'),
(45916, 10057, 31286, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com, SHP.NetworkDevelopment@superiorhealthplan.com  Sub : [SECURE] Add a provider- JUAN ALONSO HERNANDEZ & Luyando, Mariana || Superior Health ||  Good Evening,  Hope this email finds you well. I wanted to follow up regarding the enrollment status for the below mentioned providers in Superior Healthplan in our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Luyando, Mariana	1700960556  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-21 16:24:35', '2021-10-21 16:24:35'),
(45917, 10057, 31286, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com, SHP.NetworkDevelopment@superiorhealthplan.com  Sub : [SECURE] Add a provider- JUAN ALONSO HERNANDEZ & Luyando, Mariana || Superior Health ||  Good Evening,  Hope this email finds you well. I wanted to follow up regarding the enrollment status for the below mentioned providers in Superior Healthplan in our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Luyando, Mariana	1700960556  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-21 16:24:35', '2021-10-21 16:24:35'),
(45918, 10057, 31286, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: [SECURE] Add a provider- JUAN ALONSO HERNANDEZ & Luyando, Mariana || Superior Health ||  Good afternoon,  Here is the status for the requested providers-  MARIANA LUYANDO- We received your completed application on 09/24/2021.  Your effective date is 11/01/2021 and you will be receiving a welcome packet shortly.  JUAN HERNANDEZ-  We received your completed application on 09/13/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you, Samantha Cazares  Contracts Coordinator, Contracting & Network Development', NULL, NULL, '2021-10-22 08:56:01', '2021-10-22 08:56:01'),
(45919, 10057, 31286, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning,  Hope this email finds you in good health. Could you please help me out to get the latest enrollment status for below mentioned providers under TIN including all given locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-16 09:33:08', '2021-11-16 09:33:08'),
(45920, 10057, 31286, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good morning,  Here are the statuses below-  Juan Hernandez- We received your completed application on 09/13/21.  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Jeniece Wert- We received your completed application on 06/24/2021.  Your effective date is 12/01/2021 and you will be receiving a welcome packet shortly.  Thank you,  Samantha Cazares  Contracts Coordinator', NULL, NULL, '2021-11-16 13:50:33', '2021-11-16 13:50:33'),
(45921, 10057, 31286, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Greetings!  Thank you for your prompt response. Have a great day!  Regards,', NULL, NULL, '2021-11-30 15:08:27', '2021-11-30 15:08:27'),
(45922, 10057, 31286, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Afternoon,  Hope this email finds you well. I\'m writing this email to get the welcome packets. Your earliest response will be highly appreciated.   Thanks & Regards,', NULL, NULL, '2021-12-07 14:11:39', '2021-12-07 14:11:39'),
(45923, 10057, 31286, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good afternoon,  I have requested the welcome packet for Jeniece Wert and you should be receiving it shortly.  JUAN ALONSO HERNANDEZ- is currently still in credentialing. We appreciate your patience as credentialing can take up to 90 days.', NULL, NULL, '2021-12-14 13:31:33', '2021-12-14 13:31:33'),
(45924, 10057, 31286, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : ECMExecutionTeam@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good morning Steve,  Here is the Welcome Packet for Jeniece Wert is attached.  Thank you,  Richard Salas', NULL, NULL, '2021-12-21 13:22:59', '2021-12-21 13:22:59'),
(45925, 10057, 31286, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : ECMExecutionTeam@superiorhealthplan.com & SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Thank you for your response. Is there any update on JUAN ALONSO HERNANDEZ request. Please let me know.  Have a great day ahead!  Regards,', NULL, NULL, '2021-12-28 15:22:57', '2021-12-28 15:22:57'),
(45926, 20067, 31286, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health   Good Afternoon,  Hope you are doing well. I would like to know the enrollment status of the below-mentioned providers, and if any provider is enrolled kindly send me their welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Edna Michi	1992293906 Nubia Olivama Benavides	1801371935  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-05 16:33:58', '2022-01-05 16:33:58'),
(45927, 20067, 31286, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good afternoon, Hope you are doing well. I would like to know the enrollment status of the below-mentioned providers and if any of them is enrolled kindly send me their welcome kit.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 12:44:34', '2022-01-11 12:44:34'),
(45928, 20067, 31286, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from:   Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Hi there –     The below provider is still undergoing credentialing once completed a welcome letter will be sent.     Juan hernandez  1225617558     A forwarded copy of the welcome letter for the other listed provider has been resent.     Thank you', NULL, NULL, '2022-01-12 17:54:17', '2022-01-12 17:54:17'),
(45929, 20067, 31286, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning! Hope you are doing great. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 13:44:43', '2022-01-18 13:44:43'),
(45930, 20067, 31286, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning!  I would like to know the enrollment status of Juan Hernandez 1225617558 and also I would like to add the secondary and tertiary locations for provider Jeniece Wert 1659919702, Locations are listed below:  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-31 11:41:49', '2022-01-31 11:41:49'),
(45931, 20067, 31286, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health   Hello Syed,     Provider Juan Alonso Hernandez NPI 1225617558 TIN: 815123542 displays an effective date of 3/1/2022.     Respectfully,', NULL, NULL, '2022-02-17 13:02:49', '2022-02-17 13:02:49'),
(45932, 20067, 31286, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Afternoon Daniel!  Hope you are doing well. Kindly send me the welcome letter for Juan Hernandez. And what about Jeniece K Wert? Kindly update me.  Thank you,', NULL, NULL, '2022-02-24 10:18:55', '2022-02-24 10:18:55'),
(45933, 20067, 31286, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Hello Syed,     Provider: JENIECE K WERT NPI: 1659919702 TIN: 815123542 displays an effective date 12/1/2021.     A request was sent to our contracting department to send the Welcome Letters.     Please allow time to process and be sent.', NULL, NULL, '2022-02-24 10:19:24', '2022-02-24 10:19:24'),
(45934, 20067, 31286, NULL, '2022-03-15 00:00:00.000', 'Approved', 'Email received from: ECMExecutionTeam@superiorhealthplan.com  Sub:JUAN ALONSO HERNANDEZ WELCOME LETTER  JUAN ALONSO HERNANDEZ  VALLEY MED URGENT CARE PLLC  VMUC@CLAIMSMEDINC.COM        Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:    03/01/2022                                                 C/ 56674  ', NULL, NULL, '2022-03-08 14:49:51', '2022-03-08 14:49:51'),
(45935, 1006, 31287, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45936, 3040, 31287, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent Certification application and other documents also by fax to (608) 221-7535 (Tricare) ', NULL, NULL, '2021-06-04 14:38:29', '2021-06-04 14:38:29'),
(45937, 3040, 31287, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC. We already sent the credentialing form through fax.  Practice Details: Practice Name: Valley Med Urgent Care PLLC  Practice Tax ID# 81-5123542  Practice NPI# 1518404631  Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166 Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558 If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-21 11:07:05', '2021-06-21 11:07:05'),
(45938, 3040, 31287, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || Tricare ||  Hello Katherine,  Please advise the enrollment status for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC. We already sent the credentialing form through fax.  Practice Details: Practice Name: Valley Med Urgent Care PLLC  Practice Tax ID# 81-5123542  Practice NPI# 1518404631  Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166 Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558 If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-07-09 11:30:35', '2021-07-09 11:30:35'),
(45939, 3040, 31287, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece, Lira, Arturo & Hernandez, Juan || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 2: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 3: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-09 16:17:02', '2021-09-09 16:17:02'),
(45940, 10057, 31287, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:26:54', '2021-10-21 15:26:54'),
(45941, 10057, 31287, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Morning Steve,  Jacqueline Trenz can assist you with your request.    Brownsville and McAllen Texas is not in my area.  Thanks, Yvonne W. Wyatt,  Humana Military TRICARE Community Liaison II Houston/Galveston', NULL, NULL, '2021-11-23 17:35:13', '2021-11-23 17:35:13'),
(45942, 10057, 31287, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Yvonne,  Thank you for the update. Have a great day!  Regards,', NULL, NULL, '2021-12-01 16:24:14', '2021-12-01 16:24:14'),
(45943, 10057, 31287, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Jacqueline,  Hope this email finds you well. Could you please check and confirm once again, since I\'m unable to find the below mentioned providers on the Humana - Tricare directory.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Jeniece K Wert	1659919702 Homero Garcia	1730564857  Juan Hernandez we are still in contact to get his Malpractice.  Jeniece K Wert not showing for secondary and tertiary locations - previous email you have mentioned to fill out the roster, but there is no file attached.  Homero Garcia not showing in the directory.   Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-08 11:51:39', '2021-12-08 11:51:39'),
(45944, 10057, 31287, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Greetings!  Hope you are doing well. Can I get a quick response to the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-14 13:39:18', '2021-12-14 13:39:18'),
(45945, 10057, 31287, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello,  Any update on the below request. This is my SECOND REMINDER. Please get back to me with the latest update ASAP.  Regards,', NULL, NULL, '2021-12-21 13:39:21', '2021-12-21 13:39:21'),
(45946, 10057, 31287, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,  1) Juan Hernandez - We cannot move further on his application due to not having received his malpractice insurance certificate. Please see below.  2) Jeniece Wert – please see the attached Provider Roster to submit a request, to add a secondary & tertiary location.  Please email to HGBProviderRosters@humana.com.  3) Homero Garcia – provider profile is complete.  I have submitted a request to my data team to update the directory.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-28 15:29:12', '2021-12-28 15:29:12'),
(45947, 20067, 31287, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Garcia Homero	1730564857 Wert Jeniece	1659919702 Juan Hernandez	1225617558   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:11:16', '2022-01-05 17:11:16'),
(45948, 20067, 31287, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad ', NULL, NULL, '2022-01-18 14:09:27', '2022-01-18 14:09:27'),
(45949, 20067, 31287, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad', NULL, NULL, '2022-01-31 11:08:03', '2022-01-31 11:08:03'),
(45950, 20067, 31287, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good afternoon,     TRICARE does not send Welcome Kits or Letters.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE', NULL, NULL, '2022-02-16 17:30:17', '2022-02-16 17:30:17'),
(45951, 20067, 31287, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Evening!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-listed providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Nubia Benavides	1801371935	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Nubia Benavides	1801371935	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Nubia Benavides	1801371935	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Edna Michi	1992293906	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Edna Michi	1992293906	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Edna Michi	1992293906	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Juan Hernandez	1225617558	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Juan Hernandez	1225617558	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Juan Hernandez	1225617558	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Jeniece Wert	1659919702	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Jeniece Wert	1659919702	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Thank you,', NULL, NULL, '2022-03-02 17:06:16', '2022-03-02 17:06:16'),
(45952, 20067, 31287, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Secure Email received from: jtrenz@humana.com   Sub: RE: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon –     1)  Nubia Benavides  -   There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please use the attached form to submit a name update/correction.  Be sure to check the box at the top which states “Update Solo Practitioner Name”.  This needs to be corrected before credentialing can be completed. Please fax completed form to 608-221-7535.     2) Edna Michi – Please complete the 2nd attachment (Provider Roster).  On the first spreadsheet tab, include all information of the three locations.  On the second tab for Professional Info, please complete with all information on the professional provider. This will add the provider to the 3 locations.  Once complete, please email this form to HGBProviderRosters@humana.com.     3)  Juan Hernandez – There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please follow the same instructions for the form as with #1, Nubia Benavides.     4)  Jeniece Wert – Provider profile is complete.   101 E Expressway 83, Ste 170, McAllen Texas – Effective date 1/31/2022  800 E Alton Gloor, Brownsville TX – Effective date 1/31/2022.     Thank you,  Jacque Trenz', NULL, NULL, '2022-03-10 15:16:38', '2022-03-10 15:16:38'),
(45953, 20067, 31287, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Fax the provider update info at 608-221-7535  See the attachment', NULL, NULL, '2022-03-10 15:28:32', '2022-03-10 15:28:32'),
(45954, 1006, 31288, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39');
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
(45955, 1005, 31288, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s Enrollment.', NULL, NULL, '2021-06-04 09:35:32', '2021-06-04 09:35:32'),
(45956, 3040, 31288, NULL, '2021-06-21 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828 ', NULL, NULL, '2021-06-14 15:59:33', '2021-06-14 15:59:33'),
(45957, 3040, 31288, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:21:29', '2021-06-18 16:21:29'),
(45958, 3040, 31288, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:02', '2021-07-20 11:18:02'),
(45959, 3040, 31288, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,    Hope you are doing well. Please advise the enrollment status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.      Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations)  Practice Tax-ID# 81-5123542  Practice NPI# 1518404631  Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider 1:  Provider Name: Garcia, Homero  Provider NPI# 1730564857     Provider 2:  Provider Name: Lira, Arturo Alejandro  Provider NPI# 1245789502     Provider 3:  Provider Name: Lopez, Mayra Alejandra  Provider NPI# 1265945125    Provider 4:  Provider Name: Hernandez, Juan  Provider NPI# 1225617558    If you need any additional information please let me know. Waiting to hear from you soon.     Thank you   ', NULL, NULL, '2021-09-07 13:57:09', '2021-09-07 13:57:09'),
(45960, 10057, 31288, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lira, Arturo Alejandro	1245789502 Lopez, Mayra Alejandra	1265945125 Hernandez, Juan	1225617558  Please get back to me as soon as you get a chance. Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 13:24:39', '2021-10-19 13:24:39'),
(45961, 10057, 31288, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Dear Provider:  Thank you for your interest in joining the Wellcare network.  Please allow us 30 calendar days to review your request.  A Centene contracting representative will reach out to you within 30 calendar days.  Please note:  In response to your request to join the Wellcare network, you may receive correspondence from a Superior Health Plan email address.   Thank you once again for your interest.  Sincerely, Network Management', NULL, NULL, '2021-11-17 10:11:17', '2021-11-17 10:11:17'),
(45962, 10057, 31288, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  I have submitted the remaining below mentioned provider forms via your website, let me know the update.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Garcia, Homero	1730564857 Juan Hernandez	1225617558 Lopez, Mayra	1265945125  Please find the attached forms for your reference as well.  Thanks & Regards,', NULL, NULL, '2021-11-30 16:10:25', '2021-11-30 16:10:25'),
(45963, 10057, 31288, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned providers request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 15:39:23', '2021-12-07 15:39:23'),
(45964, 10057, 31288, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:30:17', '2021-12-17 15:30:17'),
(45965, 10057, 31288, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Thank you for reaching out. Can I get the welcome packets of mentioned providers?  Looking forward to hearing from you soon.  Regards,', NULL, NULL, '2021-12-27 12:57:10', '2021-12-27 12:57:10'),
(45966, 10057, 31288, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,  Here is a list of par providers for your contract, and the welcome letter.  Please see attachment.  Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-30 14:27:03', '2021-12-30 14:27:03'),
(45967, 20067, 31288, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || WellCare ||   Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Juan Hernandez	1225617558 Homero garcia	1730564857 Mayra Lopez	1265945125  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:53:25', '2022-01-05 17:53:25'),
(45968, 20067, 31288, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon!  Hope you had a great weekend. Any updates on the below-mentioned request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 14:22:57', '2022-01-18 14:22:57'),
(45969, 20067, 31288, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Received the effective date but not confirm for which location, Will approve the task next week after the confirmation.', NULL, NULL, '2022-01-31 09:49:37', '2022-01-31 09:49:37'),
(45970, 20067, 31288, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||   Good Morning,   Welcome letters will only have one address on them. The provider was requested to be loaded to 3 addresses and they are par for them all:', NULL, NULL, '2022-02-08 12:43:35', '2022-02-08 12:43:35'),
(45971, 1006, 31289, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45972, 1005, 31289, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:27:06', '2021-06-04 09:27:06'),
(45973, 3040, 31289, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'Provider enrolled in Medicare. I tried to enroll the provider in Medicare Railroad but  PTAN is not uploaded in Medicare Railroad system. It will take sometime to show up in their system. ', NULL, NULL, '2021-06-14 08:42:32', '2021-06-14 08:42:32'),
(45974, 11056, 31289, NULL, '2021-07-07 00:00:00.000', 'Initiated', 'Railroad Medicare PTAN has been assigned. Please allow three business days for the activation of this new PTAN. Please see the attachment Ref no : 21180001260', NULL, NULL, '2021-06-29 14:55:23', '2021-06-29 14:55:23'),
(45975, 3040, 31289, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JUAN A HERNANDEZ PA PROVIDER PTAN	Q00092312 PROVIDER NPI	1225617558 EFFECTIVE DATE	05/01/2021', NULL, NULL, '2021-07-20 07:03:37', '2021-07-20 07:03:37'),
(45976, 1006, 31290, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45977, 3040, 31290, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Applicant Name: JUAN HERNANDEZ  Tracking ID: T060420210002625  Submitted Date: FRI - JUNE 04 2021 02:48:47 PM EST  Submitted By: Juan Hernandez  Contact Email(s): VMUC@CLAIMSMEDINC.COM JUANAHDZ21@GMAIL.COM', NULL, NULL, '2021-06-04 13:50:27', '2021-06-04 13:50:27'),
(45978, 3040, 31290, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: JUAN HERNANDEZ Individual Specialty: PHYSICIAN ASSISTANT Individual National Provider Identifier (NPI): 1225617558 Individual Provider Transaction Access Number (PTAN): 1Q2215 Individual PTAN Effective Date: MAY 1, 2021 Employer Legal Business Name (LBN): VALLEY MED URGENT CARE PLLC Employer National Provider Identifier (NPI): 1518404631 Employer Provider Transaction Access Number (PTAN): 578343', NULL, NULL, '2021-06-11 16:24:25', '2021-06-11 16:24:25'),
(45979, 1006, 31291, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:39', '2021-06-03 17:29:39'),
(45980, 3040, 31291, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-06-04 13:20:21', '2021-06-04 13:20:21'),
(45981, 1006, 31292, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:40', '2021-06-03 17:29:40'),
(45982, 3040, 31292, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task.  ', NULL, NULL, '2021-06-04 14:21:46', '2021-06-04 14:21:46'),
(45983, 1006, 31293, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:40', '2021-06-03 17:29:40'),
(45984, 1005, 31293, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:36:58', '2021-06-04 09:36:58'),
(45985, 3040, 31293, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Healthplan in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-12 10:49:19', '2021-07-12 10:49:19'),
(45986, 10057, 31293, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email sent to : AM.Hidalgo@superiorhealthplan.com  Sub : Status Request - Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good Morning,  Hope this email finds you well. I want to get the latest update on my credentialing application of below mentioned providers under the facility tax I.D.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702  If you have any questions please let us know, we will be happy to help.  Thanks & Regards,', NULL, NULL, '2021-10-05 10:53:25', '2021-10-05 10:53:25'),
(45987, 10057, 31293, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Sent To : SHP.NetworkDevelopment@superiorhealthplan.com, AM.Houston@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Afternoon,  Hope this email finds you well. I want to get the latest update on my credentialing application for below mentioned providers under the facility tax I.D.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702  Looking forward to hearing from you soon. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-08 15:22:52', '2021-11-08 15:22:52'),
(45988, 10057, 31293, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com,   Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Hello Region 4,  Provider is requesting assistance with contract status. Location is in Brownsville, Tx  Can someone please assist?  Thank you, Patricia Torres', NULL, NULL, '2021-11-09 11:46:13', '2021-11-09 11:46:13'),
(45989, 10057, 31293, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com  Sub : Good Evening,  Please view the following provider Credentialing status:  Hernandez, Juan NPI: 1225617558 TIN: 815123542 is under Credentialing, please allow additional time to process.  Wert, Jeniece K NPI: 1659919702 TIN: 815123542 Effective Date: 12/1/2021  Respectfully,  Daniel Velez Provider Account Manager,', NULL, NULL, '2021-11-30 10:40:00', '2021-11-30 10:40:00'),
(45990, 10057, 31293, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Afternoon Daniel,  Hope you are doing well. I really appreciate your response to this request. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-06 15:52:47', '2021-12-06 15:52:47'),
(45991, 10057, 31293, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Greetings!  Any update on the Juan Hernandez, NPI - 1225617558, TIN: 815123542 request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-14 17:22:25', '2021-12-14 17:22:25'),
(45992, 10057, 31293, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Morning,  I\'m writing this email to check the status for the below mentioned request. This is my SECOND REMINDER. Kindly update me ASAP!  Regards, Steve Albert ', NULL, NULL, '2021-12-21 09:41:31', '2021-12-21 09:41:31'),
(45993, 10057, 31293, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Afternoon Steve,  Juan Hernandez, NPI: 1225617558, TIN: 815123542 is within Credentialing status.  Please allow time to process and feel free to inquire about status updates.', NULL, NULL, '2021-12-28 11:38:46', '2021-12-28 11:38:46'),
(45994, 20067, 31293, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Good Morning!  Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558    Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-05 10:30:28', '2022-01-05 10:30:28'),
(45995, 20067, 31293, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email Received from  Daniel.Velez@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||   Good Afternoon Syed,     JUAN ALONSO HERNANDEZ NPI 1225617558 TIN 815123542 is within Credentialing.     Please allow more time to process and feel free to request status updates.      Respectfully, Daniel Velez.', NULL, NULL, '2022-01-05 14:05:08', '2022-01-05 14:05:08'),
(45996, 20067, 31293, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Re: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Good Morning Daniel, Hope all is well with you. Any update on the previous request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 10:48:35', '2022-01-18 10:48:35'),
(45997, 20067, 31293, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email Received from: Daniel.Velez@superiorhealthplan.com  Sub: Re: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||   Hello Syed,  JUAN ALONSO HERNANDEZ NPI 1225617558 TIN 815123542 is currently within Credentialing.  At this time, there is no request for missing information. If there is any missing or incomplete information, the cred specialist will contact you immediately.', NULL, NULL, '2022-01-28 17:27:33', '2022-01-28 17:27:33'),
(45998, 20067, 31293, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Good Morning Daniel, Hope all is well with you. Any update on the previous request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-02-04 10:31:11', '2022-02-04 10:31:11'),
(45999, 20067, 31293, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Hello Syed,     Provider JUAN ALONSO HERNANDEZ NPI 1225617558 TIN 815123542 completed credentialing and is in-network with Superior HealthPlan effective 3/1/2022.', NULL, NULL, '2022-02-16 15:33:19', '2022-02-16 15:33:19'),
(46000, 20067, 31293, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Hello Daniel!  Thanks for the update. Can you please provide me the welcome letter.  Thank you,', NULL, NULL, '2022-02-16 15:33:42', '2022-02-16 15:33:42'),
(46001, 20067, 31293, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||   Good Morning Syed,     The agreement is sent to leadership for signature, once that has been received back from final signature the Welcome Letter along with the provider contract will be sent.     Please allow extra time for completion and delivery of information.  ', NULL, NULL, '2022-03-02 15:08:05', '2022-03-02 15:08:05'),
(46002, 20067, 31293, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter   Hello Syed,     There are open records for the following providers below under TIN 815123542, Superior HealthPlan has sent emails to the responsible party and is now awaiting for the applications.     Nubia Olivama Benavides NPI: 1801371935 Email sent on Mon 2/21/2022 2:11 PM Edna Michi NPI: 1992293906 Email sent on Mon 2/21/2022 2:22 PM ', NULL, NULL, '2022-03-17 17:25:50', '2022-03-17 17:25:50'),
(46003, 20067, 31293, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Hello Daniel,  Hope you are well. I haven\'t heard from you, Kindly update me about Juan Hernandez and also confirm that all 3 locations of Valley Med Urgent Care have been added to the provider\'s profile  Thank you,', NULL, NULL, '2022-03-17 17:34:03', '2022-03-17 17:34:03'),
(46004, 20067, 31293, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Good Morning Syed,     Juan Hernandez displays loaded with all 3 locations.     I requested that a copy of the welcome letter be sent to you.  ', NULL, NULL, '2022-03-18 10:03:44', '2022-03-18 10:03:44'),
(46005, 20067, 31293, NULL, '2022-03-29 00:00:00.000', 'Approved', 'Email received from: ECMExecutionTeam@superiorhealthplan.com  Sub:JUAN ALONSO HERNANDEZ WELCOME LETTER  JUAN ALONSO HERNANDEZ  VALLEY MED URGENT CARE PLLC  VMUC@CLAIMSMEDINC.COM        Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:    03/01/2022                                                 C/ 56674 ', NULL, NULL, '2022-03-22 14:53:32', '2022-03-22 14:53:32'),
(46006, 1006, 31294, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:40', '2021-06-03 17:29:40'),
(46007, 3040, 31294, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558   Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you.', NULL, NULL, '2021-06-04 14:44:55', '2021-06-04 14:44:55'),
(46008, 11056, 31294, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:32:15', '2021-06-18 16:32:15'),
(46009, 3040, 31294, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject; Re: Provider Update Information Form- TRPN  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:47:45', '2021-07-05 14:47:45'),
(46010, 3040, 31294, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || TRPN ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in TRPN for our group under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248   Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 16:40:24', '2021-07-22 16:40:24'),
(46011, 12062, 31294, NULL, '2021-09-29 00:00:00.000', 'In Process', 'SENT A FOLLOW UP MAIL  subject:RE: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || TRPN ||  to:mflores@trpnppo.com trpndataentry@trpnppo.com ccampos@trpnppo.com  Dear Max Flores,  Please update for below.  If there is any further information you need , please feel free to ask me. ', NULL, NULL, '2021-09-21 16:25:43', '2021-09-21 16:25:43'),
(46012, 12062, 31294, NULL, '2021-10-01 00:00:00.000', 'In Process', 'As per the attached mail received from TRPN, the request is completed .However I replied back for a welcome letter and Effective date. To:ccampos@trpnppo.com Subject:RE: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || TRPN ||   Dear Campos,  Good Day!  Please provide references such as effective date, plans and onboarding letter for a provider with below details in TRPN network.', NULL, NULL, '2021-09-23 16:43:08', '2021-09-23 16:43:08'),
(46013, 10057, 31294, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Sent To : mflores@trpnppo.com, trpndataentry@trpnppo.com, ccampos@trpnppo.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || TRPN ||  Hello,  Hope you are doing well. I\'m writing this email to check the status and to get the effective date along with the welcome letters as well for the below mentioned provider under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558  Your earliest response will be highly appreciated. have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-02 15:19:54', '2021-11-02 15:19:54'),
(46014, 10057, 31294, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Sent To : trpndataentry@trpnppo.com, ccampos@trpnppo.com & efry@trpnppo.com  Enrollment Status || Valley Med Urgent Care PLLC || Providers || TRPN ||  Good Morning,  Hope this email finds you well. Please help me out to get the latest enrollment status for below mentioned providers under TIN including all given locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Juan Hernandez	1225617558  Your earliest response will be highly appreciated. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-16 09:42:21', '2021-11-16 09:42:21'),
(46015, 10057, 31294, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email Received From : trpndataentry@trpnppo.com  Sub : RE: Enrollment Status || Valley Med Urgent Care PLLC || Providers || TRPN ||  Provider Juan Hernandez is Active, effective date 07/23/2021,  Provider Nubia Benavides is Active, effective date 10/29/2021,  Provider Edna Michi is Active, effective date 10/29/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940', NULL, NULL, '2021-11-17 10:56:28', '2021-11-17 10:56:28'),
(46016, 1006, 31295, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:40', '2021-06-03 17:29:40'),
(46017, 1005, 31295, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:37:43', '2021-06-04 09:37:43'),
(46018, 3040, 31295, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Driscoll in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-12 10:51:03', '2021-07-12 10:51:03'),
(46019, 3040, 31295, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Re: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Driscoll ||   Hello,   Hope you are doing well. I wanted to enroll the below mentioned provider in Driscoll in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-09-01 15:06:56', '2021-09-01 15:06:56'),
(46020, 10057, 31295, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  I don’t know what was missing or needed,  I’m only able to see that they were withdrawn for lack of response.  You are welcome to resubmit the requests and I can run them through again.  It is very important that the CAQH is current and accurate with special attention to practice address/information and contact person information.   We are required to send all credentialing through Aperture so, if someone from Aperture needs to request additional information, they will be able to contact the correct person.  They will also be looking for the practice information to match our request.   Once we get the records from Aperture, someone from our credentialing department may need to obtain additional information and a very prompt response is needed due to time limitations in processing.  If you would like to send the requests again, please also include the attached, additional documents for each of them.  You are welcome to send them directly to me and I will be glad to get them started again.  Since they are mid-level practitioners, we will also need a current PAA or Collaborative agreement for them.  Please let me know if you need any further assistance.  I look forward to hearing from you soon.  Karla Claunch    ', NULL, NULL, '2021-11-08 14:34:54', '2021-11-08 14:34:54'),
(46021, 10057, 31295, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Forms needs to submit.', NULL, NULL, '2021-12-01 16:04:55', '2021-12-01 16:04:55'),
(46022, 10057, 31295, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Waiting for PAA and Collaborative agreement - reminder sent to Alex', NULL, NULL, '2021-12-14 10:56:38', '2021-12-14 10:56:38'),
(46023, 10057, 31295, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing great. Please see the attached documents for the credentialing process for the below mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra	1265945125 Naranjo, Diego	1568929800  Let me know if you have any questions.  Thanks & Regards,', NULL, NULL, '2021-12-21 10:27:57', '2021-12-21 10:27:57'),
(46024, 10057, 31295, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  Thank you for these, I will hold them for their records however, we will need a Request for Contract(attached) for each provider.   There is a PAA attached for Juan Alonso Hernandez, we have no records of this provider and will also need his addendum and disclosure along with the Request for Contract.   The other PAA attached was for Homero Garcia but, we will also need one for each of the NP/PA providers.   You can send all of these documents directly to me when you’re ready.   At this time, I’m not able to start processing any of these providers without the requests but, I look forward to working with these as soon as I hear back from you.  Thank you', NULL, NULL, '2021-12-28 13:09:50', '2021-12-28 13:09:50'),
(46025, 20067, 31295, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Good Afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Diego Naranjo	1568929800 Homero García	1730564857 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 13:26:39', '2022-01-05 13:26:39'),
(46026, 20067, 31295, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Please see my comments in the table added to the right     Juan Hernandez  1225617558  No records of this provider  Diego Naranjo  1568929800  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Homero García  1730564857  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Mayra Lopez  1265945125  7/26/2021 Application withdrawn due to Incomplete/Non-Response', NULL, NULL, '2022-01-18 12:24:37', '2022-01-18 12:24:37'),
(46027, 20067, 31295, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon, Hope this email finds you well. Can you please tell me what information insurance is asking for these providers and also please tell me the procedure.  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-28 18:01:12', '2022-01-28 18:01:12'),
(46028, 20067, 31295, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub:  Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello,  I don’t know what they were missing but, they will need to start the process over again since these were withdrawn.  It is important to make sure their CAQH is current, complete and accurate.  It is also very important to make sure the practice and contact person information are correct and all current documents are loaded to their CAQH records.  You must respond to Apertutre/Verisys and our credentialing specialists when they attempt contact to retrieve additional information.  All of this will prevent delays and/or withdrawal.   When sending in the Request for Contract, also include the additional, attached documents and a PAA or Collaborative agreement for NP’s or PA’s.  Email to dhpcontracting@dchstx.org  Our inbox cannot open encrypted emails.  If you are unable to send unencrypted emails, you can send everything directly to me but, please don’t send to both.', NULL, NULL, '2022-02-04 11:23:39', '2022-02-04 11:23:39'),
(46029, 22077, 31295, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Driscoll ||  Hi Karla,  I would like to know the enrollment process for the following provider  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558  Thanks. ', NULL, NULL, '2022-04-07 14:48:04', '2022-04-07 14:48:04'),
(46030, 1006, 31296, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:40', '2021-06-03 17:29:40'),
(46031, 3040, 31296, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Providers Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-04 11:59:19', '2021-06-04 11:59:19'),
(46032, 3040, 31296, NULL, '2021-06-22 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-15 13:24:38', '2021-06-15 13:24:38'),
(46033, 11056, 31296, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:37:33', '2021-07-01 13:37:33'),
(46034, 3040, 31296, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:36', '2021-07-08 16:56:36'),
(46035, 1006, 31297, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:40', '2021-06-03 17:29:40'),
(46036, 1005, 31297, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:16:48', '2021-06-04 09:16:48'),
(46037, 3040, 31297, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.   ', NULL, NULL, '2021-06-14 15:57:13', '2021-06-14 15:57:13'),
(46038, 3040, 31297, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com   Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-07-20 14:04:21', '2021-07-20 14:04:21'),
(46039, 3040, 31297, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,  Please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,   Thanks  ', NULL, NULL, '2021-07-28 14:32:32', '2021-07-28 14:32:32');
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
(46040, 3040, 31297, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I sent the emails which are mentioned on the letter of interest form but I couldn\'t get any reply from their side. Can you please check the status and advise?  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,  Thank you  ', NULL, NULL, '2021-08-17 09:36:59', '2021-08-17 09:36:59'),
(46041, 10057, 31297, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Good Morning,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-11 09:51:08', '2021-10-11 09:51:08'),
(46042, 10057, 31297, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com, TXGQProviderRelations@healthspring.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:50:26', '2021-11-15 17:50:26'),
(46043, 10057, 31297, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Can I get the latest update on the below mentioned request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:04:47', '2021-11-30 13:04:47'),
(46044, 10057, 31297, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you in good health. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan  Hernandez	1225617558 Jeniece K  Wert	1659919702 Larry  Wright	1033769765 Teresa  Saavedra	1255676151 Eder  Hernandez	1386956852 Homero  Garcia	1730564857 Deborah  Potter	1861914053 Diego  Naranjo	1568929800 Mayra  Lopez	1265945125  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:35:55', '2021-12-06 17:35:55'),
(46045, 10057, 31297, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hey,  I\'m writing this email to check the current status on the below mentioned request. This is my second reminder.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-13 12:41:53', '2021-12-13 12:41:53'),
(46046, 10057, 31297, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Steve,  The last Letter of Interest that was submitted to Valley Organized Physicians/LVPA was in October of 2018. The LVPA Board of Directors determined that there was no network need and appropriate communication was provided via mail. If the group would like to be reconsidered, please fill out the attached LOI and we can make sure to review during our January 2022 Board of Directors meeting. I is going to be important that you list out all locations as well.  Please let me know if you have any other questions.  Thank you, Iliana', NULL, NULL, '2021-12-20 11:45:22', '2021-12-20 11:45:22'),
(46047, 10057, 31297, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Thank you for reaching out. Please find the attached LOI for groups and providers.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125 Escobar, Angiollet	1962917997 Rodriguez, Cynthia	1124282553  Please revert back to me once you have the update. Have a great day!  Regards,', NULL, NULL, '2021-12-27 11:07:40', '2021-12-27 11:07:40'),
(46048, 20067, 31297, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Subject: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hello Good Morning,  Hope you are doing well. I want to know the enrollment status for the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Jeniece Wert	1659919702 Cynthia Rodriguez	1124282553 Deborah Potter	1861914053 Larry Wright	1033769765 Teresa Saavedra	1255676151 Diego Naranjo	1568929800 Eder Hernandez	1386956852 Homero Garcia	1730564857 Angiollet Escobar	1962917997 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.  ', NULL, NULL, '2022-01-05 12:46:02', '2022-01-05 12:46:02'),
(46049, 20067, 31297, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Hello Syed,     I emailed Steve Albert, but the email bounced back.     We will be meeting with our LVPA and HOPE Board of Directors the week of the  24th where we will be discussing your group. Please fill out 1 LOI for the group with all location listed.  Please email me with any questions that you may have.     Thank you.     Iliana', NULL, NULL, '2022-01-11 13:55:13', '2022-01-11 13:55:13'),
(46050, 20067, 31297, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Good afternoon,  Hope all is well with you. The LOI form which you sent me doesn\'t have fields for additional locations. Kindly see the attachment below  Eagerly waiting to hear from you   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 14:02:11', '2022-01-11 14:02:11'),
(46051, 20067, 31297, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Thank you for the updated LOI. I added all locations. We meet with our Board of Directors on January 24th. Will be InTouch. ', NULL, NULL, '2022-01-11 17:47:53', '2022-01-11 17:47:53'),
(46052, 20067, 31297, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Will follow-up next week because the meeting of Board of Directors will be on  24th January', NULL, NULL, '2022-01-18 10:59:27', '2022-01-18 10:59:27'),
(46053, 20067, 31297, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Good Evening! Hope this email finds you well. Any updates on the request?  Eagerly waiting to hear from you, Thanks and Regards,', NULL, NULL, '2022-01-28 17:53:51', '2022-01-28 17:53:51'),
(46054, 20067, 31297, NULL, '2022-02-11 00:00:00.000', 'Not Eligible', 'Email received from: dulce.lumbrera@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hi Syed,  Thank you for reaching out. Please see attached for a response to the letter of interest that was presented at the Board of Director meeting. Thank you', NULL, NULL, '2022-02-04 10:44:36', '2022-02-04 10:44:36'),
(46055, 1006, 31298, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:40', '2021-06-03 17:29:40'),
(46056, 3040, 31298, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider  ', NULL, NULL, '2021-06-04 11:41:49', '2021-06-04 11:41:49'),
(46057, 1006, 31299, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:40', '2021-06-03 17:29:40'),
(46058, 3040, 31299, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || Triwest ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and provider in Triwest for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-04 14:41:52', '2021-06-04 14:41:52'),
(46059, 3040, 31299, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:39:22', '2021-06-18 15:39:22'),
(46060, 3040, 31299, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:34:53', '2021-07-16 11:34:53'),
(46061, 1006, 31300, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:40', '2021-06-03 17:29:40'),
(46062, 3040, 31300, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-06-04 11:21:56', '2021-06-04 11:21:56'),
(46063, 1006, 31302, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:40', '2021-06-03 17:29:40'),
(46064, 3040, 31302, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task.  ', NULL, NULL, '2021-06-04 15:00:12', '2021-06-04 15:00:12'),
(46065, 3040, 31302, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:20', '2021-07-20 09:22:20'),
(46066, 3040, 31302, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:21', '2021-08-17 09:20:21'),
(46067, 3040, 31302, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:50', '2021-08-27 09:16:50'),
(46068, 1006, 31313, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:40', '2021-06-03 17:29:40'),
(46069, 3040, 31313, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'enaissance Physicians does not cover Brownsville or McAllen, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-06-04 11:22:58', '2021-06-04 11:22:58'),
(46070, 1006, 31314, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:41', '2021-06-03 17:29:41'),
(46071, 1005, 31314, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-04 09:18:56', '2021-06-04 09:18:56'),
(46072, 3040, 31314, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-06-04 11:20:25', '2021-06-04 11:20:25'),
(46073, 1006, 31315, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:29:41', '2021-06-03 17:29:41'),
(46074, 3040, 31315, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-06-04 11:27:03', '2021-06-04 11:27:03'),
(46075, 1006, 31316, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46076, 3040, 31316, NULL, '2021-06-11 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 310023', NULL, NULL, '2021-06-04 16:03:11', '2021-06-04 16:03:11'),
(46077, 3040, 31316, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 310023 || Valley Med Urgent Care PLLC || Hernandez, Juan || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in BCBS for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address:  2534 Boca Chica Blvd. Brownsville, TX 78521-3496   Secondary Address:  101 E. Expy 83 Ste. 170 McAllen, TX 78501-1166 Tertiary Address:  800 E. Alton Gloor Ave. Brownsville, TX 78521-3496  Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-22 11:33:21', '2021-06-22 11:33:21'),
(46078, 3040, 31316, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email rcvd from: TXProviderUpdateSubmission@bcbstx.com  Subject: Application ID: 310023 || Valley Med Urgent Care PLLC || Hernandez, Juan || BCBS || : Case Number - 02567289  Good afternoon,  I have located your application the provider’s record number for your group has been set up.  Juan A Hernandez Provider record # 8PR463  For any questions regarding network contracting, credentialing, network effective dates or status requests, please reach out to your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number), fax, and email contact methods.   Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-07-12 14:28:50', '2021-07-12 14:28:50'),
(46079, 10057, 31316, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email Sent To : Noemi_Diaz@bcbstx.com  Sub : BCBS - Enrollment Query  Good Afternoon,  Hope you are doing well. I am writing this email to get the latest update on the credentialing applications of below mentioned providers.  Group Name	Valley Med Urgent Care PLLC (Two locations) Tax ID	81-3237149 Group NPI	1821542432 Primary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Provider Name	NPI Wert, Jeniece K	1659919702 - Case # 02552862 Luyando, Mariana	1518404631 - Application # 334796  Please feel free to call or email me. Waiting to hear from you soon  Thanks & Regards,', NULL, NULL, '2021-10-05 14:48:35', '2021-10-05 14:48:35'),
(46080, 10057, 31316, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Called on mentioned number to follow up (210) 558-5149  Representative told she is forwarding a request to add McAllen & Alton Gloor Locations.  Need to Follow-up after 10 days through email Noemi_Diaz@bcbstx.com.', NULL, NULL, '2021-11-09 15:14:47', '2021-11-09 15:14:47'),
(46081, 10057, 31316, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || VMUC || Edna Michi & Juan Hernandez || BCBS  Hello,  Can I get the latest update on the below mentioned providers for 02 locations.  Group Name	Valley Med Urgent Care PLLC (Two locations) Tax ID	81-5123542 Group NPI	1518404631 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name	NPI Juan Hernandez	1225617558 Edna Michi	1992293906  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:28:16', '2021-11-30 11:28:16'),
(46082, 10057, 31316, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Received From : Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || VMUC || Edna Michi & Juan Hernandez || BCBS  Good afternoon,  Juan Hernandez does have the 2 locations listed for him.  I sent a request to our provider relations area to get those added to Edna Michi as well.  Thank you,  All the Best,  Noemi Diaz Network Management Consultant | Network Management - West Region Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-12-06 16:27:30', '2021-12-06 16:27:30'),
(46083, 10057, 31316, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || VMUC || Edna Michi & Juan Hernandez || BCBS  Greetings!  Thank you for your response. I just want to follow-up on location addition requests, is there any update on that ?  Please let me know, once you get a chance.  Kind Regards,', NULL, NULL, '2021-12-16 10:51:29', '2021-12-16 10:51:29'),
(46084, 10057, 31316, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email Received From : Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || VMUC || Edna Michi & Juan Hernandez || BCBS  Good morning,  The satellite locations have been added to Edna Michi, PA.', NULL, NULL, '2021-12-16 13:53:48', '2021-12-16 13:53:48'),
(46085, 1006, 31317, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46086, 3040, 31317, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-06-04 11:01:18', '2021-06-04 11:01:18'),
(46087, 1006, 31318, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46088, 1005, 31318, NULL, '2021-06-12 00:00:00.000', 'Initiated', 'CAQH Provider ID:  15160227 CAQH account created and Spoke with Cigna Rep they asked to wait for 24 hour for CAQH to verify the information and attest it so Cigna may extract the details from there.', NULL, NULL, '2021-06-04 15:04:06', '2021-06-04 15:04:06'),
(46089, 3040, 31318, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Provider ID: 3567367 Application no: 12638455', NULL, NULL, '2021-06-09 16:57:15', '2021-06-09 16:57:15'),
(46090, 3040, 31318, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email rcvd from: discovercigna@information.cigna.com  Subject: Cigna Credentialing Status Update: Application Received  Re:	Reference number 12638455 Application to participate in the Cigna medical network Dear JUAN HERNANDEZ,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.', NULL, NULL, '2021-06-28 14:31:49', '2021-06-28 14:31:49'),
(46091, 3040, 31318, NULL, '2021-07-26 00:00:00.000', 'In Process', '', NULL, NULL, '2021-07-19 08:36:54', '2021-07-19 08:36:54'),
(46092, 3040, 31318, NULL, '2021-07-26 00:00:00.000', 'In Process', 'I had a word (Luis)  Cigna representative and he advised that application is still in reviewing process and will take up 90-120 days    Ref: Luis A 07/19/2021', NULL, NULL, '2021-07-19 08:37:06', '2021-07-19 08:37:06'),
(46093, 12062, 31318, NULL, '2021-09-21 00:00:00.000', 'In Process', 'I spoke with Cigna representative, they advised to send email on intake_pdm@cigna.com to add provide locations.  The reference to my call was : Gigi as rep name and 09/14/2021   subject:	ADD PROVIDER LOCATONS - HERNANDEZ , JUAN ALONSO  Dear Cigna Team,  Good day !  This is to inform you that the provider with the following details has already been in network with Cigna . However we want to add secondary and tertiary locations of the same provider.  Provider Details: Provider Name: HERNANDEZ,JUAN ALONSO Provider NPI# : 1225617558   Practice Name: Valley Med Urgent Care PLLC Practice NPI# :   151840463 Practice TIN# : 81-5123542  Primary Address: 2534 Boca Chica Blvd , Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd ,Brownsville , TX 78526-4248 Tertiary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Please feel free to ask me if you need further details in this regard.  Thanking you in advance.', NULL, NULL, '2021-09-13 14:12:22', '2021-09-13 14:12:22'),
(46094, 10057, 31318, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Sent To : 	intake_pdm@cigna.com  Sub : ADD PROVIDER LOCATONS - HERNANDEZ, JUAN ALONSO  Good Afternoon,  Hope this email finds you well. I wanted to check the status for the below mentioned provider and locations. Please note the provider is already in the Cigna network. We just want to add secondary and tertiary locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631  Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-22 11:26:18', '2021-10-22 11:26:18'),
(46095, 10057, 31318, NULL, '2021-11-10 00:00:00.000', 'Approved', 'Effective Date: 08/02/2021  Call reference code : Joe 11/03/2021  Please find attachments.', NULL, NULL, '2021-11-03 08:42:36', '2021-11-03 08:42:36'),
(46096, 1006, 31319, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46097, 3040, 31319, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || UHC ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and provider in UHC for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-04 15:36:41', '2021-06-04 15:36:41'),
(46098, 3040, 31319, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com   Subject: Re: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || UHC ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in UHC for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 11:40:54', '2021-06-22 11:40:54'),
(46099, 3040, 31319, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject:  Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || UHC ||  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned provider in UHC for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-12 14:27:01', '2021-07-12 14:27:01'),
(46100, 3040, 31319, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || UHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in UHC for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-08-30 11:48:02', '2021-08-30 11:48:02'),
(46101, 3040, 31319, NULL, '2021-09-21 00:00:00.000', 'Approved', 'Provider is participating with UHC. For more details please see attachment. ', NULL, NULL, '2021-09-14 13:27:58', '2021-09-14 13:27:58'),
(46102, 1006, 31320, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46103, 1005, 31320, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:39:05', '2021-06-04 09:39:05'),
(46104, 3040, 31320, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'TCHP does not cover Hidalgo or Cameron County for VMUC. ', NULL, NULL, '2021-06-04 11:28:47', '2021-06-04 11:28:47'),
(46105, 1006, 31321, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46106, 3040, 31321, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Effective Date: 11/01/2017  Group has an ancillary contract.', NULL, NULL, '2021-06-04 14:01:17', '2021-06-04 14:01:17'),
(46107, 1006, 31322, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46108, 1005, 31322, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:37:07', '2021-06-04 09:37:07'),
(46109, 3040, 31322, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html ', NULL, NULL, '2021-06-04 11:26:00', '2021-06-04 11:26:00'),
(46110, 1006, 31323, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46111, 1005, 31323, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:37:24', '2021-06-04 09:37:24'),
(46112, 3040, 31323, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference. ', NULL, NULL, '2021-06-04 11:24:36', '2021-06-04 11:24:36'),
(46113, 1006, 31324, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46114, 1005, 31324, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Aetna\'s approval.', NULL, NULL, '2021-06-04 09:14:01', '2021-06-04 09:14:01'),
(46115, 11056, 31324, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Talked to Chris for enrollment procedure for First Health at Aetna. Form has been submitted. Waiting for enrollment. Please see attachments. Ref no. of call is : 6026518636 Ref code for form is : MEDICAL', NULL, NULL, '2021-06-24 15:40:22', '2021-06-24 15:40:22'),
(46116, 3040, 31324, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-07-13 13:25:15', '2021-07-13 13:25:15'),
(46117, 1006, 31325, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46118, 3040, 31325, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.  ', NULL, NULL, '2021-06-04 13:54:58', '2021-06-04 13:54:58'),
(46119, 3040, 31325, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Provider Application – Hernandez  Greetings,  I wanted to know the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 09:23:18', '2021-06-21 09:23:18'),
(46120, 3040, 31325, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Provider Application – Hernandez  Hello,  Hope you are doing well. Please advise the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-07-05 10:52:39', '2021-07-05 10:52:39'),
(46121, 3040, 31325, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Provider Application – Hernandez  Hi,  Provider \'\' Hernandez, Juan A PA \'\' is Effective \'\' 08/01/2021 \'\'  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :81311)  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2021-07-23 13:57:56', '2021-07-23 13:57:56'),
(46122, 3040, 31325, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject:  Provider Application – Hernandez  Hello,   Hope you are doing well. Please note that I checked the Health Smart provider directory and the provider is not showing up in the directory. Can you please check and advise?  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thank you ', NULL, NULL, '2021-07-23 13:58:23', '2021-07-23 13:58:23'),
(46123, 3040, 31325, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Provider Application – Hernandez  Greetings,  Hope you are doing well. Please note that I checked the Health smart provider directory and it shows the provider is participating at the primary location which is 2534 Boca Chica Blvd Brownsville TX 78521 and the remaining 02 which is 800 E Alton Gloor Blvd Brownsville , TX 78526 & 101 E Expressway 83, Suite 170 Mcallen TX 78501 locations are not showing in the directory. Can you please check & advise?   Thank you ', NULL, NULL, '2021-08-30 14:19:51', '2021-08-30 14:19:51'),
(46124, 10057, 31325, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : pr.south@healthsmart.com  Sub : Providers Application – Health Smart  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631  Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Potter, Deborah	1861914053  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-14 16:08:56', '2021-10-14 16:08:56'),
(46125, 10057, 31325, NULL, '2021-11-12 00:00:00.000', 'Approved', 'Email Received From : mdiprsupport@healthsmart.com  Sub : Providers Application – Health Smart  Hi,  01- Please see the following Providers with effective dates.  Provider Name   Effective Date   Juan A Hernandez, PA  08/01/2021   Deborah Potter, NP  06/01/2021   02- We are returning your application due to missing information listed below.  Provider Name   Missing Information   LUYANDO, MARIANA PA   Current certificate of Insurance.   Please review the attached Application Review Form and forward the missing information within the next 5 days. Alternatively, please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-11-05 13:41:30', '2021-11-05 13:41:30'),
(46126, 1006, 31326, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46127, 3040, 31326, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Service Case Number:	7630381 Details have been emailed to you at: vmuc@claimsmedinc.com', NULL, NULL, '2021-06-04 14:19:49', '2021-06-04 14:19:49'),
(46128, 3040, 31326, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Service Case Number:	7647780 Details have been emailed to you at: vmuc@claimsmedinc.com', NULL, NULL, '2021-06-22 13:24:21', '2021-06-22 13:24:21'),
(46129, 3040, 31326, NULL, '2021-07-19 00:00:00.000', 'In Process', 'I had a word with PAM B Multiplan representative and she advise provider is in-network with both Multiplan & PHCS but provider is not showing on directory. After discussion with Brad he said we can\'t rely on the effective provider need to show up on directory. ', NULL, NULL, '2021-07-12 14:45:58', '2021-07-12 14:45:58'),
(46130, 3040, 31326, NULL, '2021-07-20 00:00:00.000', 'Approved', '', NULL, NULL, '2021-07-13 13:32:53', '2021-07-13 13:32:53'),
(46131, 1006, 31327, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46132, 1005, 31327, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:26:07', '2021-06-04 09:26:07'),
(46133, 3040, 31327, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-06-04 14:05:39', '2021-06-04 14:05:39'),
(46134, 1006, 31328, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46135, 1005, 31328, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:24:17', '2021-06-04 09:24:17'),
(46136, 3040, 31328, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Application Status            Submitted PEP Ticket Number          17843821', NULL, NULL, '2021-06-11 17:23:37', '2021-06-11 17:23:37'),
(46137, 1005, 31328, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Checked online and the application is currently \"In Progress\".', NULL, NULL, '2021-06-29 11:44:13', '2021-06-29 11:44:13'),
(46138, 3040, 31328, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Provider is participating with Medicaid. Please see attachment. ', NULL, NULL, '2021-07-12 10:07:52', '2021-07-12 10:07:52'),
(46139, 1006, 31329, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46140, 1005, 31329, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:26:20', '2021-06-04 09:26:20'),
(46141, 3040, 31329, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and provider in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-04 14:12:23', '2021-06-04 14:12:23'),
(46142, 3040, 31329, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task. ', NULL, NULL, '2021-06-16 16:21:23', '2021-06-16 16:21:23'),
(46143, 3040, 31329, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:08', '2021-07-20 11:30:08'),
(46144, 3040, 31329, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:18:47', '2021-07-27 16:18:47'),
(46145, 1006, 31331, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46146, 1005, 31331, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-04 09:19:23', '2021-06-04 09:19:23'),
(46147, 3040, 31331, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com  ', NULL, NULL, '2021-06-04 11:19:09', '2021-06-04 11:19:09'),
(46148, 1006, 31332, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46149, 1005, 31332, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:38:50', '2021-06-04 09:38:50'),
(46150, 3040, 31332, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Superior Health ||   Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Healthplan in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-12 10:47:47', '2021-07-12 10:47:47'),
(46151, 3040, 31332, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject: Re: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Superior Health ||  Hello,  Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Healthplan in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-08-27 13:19:18', '2021-08-27 13:19:18'),
(46152, 3040, 31332, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: RE: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Superior Health ||  Good Afternoon Adil,  To request network participation, please follow the enrollment process: Add a Provider to an Existing Group Contract  Upon completion, you should receive an email within a minimum of two weeks. Please make sure to review your Spam folder and respond within a timely manner.  If I may be of assistance, please do not hesitate to contact me.  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA', NULL, NULL, '2021-09-01 09:59:37', '2021-09-01 09:59:37'),
(46153, 12062, 31332, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email received from : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  & replied to SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Fwd: [SECURE] Add a provider- JUAN ALONSO HERNANDEZ   Dear Provider,  We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.             Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com  for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.          To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/     For Re-Credentialing, please email your information to credentialing@centene.com.     Samantha Cazares Superior Health Plan | Network Operations  I have replied to this email with a completed add provide application form   Attached form for your reference.', NULL, NULL, '2021-09-09 13:53:40', '2021-09-09 13:53:40'),
(46154, 10057, 31332, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com, SHP.NetworkDevelopment@superiorhealthplan.com  Sub : [SECURE] Add a provider- JUAN ALONSO HERNANDEZ & Luyando, Mariana || Superior Health ||  Good Evening,  Hope this email finds you well. I wanted to follow up regarding the enrollment status for the below mentioned providers in Superior Healthplan in our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Luyando, Mariana	1700960556  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-21 16:24:44', '2021-10-21 16:24:44');
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
(46155, 10057, 31332, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: [SECURE] Add a provider- JUAN ALONSO HERNANDEZ & Luyando, Mariana || Superior Health ||  Good afternoon,  Here is the status for the requested providers-  MARIANA LUYANDO- We received your completed application on 09/24/2021.  Your effective date is 11/01/2021 and you will be receiving a welcome packet shortly.  JUAN HERNANDEZ-  We received your completed application on 09/13/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you, Samantha Cazares  Contracts Coordinator, Contracting & Network Development', NULL, NULL, '2021-10-22 08:56:12', '2021-10-22 08:56:12'),
(46156, 10057, 31332, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning,  Hope this email finds you in good health. Could you please help me out to get the latest enrollment status for below mentioned providers under TIN including all given locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-16 09:33:02', '2021-11-16 09:33:02'),
(46157, 10057, 31332, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good morning,  Here are the statuses below-  Juan Hernandez- We received your completed application on 09/13/21.  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Jeniece Wert- We received your completed application on 06/24/2021.  Your effective date is 12/01/2021 and you will be receiving a welcome packet shortly.  Thank you,  Samantha Cazares  Contracts Coordinator', NULL, NULL, '2021-11-16 13:50:27', '2021-11-16 13:50:27'),
(46158, 10057, 31332, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Greetings!  Thank you for your prompt response. Have a great day!  Regards,', NULL, NULL, '2021-11-30 15:08:03', '2021-11-30 15:08:03'),
(46159, 10057, 31332, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Afternoon,  Hope this email finds you well. I\'m writing this email to get the welcome packets. Your earliest response will be highly appreciated.   Thanks & Regards,', NULL, NULL, '2021-12-07 14:11:33', '2021-12-07 14:11:33'),
(46160, 10057, 31332, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good afternoon,  I have requested the welcome packet for Jeniece Wert and you should be receiving it shortly.  JUAN ALONSO HERNANDEZ- is currently still in credentialing. We appreciate your patience as credentialing can take up to 90 days.', NULL, NULL, '2021-12-14 13:31:27', '2021-12-14 13:31:27'),
(46161, 10057, 31332, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : ECMExecutionTeam@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good morning Steve,  Here is the Welcome Packet for Jeniece Wert is attached.  Thank you,  Richard Salas', NULL, NULL, '2021-12-21 13:22:53', '2021-12-21 13:22:53'),
(46162, 10057, 31332, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : ECMExecutionTeam@superiorhealthplan.com & SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Thank you for your response. Is there any update on JUAN ALONSO HERNANDEZ request. Please let me know.  Have a great day ahead!  Regards,', NULL, NULL, '2021-12-28 15:22:52', '2021-12-28 15:22:52'),
(46163, 20067, 31332, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health   Good Afternoon,  Hope you are doing well. I would like to know the enrollment status of the below-mentioned providers, and if any provider is enrolled kindly send me their welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Edna Michi	1992293906 Nubia Olivama Benavides	1801371935  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-05 16:33:42', '2022-01-05 16:33:42'),
(46164, 20067, 31332, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good afternoon, Hope you are doing well. I would like to know the enrollment status of the below-mentioned providers and if any of them is enrolled kindly send me their welcome kit.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 12:44:24', '2022-01-11 12:44:24'),
(46165, 20067, 31332, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from:   Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Hi there –     The below provider is still undergoing credentialing once completed a welcome letter will be sent.     Juan hernandez  1225617558     A forwarded copy of the welcome letter for the other listed provider has been resent.     Thank you', NULL, NULL, '2022-01-12 17:53:31', '2022-01-12 17:53:31'),
(46166, 20067, 31332, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning! Hope you are doing great. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 13:44:36', '2022-01-18 13:44:36'),
(46167, 20067, 31332, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning!  I would like to know the enrollment status of Juan Hernandez 1225617558 and also I would like to add the secondary and tertiary locations for provider Jeniece Wert 1659919702, Locations are listed below:  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-31 11:41:43', '2022-01-31 11:41:43'),
(46168, 20067, 31332, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health   Hello Syed,     Provider Juan Alonso Hernandez NPI 1225617558 TIN: 815123542 displays an effective date of 3/1/2022.     Respectfully,', NULL, NULL, '2022-02-17 13:02:03', '2022-02-17 13:02:03'),
(46169, 20067, 31332, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Afternoon Daniel!  Hope you are doing well. Kindly send me the welcome letter for Juan Hernandez. And what about Jeniece K Wert? Kindly update me.  Thank you,', NULL, NULL, '2022-02-24 10:18:49', '2022-02-24 10:18:49'),
(46170, 20067, 31332, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Hello Syed,     Provider: JENIECE K WERT NPI: 1659919702 TIN: 815123542 displays an effective date 12/1/2021.     A request was sent to our contracting department to send the Welcome Letters.     Please allow time to process and be sent.', NULL, NULL, '2022-02-24 10:19:18', '2022-02-24 10:19:18'),
(46171, 20067, 31332, NULL, '2022-03-15 00:00:00.000', 'Approved', 'Email received from: ECMExecutionTeam@superiorhealthplan.com  Sub:JUAN ALONSO HERNANDEZ WELCOME LETTER  JUAN ALONSO HERNANDEZ  VALLEY MED URGENT CARE PLLC  VMUC@CLAIMSMEDINC.COM        Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:    03/01/2022                                                 C/ 56674  ', NULL, NULL, '2022-03-08 14:49:42', '2022-03-08 14:49:42'),
(46172, 1006, 31333, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46173, 3040, 31333, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent Certification application and other documents also by fax to (608) 221-7535 (Tricare) ', NULL, NULL, '2021-06-04 14:38:33', '2021-06-04 14:38:33'),
(46174, 3040, 31333, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC. We already sent the credentialing form through fax.  Practice Details: Practice Name: Valley Med Urgent Care PLLC  Practice Tax ID# 81-5123542  Practice NPI# 1518404631  Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166 Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558 If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-21 11:07:00', '2021-06-21 11:07:00'),
(46175, 3040, 31333, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || Tricare ||  Hello Katherine,  Please advise the enrollment status for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC. We already sent the credentialing form through fax.  Practice Details: Practice Name: Valley Med Urgent Care PLLC  Practice Tax ID# 81-5123542  Practice NPI# 1518404631  Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166 Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558 If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-07-09 11:30:32', '2021-07-09 11:30:32'),
(46176, 3040, 31333, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece, Lira, Arturo & Hernandez, Juan || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 2: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 3: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-09 16:17:02', '2021-09-09 16:17:02'),
(46177, 10057, 31333, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:26:48', '2021-10-21 15:26:48'),
(46178, 10057, 31333, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Morning Steve,  Jacqueline Trenz can assist you with your request.    Brownsville and McAllen Texas is not in my area.  Thanks, Yvonne W. Wyatt,  Humana Military TRICARE Community Liaison II Houston/Galveston', NULL, NULL, '2021-11-23 17:35:07', '2021-11-23 17:35:07'),
(46179, 10057, 31333, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Yvonne,  Thank you for the update. Have a great day!  Regards,', NULL, NULL, '2021-12-01 16:24:08', '2021-12-01 16:24:08'),
(46180, 10057, 31333, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Jacqueline,  Hope this email finds you well. Could you please check and confirm once again, since I\'m unable to find the below mentioned providers on the Humana - Tricare directory.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Jeniece K Wert	1659919702 Homero Garcia	1730564857  Juan Hernandez we are still in contact to get his Malpractice.  Jeniece K Wert not showing for secondary and tertiary locations - previous email you have mentioned to fill out the roster, but there is no file attached.  Homero Garcia not showing in the directory.   Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-08 11:51:34', '2021-12-08 11:51:34'),
(46181, 10057, 31333, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Greetings!  Hope you are doing well. Can I get a quick response to the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-14 13:39:13', '2021-12-14 13:39:13'),
(46182, 10057, 31333, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello,  Any update on the below request. This is my SECOND REMINDER. Please get back to me with the latest update ASAP.  Regards,', NULL, NULL, '2021-12-21 13:39:15', '2021-12-21 13:39:15'),
(46183, 10057, 31333, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,  1) Juan Hernandez - We cannot move further on his application due to not having received his malpractice insurance certificate. Please see below.  2) Jeniece Wert – please see the attached Provider Roster to submit a request, to add a secondary & tertiary location.  Please email to HGBProviderRosters@humana.com.  3) Homero Garcia – provider profile is complete.  I have submitted a request to my data team to update the directory.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-28 15:29:06', '2021-12-28 15:29:06'),
(46184, 20067, 31333, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Garcia Homero	1730564857 Wert Jeniece	1659919702 Juan Hernandez	1225617558   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:11:05', '2022-01-05 17:11:05'),
(46185, 20067, 31333, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad ', NULL, NULL, '2022-01-18 14:09:20', '2022-01-18 14:09:20'),
(46186, 20067, 31333, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad', NULL, NULL, '2022-01-31 11:07:56', '2022-01-31 11:07:56'),
(46187, 20067, 31333, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good afternoon,     TRICARE does not send Welcome Kits or Letters.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE', NULL, NULL, '2022-02-16 17:30:10', '2022-02-16 17:30:10'),
(46188, 20067, 31333, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Evening!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-listed providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Nubia Benavides	1801371935	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Nubia Benavides	1801371935	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Nubia Benavides	1801371935	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Edna Michi	1992293906	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Edna Michi	1992293906	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Edna Michi	1992293906	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Juan Hernandez	1225617558	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Juan Hernandez	1225617558	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Juan Hernandez	1225617558	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Jeniece Wert	1659919702	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Jeniece Wert	1659919702	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Thank you,', NULL, NULL, '2022-03-02 17:06:11', '2022-03-02 17:06:11'),
(46189, 20067, 31333, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Secure Email received from: jtrenz@humana.com   Sub: RE: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon –     1)  Nubia Benavides  -   There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please use the attached form to submit a name update/correction.  Be sure to check the box at the top which states “Update Solo Practitioner Name”.  This needs to be corrected before credentialing can be completed. Please fax completed form to 608-221-7535.     2) Edna Michi – Please complete the 2nd attachment (Provider Roster).  On the first spreadsheet tab, include all information of the three locations.  On the second tab for Professional Info, please complete with all information on the professional provider. This will add the provider to the 3 locations.  Once complete, please email this form to HGBProviderRosters@humana.com.     3)  Juan Hernandez – There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please follow the same instructions for the form as with #1, Nubia Benavides.     4)  Jeniece Wert – Provider profile is complete.   101 E Expressway 83, Ste 170, McAllen Texas – Effective date 1/31/2022  800 E Alton Gloor, Brownsville TX – Effective date 1/31/2022.     Thank you,  Jacque Trenz', NULL, NULL, '2022-03-10 15:16:31', '2022-03-10 15:16:31'),
(46190, 20067, 31333, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Fax the provider update info at 608-221-7535  See the attachment', NULL, NULL, '2022-03-10 15:28:23', '2022-03-10 15:28:23'),
(46191, 1006, 31334, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46192, 1005, 31334, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s Enrollment.', NULL, NULL, '2021-06-04 09:35:27', '2021-06-04 09:35:27'),
(46193, 3040, 31334, NULL, '2021-06-21 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828 ', NULL, NULL, '2021-06-14 15:59:28', '2021-06-14 15:59:28'),
(46194, 3040, 31334, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:21:26', '2021-06-18 16:21:26'),
(46195, 3040, 31334, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:01', '2021-07-20 11:18:01'),
(46196, 3040, 31334, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,    Hope you are doing well. Please advise the enrollment status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.      Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations)  Practice Tax-ID# 81-5123542  Practice NPI# 1518404631  Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider 1:  Provider Name: Garcia, Homero  Provider NPI# 1730564857     Provider 2:  Provider Name: Lira, Arturo Alejandro  Provider NPI# 1245789502     Provider 3:  Provider Name: Lopez, Mayra Alejandra  Provider NPI# 1265945125    Provider 4:  Provider Name: Hernandez, Juan  Provider NPI# 1225617558    If you need any additional information please let me know. Waiting to hear from you soon.     Thank you   ', NULL, NULL, '2021-09-07 13:57:09', '2021-09-07 13:57:09'),
(46197, 10057, 31334, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status for the remaining providers in Wellcare in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lira, Arturo Alejandro	1245789502 Lopez, Mayra Alejandra	1265945125 Hernandez, Juan	1225617558  Please get back to me as soon as you get a chance. Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 13:24:32', '2021-10-19 13:24:32'),
(46198, 10057, 31334, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Dear Provider:  Thank you for your interest in joining the Wellcare network.  Please allow us 30 calendar days to review your request.  A Centene contracting representative will reach out to you within 30 calendar days.  Please note:  In response to your request to join the Wellcare network, you may receive correspondence from a Superior Health Plan email address.   Thank you once again for your interest.  Sincerely, Network Management', NULL, NULL, '2021-11-17 10:11:11', '2021-11-17 10:11:11'),
(46199, 10057, 31334, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  I have submitted the remaining below mentioned provider forms via your website, let me know the update.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Garcia, Homero	1730564857 Juan Hernandez	1225617558 Lopez, Mayra	1265945125  Please find the attached forms for your reference as well.  Thanks & Regards,', NULL, NULL, '2021-11-30 16:10:19', '2021-11-30 16:10:19'),
(46200, 10057, 31334, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned providers request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 15:38:41', '2021-12-07 15:38:41'),
(46201, 10057, 31334, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:30:07', '2021-12-17 15:30:07'),
(46202, 10057, 31334, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Thank you for reaching out. Can I get the welcome packets of mentioned providers?  Looking forward to hearing from you soon.  Regards,', NULL, NULL, '2021-12-27 12:57:03', '2021-12-27 12:57:03'),
(46203, 10057, 31334, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,  Here is a list of par providers for your contract, and the welcome letter.  Please see attachment.  Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-30 14:26:28', '2021-12-30 14:26:28'),
(46204, 20067, 31334, NULL, '2022-01-12 00:00:00.000', 'In Process', '', NULL, NULL, '2022-01-05 17:53:14', '2022-01-05 17:53:14'),
(46205, 20067, 31334, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon!  Hope you had a great weekend. Any updates on the below-mentioned request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 14:22:52', '2022-01-18 14:22:52'),
(46206, 20067, 31334, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Received the effective date but not confirm for which location, Will approve the task next week after the confirmation.', NULL, NULL, '2022-01-31 09:49:31', '2022-01-31 09:49:31'),
(46207, 20067, 31334, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||   Good Morning,   Welcome letters will only have one address on them. The provider was requested to be loaded to 3 addresses and they are par for them all:', NULL, NULL, '2022-02-08 12:44:01', '2022-02-08 12:44:01'),
(46208, 1006, 31335, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46209, 1005, 31335, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:27:01', '2021-06-04 09:27:01'),
(46210, 3040, 31335, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'Provider enrolled in Medicare. I tried to enroll the provider in Medicare Railroad but  PTAN is not uploaded in Medicare Railroad system. It will take sometime to show up in their system. ', NULL, NULL, '2021-06-14 08:42:27', '2021-06-14 08:42:27'),
(46211, 11056, 31335, NULL, '2021-07-07 00:00:00.000', 'Initiated', 'Railroad Medicare PTAN has been assigned. Please allow three business days for the activation of this new PTAN. Please see the attachment Ref no : 21180001260', NULL, NULL, '2021-06-29 14:55:15', '2021-06-29 14:55:15'),
(46212, 3040, 31335, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JUAN A HERNANDEZ PA PROVIDER PTAN	Q00092312 PROVIDER NPI	1225617558 EFFECTIVE DATE	05/01/2021', NULL, NULL, '2021-07-20 07:03:37', '2021-07-20 07:03:37'),
(46213, 1006, 31336, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:19', '2021-06-03 17:35:19'),
(46214, 3040, 31336, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Applicant Name: JUAN HERNANDEZ  Tracking ID: T060420210002625  Submitted Date: FRI - JUNE 04 2021 02:48:47 PM EST  Submitted By: Juan Hernandez  Contact Email(s): VMUC@CLAIMSMEDINC.COM JUANAHDZ21@GMAIL.COM', NULL, NULL, '2021-06-04 13:50:32', '2021-06-04 13:50:32'),
(46215, 3040, 31336, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: JUAN HERNANDEZ Individual Specialty: PHYSICIAN ASSISTANT Individual National Provider Identifier (NPI): 1225617558 Individual Provider Transaction Access Number (PTAN): 1Q2215 Individual PTAN Effective Date: MAY 1, 2021 Employer Legal Business Name (LBN): VALLEY MED URGENT CARE PLLC Employer National Provider Identifier (NPI): 1518404631 Employer Provider Transaction Access Number (PTAN): 578343', NULL, NULL, '2021-06-11 16:24:31', '2021-06-11 16:24:31'),
(46216, 1006, 31337, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20'),
(46217, 3040, 31337, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-06-04 13:20:31', '2021-06-04 13:20:31'),
(46218, 1006, 31338, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20'),
(46219, 3040, 31338, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task.  ', NULL, NULL, '2021-06-04 14:21:56', '2021-06-04 14:21:56'),
(46220, 1006, 31339, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20'),
(46221, 1005, 31339, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:36:54', '2021-06-04 09:36:54'),
(46222, 3040, 31339, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Healthplan in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-12 10:49:19', '2021-07-12 10:49:19'),
(46223, 10057, 31339, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email sent to : AM.Hidalgo@superiorhealthplan.com  Sub : Status Request - Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good Morning,  Hope this email finds you well. I want to get the latest update on my credentialing application of below mentioned providers under the facility tax I.D.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702  If you have any questions please let us know, we will be happy to help.  Thanks & Regards,', NULL, NULL, '2021-10-05 10:52:52', '2021-10-05 10:52:52'),
(46224, 10057, 31339, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Sent To : SHP.NetworkDevelopment@superiorhealthplan.com, AM.Houston@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Afternoon,  Hope this email finds you well. I want to get the latest update on my credentialing application for below mentioned providers under the facility tax I.D.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702  Looking forward to hearing from you soon. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-08 15:22:45', '2021-11-08 15:22:45'),
(46225, 10057, 31339, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com,   Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Hello Region 4,  Provider is requesting assistance with contract status. Location is in Brownsville, Tx  Can someone please assist?  Thank you, Patricia Torres', NULL, NULL, '2021-11-09 11:46:07', '2021-11-09 11:46:07'),
(46226, 10057, 31339, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com  Sub : Good Evening,  Please view the following provider Credentialing status:  Hernandez, Juan NPI: 1225617558 TIN: 815123542 is under Credentialing, please allow additional time to process.  Wert, Jeniece K NPI: 1659919702 TIN: 815123542 Effective Date: 12/1/2021  Respectfully,  Daniel Velez Provider Account Manager,', NULL, NULL, '2021-11-30 10:39:54', '2021-11-30 10:39:54'),
(46227, 10057, 31339, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Afternoon Daniel,  Hope you are doing well. I really appreciate your response to this request. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-06 15:52:39', '2021-12-06 15:52:39'),
(46228, 10057, 31339, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Greetings!  Any update on the Juan Hernandez, NPI - 1225617558, TIN: 815123542 request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-14 17:22:16', '2021-12-14 17:22:16'),
(46229, 10057, 31339, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Morning,  I\'m writing this email to check the status for the below mentioned request. This is my SECOND REMINDER. Kindly update me ASAP!  Regards, Steve Albert ', NULL, NULL, '2021-12-21 09:41:26', '2021-12-21 09:41:26'),
(46230, 10057, 31339, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Afternoon Steve,  Juan Hernandez, NPI: 1225617558, TIN: 815123542 is within Credentialing status.  Please allow time to process and feel free to inquire about status updates.', NULL, NULL, '2021-12-28 11:38:40', '2021-12-28 11:38:40'),
(46231, 20067, 31339, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Good Morning!  Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558    Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-05 10:30:22', '2022-01-05 10:30:22'),
(46232, 20067, 31339, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email Received from  Daniel.Velez@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||   Good Afternoon Syed,     JUAN ALONSO HERNANDEZ NPI 1225617558 TIN 815123542 is within Credentialing.     Please allow more time to process and feel free to request status updates.      Respectfully, Daniel Velez.', NULL, NULL, '2022-01-05 14:04:46', '2022-01-05 14:04:46'),
(46233, 20067, 31339, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Re: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Good Morning Daniel, Hope all is well with you. Any update on the previous request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 10:48:28', '2022-01-18 10:48:28'),
(46234, 20067, 31339, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email Received from: Daniel.Velez@superiorhealthplan.com  Sub: Re: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||   Hello Syed,  JUAN ALONSO HERNANDEZ NPI 1225617558 TIN 815123542 is currently within Credentialing.  At this time, there is no request for missing information. If there is any missing or incomplete information, the cred specialist will contact you immediately.', NULL, NULL, '2022-01-28 17:27:25', '2022-01-28 17:27:25'),
(46235, 20067, 31339, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Good Morning Daniel, Hope all is well with you. Any update on the previous request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-02-04 10:31:04', '2022-02-04 10:31:04'),
(46236, 20067, 31339, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Hello Syed,     Provider JUAN ALONSO HERNANDEZ NPI 1225617558 TIN 815123542 completed credentialing and is in-network with Superior HealthPlan effective 3/1/2022.', NULL, NULL, '2022-02-16 15:33:12', '2022-02-16 15:33:12'),
(46237, 20067, 31339, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Hello Daniel!  Thanks for the update. Can you please provide me the welcome letter.  Thank you,', NULL, NULL, '2022-02-16 15:33:35', '2022-02-16 15:33:35'),
(46238, 20067, 31339, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||   Good Morning Syed,     The agreement is sent to leadership for signature, once that has been received back from final signature the Welcome Letter along with the provider contract will be sent.     Please allow extra time for completion and delivery of information.  ', NULL, NULL, '2022-03-02 15:07:57', '2022-03-02 15:07:57'),
(46239, 20067, 31339, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter   Hello Syed,     There are open records for the following providers below under TIN 815123542, Superior HealthPlan has sent emails to the responsible party and is now awaiting for the applications.     Nubia Olivama Benavides NPI: 1801371935 Email sent on Mon 2/21/2022 2:11 PM Edna Michi NPI: 1992293906 Email sent on Mon 2/21/2022 2:22 PM ', NULL, NULL, '2022-03-17 17:25:40', '2022-03-17 17:25:40'),
(46240, 20067, 31339, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Hello Daniel,  Hope you are well. I haven\'t heard from you, Kindly update me about Juan Hernandez and also confirm that all 3 locations of Valley Med Urgent Care have been added to the provider\'s profile  Thank you,', NULL, NULL, '2022-03-17 17:34:11', '2022-03-17 17:34:11'),
(46241, 20067, 31339, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Good Morning Syed,     Juan Hernandez displays loaded with all 3 locations.     I requested that a copy of the welcome letter be sent to you.  ', NULL, NULL, '2022-03-18 10:03:38', '2022-03-18 10:03:38'),
(46242, 20067, 31339, NULL, '2022-03-29 00:00:00.000', 'Approved', 'Email received from: ECMExecutionTeam@superiorhealthplan.com  Sub:JUAN ALONSO HERNANDEZ WELCOME LETTER  JUAN ALONSO HERNANDEZ  VALLEY MED URGENT CARE PLLC  VMUC@CLAIMSMEDINC.COM        Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:    03/01/2022                                                 C/ 56674 Email received from: ECMExecutionTeam@superiorhealthplan.com  Sub:JUAN ALONSO HERNANDEZ WELCOME LETTER  JUAN ALONSO HERNANDEZ  VALLEY MED URGENT CARE PLLC  VMUC@CLAIMSMEDINC.COM        Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:    03/01/2022                                                 C/ 56674 ', NULL, NULL, '2022-03-22 14:53:26', '2022-03-22 14:53:26'),
(46243, 1006, 31340, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20');
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
(46244, 3040, 31340, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558   Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you.', NULL, NULL, '2021-06-04 14:44:59', '2021-06-04 14:44:59'),
(46245, 11056, 31340, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:41:45', '2021-06-18 16:41:45'),
(46246, 3040, 31340, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject; Re: Provider Update Information Form- TRPN  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:47:45', '2021-07-05 14:47:45'),
(46247, 3040, 31340, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || TRPN ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in TRPN for our group under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248   Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 16:40:26', '2021-07-22 16:40:26'),
(46248, 12062, 31340, NULL, '2021-09-29 00:00:00.000', 'In Process', 'SENT A FOLLOW UP MAIL  subject:RE: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || TRPN ||  to:mflores@trpnppo.com trpndataentry@trpnppo.com ccampos@trpnppo.com  Dear Max Flores,  Please update for below.  If there is any further information you need , please feel free to ask me. ', NULL, NULL, '2021-09-21 16:25:27', '2021-09-21 16:25:27'),
(46249, 12062, 31340, NULL, '2021-10-01 00:00:00.000', 'In Process', 'As per the attached mail received from TRPN, the request is completed .However I replied back for a welcome letter and Effective date. To:ccampos@trpnppo.com Subject:RE: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || TRPN ||   Dear Campos,  Good Day!  Please provide references such as effective date, plans and onboarding letter for a provider with below details in TRPN network.', NULL, NULL, '2021-09-23 16:42:51', '2021-09-23 16:42:51'),
(46250, 10057, 31340, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Sent To : mflores@trpnppo.com, trpndataentry@trpnppo.com, ccampos@trpnppo.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || TRPN ||  Hello,  Hope you are doing well. I\'m writing this email to check the status and to get the effective date along with the welcome letters as well for the below mentioned provider under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558  Your earliest response will be highly appreciated. have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-02 15:19:49', '2021-11-02 15:19:49'),
(46251, 10057, 31340, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Sent To : trpndataentry@trpnppo.com, ccampos@trpnppo.com & efry@trpnppo.com  Enrollment Status || Valley Med Urgent Care PLLC || Providers || TRPN ||  Good Morning,  Hope this email finds you well. Please help me out to get the latest enrollment status for below mentioned providers under TIN including all given locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Juan Hernandez	1225617558  Your earliest response will be highly appreciated. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-16 09:42:15', '2021-11-16 09:42:15'),
(46252, 10057, 31340, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email Received From : trpndataentry@trpnppo.com  Sub : RE: Enrollment Status || Valley Med Urgent Care PLLC || Providers || TRPN ||  Provider Juan Hernandez is Active, effective date 07/23/2021,  Provider Nubia Benavides is Active, effective date 10/29/2021,  Provider Edna Michi is Active, effective date 10/29/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940', NULL, NULL, '2021-11-17 10:56:10', '2021-11-17 10:56:10'),
(46253, 1006, 31341, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20'),
(46254, 1005, 31341, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:37:38', '2021-06-04 09:37:38'),
(46255, 3040, 31341, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Driscoll in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-12 10:51:04', '2021-07-12 10:51:04'),
(46256, 3040, 31341, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Re: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Driscoll ||   Hello,   Hope you are doing well. I wanted to enroll the below mentioned provider in Driscoll in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-09-01 15:06:57', '2021-09-01 15:06:57'),
(46257, 10057, 31341, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  I don’t know what was missing or needed,  I’m only able to see that they were withdrawn for lack of response.  You are welcome to resubmit the requests and I can run them through again.  It is very important that the CAQH is current and accurate with special attention to practice address/information and contact person information.   We are required to send all credentialing through Aperture so, if someone from Aperture needs to request additional information, they will be able to contact the correct person.  They will also be looking for the practice information to match our request.   Once we get the records from Aperture, someone from our credentialing department may need to obtain additional information and a very prompt response is needed due to time limitations in processing.  If you would like to send the requests again, please also include the attached, additional documents for each of them.  You are welcome to send them directly to me and I will be glad to get them started again.  Since they are mid-level practitioners, we will also need a current PAA or Collaborative agreement for them.  Please let me know if you need any further assistance.  I look forward to hearing from you soon.  Karla Claunch    ', NULL, NULL, '2021-11-08 14:34:47', '2021-11-08 14:34:47'),
(46258, 10057, 31341, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Forms needs to submit.', NULL, NULL, '2021-12-01 16:04:46', '2021-12-01 16:04:46'),
(46259, 10057, 31341, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Waiting for PAA and Collaborative agreement - reminder sent to Alex', NULL, NULL, '2021-12-14 10:56:30', '2021-12-14 10:56:30'),
(46260, 10057, 31341, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing great. Please see the attached documents for the credentialing process for the below mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra	1265945125 Naranjo, Diego	1568929800  Let me know if you have any questions.  Thanks & Regards,', NULL, NULL, '2021-12-21 10:27:51', '2021-12-21 10:27:51'),
(46261, 10057, 31341, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  Thank you for these, I will hold them for their records however, we will need a Request for Contract(attached) for each provider.   There is a PAA attached for Juan Alonso Hernandez, we have no records of this provider and will also need his addendum and disclosure along with the Request for Contract.   The other PAA attached was for Homero Garcia but, we will also need one for each of the NP/PA providers.   You can send all of these documents directly to me when you’re ready.   At this time, I’m not able to start processing any of these providers without the requests but, I look forward to working with these as soon as I hear back from you.  Thank you', NULL, NULL, '2021-12-28 13:09:43', '2021-12-28 13:09:43'),
(46262, 20067, 31341, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Good Afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Diego Naranjo	1568929800 Homero García	1730564857 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 13:26:03', '2022-01-05 13:26:03'),
(46263, 20067, 31341, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Please see my comments in the table added to the right     Juan Hernandez  1225617558  No records of this provider  Diego Naranjo  1568929800  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Homero García  1730564857  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Mayra Lopez  1265945125  7/26/2021 Application withdrawn due to Incomplete/Non-Response', NULL, NULL, '2022-01-18 12:24:29', '2022-01-18 12:24:29'),
(46264, 20067, 31341, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon, Hope this email finds you well. Can you please tell me what information insurance is asking for these providers and also please tell me the procedure.  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-28 18:01:04', '2022-01-28 18:01:04'),
(46265, 20067, 31341, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub:  Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello,  I don’t know what they were missing but, they will need to start the process over again since these were withdrawn.  It is important to make sure their CAQH is current, complete and accurate.  It is also very important to make sure the practice and contact person information are correct and all current documents are loaded to their CAQH records.  You must respond to Apertutre/Verisys and our credentialing specialists when they attempt contact to retrieve additional information.  All of this will prevent delays and/or withdrawal.   When sending in the Request for Contract, also include the additional, attached documents and a PAA or Collaborative agreement for NP’s or PA’s.  Email to dhpcontracting@dchstx.org  Our inbox cannot open encrypted emails.  If you are unable to send unencrypted emails, you can send everything directly to me but, please don’t send to both.', NULL, NULL, '2022-02-04 11:23:18', '2022-02-04 11:23:18'),
(46266, 22077, 31341, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Driscoll ||  Hi Karla,  I would like to know the enrollment process for the following provider  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558  Thanks. ', NULL, NULL, '2022-04-07 14:48:31', '2022-04-07 14:48:31'),
(46267, 1006, 31342, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20'),
(46268, 3040, 31342, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Providers Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-04 11:59:24', '2021-06-04 11:59:24'),
(46269, 3040, 31342, NULL, '2021-06-22 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-15 13:24:35', '2021-06-15 13:24:35'),
(46270, 11056, 31342, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:37:40', '2021-07-01 13:37:40'),
(46271, 3040, 31342, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:36', '2021-07-08 16:56:36'),
(46272, 1006, 31343, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20'),
(46273, 1005, 31343, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:16:42', '2021-06-04 09:16:42'),
(46274, 3040, 31343, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.   ', NULL, NULL, '2021-06-14 15:57:09', '2021-06-14 15:57:09'),
(46275, 3040, 31343, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com   Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-07-20 14:04:22', '2021-07-20 14:04:22'),
(46276, 3040, 31343, NULL, '2021-08-04 00:00:00.000', 'In Process', '', NULL, NULL, '2021-07-28 14:32:31', '2021-07-28 14:32:31'),
(46277, 3040, 31343, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I sent the emails which are mentioned on the letter of interest form but I couldn\'t get any reply from their side. Can you please check the status and advise?  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,  Thank you  ', NULL, NULL, '2021-08-17 09:36:59', '2021-08-17 09:36:59'),
(46278, 10057, 31343, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Good Morning,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-11 09:50:53', '2021-10-11 09:50:53'),
(46279, 10057, 31343, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com, TXGQProviderRelations@healthspring.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:50:03', '2021-11-15 17:50:03'),
(46280, 10057, 31343, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Can I get the latest update on the below mentioned request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 12:00:29', '2021-11-30 12:00:29'),
(46281, 10057, 31343, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you in good health. I want to know the enrollment status for the below mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan  Hernandez	1225617558 Jeniece K  Wert	1659919702 Larry  Wright	1033769765 Teresa  Saavedra	1255676151 Eder  Hernandez	1386956852 Homero  Garcia	1730564857 Deborah  Potter	1861914053 Diego  Naranjo	1568929800 Mayra  Lopez	1265945125  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:39:14', '2021-12-06 17:39:14'),
(46282, 10057, 31343, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hey,  I\'m writing this email to check the current status on the below mentioned request. This is my second reminder.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-13 12:44:41', '2021-12-13 12:44:41'),
(46283, 10057, 31343, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Steve,  The last Letter of Interest that was submitted to Valley Organized Physicians/LVPA was in October of 2018. The LVPA Board of Directors determined that there was no network need and appropriate communication was provided via mail. If the group would like to be reconsidered, please fill out the attached LOI and we can make sure to review during our January 2022 Board of Directors meeting. I is going to be important that you list out all locations as well.  Please let me know if you have any other questions.  Thank you, Iliana', NULL, NULL, '2021-12-20 11:47:03', '2021-12-20 11:47:03'),
(46284, 10057, 31343, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Thank you for reaching out. Please find the attached LOI for groups and providers.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125 Escobar, Angiollet	1962917997 Rodriguez, Cynthia	1124282553  Please revert back to me once you have the update. Have a great day!  Regards,', NULL, NULL, '2021-12-27 11:07:34', '2021-12-27 11:07:34'),
(46285, 20067, 31343, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Subject: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hello Good Morning,  Hope you are doing well. I want to know the enrollment status for the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Jeniece Wert	1659919702 Cynthia Rodriguez	1124282553 Deborah Potter	1861914053 Larry Wright	1033769765 Teresa Saavedra	1255676151 Diego Naranjo	1568929800 Eder Hernandez	1386956852 Homero Garcia	1730564857 Angiollet Escobar	1962917997 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.  ', NULL, NULL, '2022-01-05 12:45:34', '2022-01-05 12:45:34'),
(46286, 20067, 31343, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Hello Syed,     I emailed Steve Albert, but the email bounced back.     We will be meeting with our LVPA and HOPE Board of Directors the week of the  24th where we will be discussing your group. Please fill out 1 LOI for the group with all location listed.  Please email me with any questions that you may have.     Thank you.     Iliana', NULL, NULL, '2022-01-11 13:55:06', '2022-01-11 13:55:06'),
(46287, 20067, 31343, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Good afternoon,  Hope all is well with you. The LOI form which you sent me doesn\'t have fields for additional locations. Kindly see the attachment below  Eagerly waiting to hear from you   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 14:02:04', '2022-01-11 14:02:04'),
(46288, 20067, 31343, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Thank you for the updated LOI. I added all locations. We meet with our Board of Directors on January 24th. Will be InTouch. ', NULL, NULL, '2022-01-11 17:47:45', '2022-01-11 17:47:45'),
(46289, 20067, 31343, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Will follow-up next week because the meeting of Board of Directors will be on  24th January', NULL, NULL, '2022-01-18 10:59:15', '2022-01-18 10:59:15'),
(46290, 20067, 31343, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Good Evening! Hope this email finds you well. Any updates on the request?  Eagerly waiting to hear from you, Thanks and Regards,', NULL, NULL, '2022-01-28 17:53:43', '2022-01-28 17:53:43'),
(46291, 20067, 31343, NULL, '2022-02-11 00:00:00.000', 'Not Eligible', 'Email received from: dulce.lumbrera@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hi Syed,  Thank you for reaching out. Please see attached for a response to the letter of interest that was presented at the Board of Director meeting. Thank you', NULL, NULL, '2022-02-04 10:43:55', '2022-02-04 10:43:55'),
(46292, 1006, 31344, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20'),
(46293, 3040, 31344, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider  ', NULL, NULL, '2021-06-04 11:41:59', '2021-06-04 11:41:59'),
(46294, 1006, 31345, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20'),
(46295, 3040, 31345, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || Triwest ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and provider in Triwest for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-04 14:41:56', '2021-06-04 14:41:56'),
(46296, 3040, 31345, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:39:18', '2021-06-18 15:39:18'),
(46297, 3040, 31345, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:34:53', '2021-07-16 11:34:53'),
(46298, 1006, 31346, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20'),
(46299, 3040, 31346, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-06-04 11:22:02', '2021-06-04 11:22:02'),
(46300, 1006, 31348, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20'),
(46301, 3040, 31348, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task.  ', NULL, NULL, '2021-06-04 15:00:21', '2021-06-04 15:00:21'),
(46302, 3040, 31348, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:19', '2021-07-20 09:22:19'),
(46303, 3040, 31348, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:20', '2021-08-17 09:20:20'),
(46304, 3040, 31348, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:49', '2021-08-27 09:16:49'),
(46305, 1006, 31358, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20'),
(46306, 3040, 31358, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'enaissance Physicians does not cover Brownsville or McAllen, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-06-04 11:23:03', '2021-06-04 11:23:03'),
(46307, 1006, 31359, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20'),
(46308, 1005, 31359, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-04 09:18:50', '2021-06-04 09:18:50'),
(46309, 3040, 31359, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-06-04 11:20:36', '2021-06-04 11:20:36'),
(46310, 1006, 31360, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:35:20', '2021-06-03 17:35:20'),
(46311, 3040, 31360, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-06-04 11:27:08', '2021-06-04 11:27:08'),
(46312, 1006, 31361, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:20', '2021-06-03 17:40:20'),
(46313, 3040, 31361, NULL, '2021-06-11 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 310023', NULL, NULL, '2021-06-04 16:03:07', '2021-06-04 16:03:07'),
(46314, 3040, 31361, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 310023 || Valley Med Urgent Care PLLC || Hernandez, Juan || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in BCBS for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address:  2534 Boca Chica Blvd. Brownsville, TX 78521-3496   Secondary Address:  101 E. Expy 83 Ste. 170 McAllen, TX 78501-1166 Tertiary Address:  800 E. Alton Gloor Ave. Brownsville, TX 78521-3496  Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-22 11:33:17', '2021-06-22 11:33:17'),
(46315, 3040, 31361, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email rcvd from: TXProviderUpdateSubmission@bcbstx.com  Subject: Application ID: 310023 || Valley Med Urgent Care PLLC || Hernandez, Juan || BCBS || : Case Number - 02567289  Good afternoon,  I have located your application the provider’s record number for your group has been set up.  Juan A Hernandez Provider record # 8PR463  For any questions regarding network contracting, credentialing, network effective dates or status requests, please reach out to your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number), fax, and email contact methods.   Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-07-12 14:28:50', '2021-07-12 14:28:50'),
(46316, 10057, 31361, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email Sent To : Noemi_Diaz@bcbstx.com  Sub : BCBS - Enrollment Query  Good Afternoon,  Hope you are doing well. I am writing this email to get the latest update on the credentialing applications of below mentioned providers.  Group Name	Valley Med Urgent Care PLLC (Two locations) Tax ID	81-3237149 Group NPI	1821542432 Primary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Provider Name	NPI Wert, Jeniece K	1659919702 - Case # 02552862 Luyando, Mariana	1518404631 - Application # 334796  Please feel free to call or email me. Waiting to hear from you soon  Thanks & Regards,', NULL, NULL, '2021-10-05 14:47:54', '2021-10-05 14:47:54'),
(46317, 10057, 31361, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Called on mentioned number to follow up (210) 558-5149  Representative told she is forwarding a request to add McAllen & Alton Gloor Locations.  Need to Follow-up after 10 days through email Noemi_Diaz@bcbstx.com.', NULL, NULL, '2021-11-09 15:14:36', '2021-11-09 15:14:36'),
(46318, 10057, 31361, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || VMUC || Edna Michi & Juan Hernandez || BCBS  Hello,  Can I get the latest update on the below mentioned providers for 02 locations.  Group Name	Valley Med Urgent Care PLLC (Two locations) Tax ID	81-5123542 Group NPI	1518404631 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name	NPI Juan Hernandez	1225617558 Edna Michi	1992293906  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:28:11', '2021-11-30 11:28:11'),
(46319, 10057, 31361, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Received From : Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || VMUC || Edna Michi & Juan Hernandez || BCBS  Good afternoon,  Juan Hernandez does have the 2 locations listed for him.  I sent a request to our provider relations area to get those added to Edna Michi as well.  Thank you,  All the Best,  Noemi Diaz Network Management Consultant | Network Management - West Region Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-12-06 16:27:20', '2021-12-06 16:27:20'),
(46320, 10057, 31361, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || VMUC || Edna Michi & Juan Hernandez || BCBS  Greetings!  Thank you for your response. I just want to follow-up on location addition requests, is there any update on that ?  Please let me know, once you get a chance.  Kind Regards,', NULL, NULL, '2021-12-16 10:51:21', '2021-12-16 10:51:21'),
(46321, 10057, 31361, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Email Received From : Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || VMUC || Edna Michi & Juan Hernandez || BCBS  Good morning,  The satellite locations have been added to Edna Michi, PA.', NULL, NULL, '2021-12-16 13:52:18', '2021-12-16 13:52:18'),
(46322, 1006, 31362, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:20', '2021-06-03 17:40:20'),
(46323, 3040, 31362, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-06-04 11:01:32', '2021-06-04 11:01:32'),
(46324, 1006, 31363, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:20', '2021-06-03 17:40:20'),
(46325, 1005, 31363, NULL, '2021-06-12 00:00:00.000', 'Initiated', 'CAQH Provider ID:  15160227 CAQH account created and Spoke with Cigna Rep they asked to wait for 24 hour for CAQH to verify the information and attest it so Cigna may extract the details from there.', NULL, NULL, '2021-06-04 15:03:51', '2021-06-04 15:03:51'),
(46326, 3040, 31363, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Provider ID: 3567367 Application no: 12638455', NULL, NULL, '2021-06-09 16:57:11', '2021-06-09 16:57:11'),
(46327, 3040, 31363, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email rcvd from: discovercigna@information.cigna.com  Subject: Cigna Credentialing Status Update: Application Received  Re:	Reference number 12638455 Application to participate in the Cigna medical network Dear JUAN HERNANDEZ,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.', NULL, NULL, '2021-06-28 14:31:44', '2021-06-28 14:31:44'),
(46328, 3040, 31363, NULL, '2021-07-26 00:00:00.000', 'In Process', 'I had a word (Luis)  Cigna representative and he advised that application is still in reviewing process and will take up 90-120 days    Ref: Luis A 07/19/2021', NULL, NULL, '2021-07-19 08:36:57', '2021-07-19 08:36:57'),
(46329, 12062, 31363, NULL, '2021-09-21 00:00:00.000', 'In Process', 'I spoke with Cigna representative, they advised to send email on intake_pdm@cigna.com to add provide locations.  The reference to my call was : Gigi as rep name and 09/14/2021   subject:	ADD PROVIDER LOCATONS - HERNANDEZ , JUAN ALONSO  Dear Cigna Team,  Good day !  This is to inform you that the provider with the following details has already been in network with Cigna . However we want to add secondary and tertiary locations of the same provider.  Provider Details: Provider Name: HERNANDEZ,JUAN ALONSO Provider NPI# : 1225617558   Practice Name: Valley Med Urgent Care PLLC Practice NPI# :   151840463 Practice TIN# : 81-5123542  Primary Address: 2534 Boca Chica Blvd , Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd ,Brownsville , TX 78526-4248 Tertiary Address:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Please feel free to ask me if you need further details in this regard.  Thanking you in advance.', NULL, NULL, '2021-09-13 14:13:25', '2021-09-13 14:13:25');
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
(46330, 10057, 31363, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Sent To : 	intake_pdm@cigna.com  Sub : ADD PROVIDER LOCATONS - HERNANDEZ, JUAN ALONSO  Good Afternoon,  Hope this email finds you well. I wanted to check the status for the below mentioned provider and locations. Please note the provider is already in the Cigna network. We just want to add secondary and tertiary locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631  Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-22 11:26:26', '2021-10-22 11:26:26'),
(46331, 10057, 31363, NULL, '2021-11-10 00:00:00.000', 'Approved', 'Effective Date: 08/02/2021  Call reference code : Joe 11/03/2021  Please find attachments.', NULL, NULL, '2021-11-03 08:43:57', '2021-11-03 08:43:57'),
(46332, 1006, 31364, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:20', '2021-06-03 17:40:20'),
(46333, 3040, 31364, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || UHC ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and provider in UHC for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-04 15:36:37', '2021-06-04 15:36:37'),
(46334, 3040, 31364, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: hpdemo@uhc.com   Subject: Re: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || UHC ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in UHC for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 11:40:48', '2021-06-22 11:40:48'),
(46335, 3040, 31364, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject:  Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || UHC ||  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned provider in UHC for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-12 14:27:03', '2021-07-12 14:27:03'),
(46336, 3040, 31364, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || UHC ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in UHC for our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-08-30 11:48:05', '2021-08-30 11:48:05'),
(46337, 3040, 31364, NULL, '2021-09-21 00:00:00.000', 'Approved', 'Provider is participating with UHC. For more details please see attachment. ', NULL, NULL, '2021-09-14 13:27:59', '2021-09-14 13:27:59'),
(46338, 1006, 31365, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:20', '2021-06-03 17:40:20'),
(46339, 1005, 31365, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:39:00', '2021-06-04 09:39:00'),
(46340, 3040, 31365, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'TCHP does not cover Hidalgo or Cameron County for VMUC. ', NULL, NULL, '2021-06-04 11:28:52', '2021-06-04 11:28:52'),
(46341, 1006, 31366, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:20', '2021-06-03 17:40:20'),
(46342, 3040, 31366, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Effective Date: 11/01/2017  Group has an ancillary contract.', NULL, NULL, '2021-06-04 14:01:26', '2021-06-04 14:01:26'),
(46343, 3040, 31366, NULL, '2021-06-23 00:00:00.000', 'Revalidation', 'Email rcvd from: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Your request was received and is in the queue to be worked.  You will receive an email notification once your request has been completed.  Thank you', NULL, NULL, '2021-06-16 15:05:01', '2021-06-16 15:05:01'),
(46344, 3040, 31366, NULL, '2021-06-29 00:00:00.000', 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:47:53', '2021-06-22 11:47:53'),
(46345, 3040, 31366, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Group has an ancillary contract. No need to add individual providers. We already sent the request for location addition once the location under the contract we gonna update the providers task. ', NULL, NULL, '2021-07-09 12:02:45', '2021-07-09 12:02:45'),
(46346, 3040, 31366, NULL, '2021-07-27 00:00:00.000', 'Revalidated', 'Group has an ancillary contract. No need to add individual providers.', NULL, NULL, '2021-07-20 11:50:46', '2021-07-20 11:50:46'),
(46347, 1006, 31367, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46348, 1005, 31367, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:37:03', '2021-06-04 09:37:03'),
(46349, 3040, 31367, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html ', NULL, NULL, '2021-06-04 11:26:16', '2021-06-04 11:26:16'),
(46350, 1006, 31368, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46351, 1005, 31368, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:37:17', '2021-06-04 09:37:17'),
(46352, 3040, 31368, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference. ', NULL, NULL, '2021-06-04 11:24:49', '2021-06-04 11:24:49'),
(46353, 1006, 31369, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46354, 1005, 31369, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Aetna\'s approval.', NULL, NULL, '2021-06-04 09:13:55', '2021-06-04 09:13:55'),
(46355, 11056, 31369, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Talked to Chris for enrollment procedure for First Health at Aetna. Form has been submitted. Waiting for enrollment. Please see attachments. Ref no. of call is : 6026518636 Ref code for form is : MEDICAL', NULL, NULL, '2021-06-24 15:41:55', '2021-06-24 15:41:55'),
(46356, 3040, 31369, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-07-13 13:25:21', '2021-07-13 13:25:21'),
(46357, 1006, 31370, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46358, 3040, 31370, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.  ', NULL, NULL, '2021-06-04 13:55:02', '2021-06-04 13:55:02'),
(46359, 3040, 31370, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Provider Application – Hernandez  Greetings,  I wanted to know the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 09:23:14', '2021-06-21 09:23:14'),
(46360, 3040, 31370, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Provider Application – Hernandez  Hello,  Hope you are doing well. Please advise the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-07-05 10:52:33', '2021-07-05 10:52:33'),
(46361, 3040, 31370, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Provider Application – Hernandez  Hi,  Provider \'\' Hernandez, Juan A PA \'\' is Effective \'\' 08/01/2021 \'\'  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :81311)  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2021-07-23 13:57:48', '2021-07-23 13:57:48'),
(46362, 3040, 31370, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject:  Provider Application – Hernandez  Hello,   Hope you are doing well. Please note that I checked the Health Smart provider directory and the provider is not showing up in the directory. Can you please check and advise?  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thank you ', NULL, NULL, '2021-07-23 13:58:25', '2021-07-23 13:58:25'),
(46363, 3040, 31370, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Provider Application – Hernandez  Greetings,  Hope you are doing well. Please note that I checked the Health smart provider directory and it shows the provider is participating at the primary location which is 2534 Boca Chica Blvd Brownsville TX 78521 and the remaining 02 which is 800 E Alton Gloor Blvd Brownsville , TX 78526 & 101 E Expressway 83, Suite 170 Mcallen TX 78501 locations are not showing in the directory. Can you please check & advise?   Thank you ', NULL, NULL, '2021-08-30 14:19:53', '2021-08-30 14:19:53'),
(46364, 10057, 31370, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : pr.south@healthsmart.com  Sub : Providers Application – Health Smart  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631  Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Potter, Deborah	1861914053  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-14 16:08:48', '2021-10-14 16:08:48'),
(46365, 10057, 31370, NULL, '2021-11-12 00:00:00.000', 'Approved', 'Email Received From : mdiprsupport@healthsmart.com  Sub : Providers Application – Health Smart  Hi,  01- Please see the following Providers with effective dates.  Provider Name   Effective Date   Juan A Hernandez, PA  08/01/2021   Deborah Potter, NP  06/01/2021   02- We are returning your application due to missing information listed below.  Provider Name   Missing Information   LUYANDO, MARIANA PA   Current certificate of Insurance.   Please review the attached Application Review Form and forward the missing information within the next 5 days. Alternatively, please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-11-05 13:41:05', '2021-11-05 13:41:05'),
(46366, 1006, 31371, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46367, 3040, 31371, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Service Case Number:	7630381 Details have been emailed to you at: vmuc@claimsmedinc.com', NULL, NULL, '2021-06-04 14:19:52', '2021-06-04 14:19:52'),
(46368, 3040, 31371, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Service Case Number:	7647780 Details have been emailed to you at: vmuc@claimsmedinc.com', NULL, NULL, '2021-06-22 13:24:32', '2021-06-22 13:24:32'),
(46369, 3040, 31371, NULL, '2021-07-19 00:00:00.000', 'In Process', 'I had a word with PAM B Multiplan representative and she advise provider is in-network with both Multiplan & PHCS but provider is not showing on directory. After discussion with Brad he said we can\'t rely on the effective provider need to show up on directory. ', NULL, NULL, '2021-07-12 14:45:59', '2021-07-12 14:45:59'),
(46370, 3040, 31371, NULL, '2021-07-20 00:00:00.000', 'Approved', '', NULL, NULL, '2021-07-13 13:32:54', '2021-07-13 13:32:54'),
(46371, 1006, 31372, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46372, 1005, 31372, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:26:01', '2021-06-04 09:26:01'),
(46373, 3040, 31372, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-06-04 14:05:44', '2021-06-04 14:05:44'),
(46374, 1006, 31373, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46375, 1005, 31373, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:24:09', '2021-06-04 09:24:09'),
(46376, 3040, 31373, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Application Status            Submitted PEP Ticket Number          17843821', NULL, NULL, '2021-06-11 17:23:46', '2021-06-11 17:23:46'),
(46377, 1005, 31373, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Checked online and the application is currently \"In Progress\".', NULL, NULL, '2021-06-29 11:44:07', '2021-06-29 11:44:07'),
(46378, 3040, 31373, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Provider is participating with Medicaid. Please see attachment. ', NULL, NULL, '2021-07-12 10:07:54', '2021-07-12 10:07:54'),
(46379, 1006, 31374, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46380, 1005, 31374, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:26:15', '2021-06-04 09:26:15'),
(46381, 3040, 31374, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and provider in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-04 14:12:27', '2021-06-04 14:12:27'),
(46382, 3040, 31374, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task. ', NULL, NULL, '2021-06-16 16:20:58', '2021-06-16 16:20:58'),
(46383, 3040, 31374, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-20 11:30:05', '2021-07-20 11:30:05'),
(46384, 3040, 31374, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:18:46', '2021-07-27 16:18:46'),
(46385, 1006, 31376, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46386, 1005, 31376, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-04 09:19:18', '2021-06-04 09:19:18'),
(46387, 3040, 31376, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com  ', NULL, NULL, '2021-06-04 11:19:20', '2021-06-04 11:19:20'),
(46388, 1006, 31377, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46389, 1005, 31377, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:38:44', '2021-06-04 09:38:44'),
(46390, 3040, 31377, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Superior Health ||   Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Healthplan in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-12 10:47:45', '2021-07-12 10:47:45'),
(46391, 3040, 31377, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject: Re: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Superior Health ||  Hello,  Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Healthplan in our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-08-27 13:19:20', '2021-08-27 13:19:20'),
(46392, 3040, 31377, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: RE: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Superior Health ||  Good Afternoon Adil,  To request network participation, please follow the enrollment process: Add a Provider to an Existing Group Contract  Upon completion, you should receive an email within a minimum of two weeks. Please make sure to review your Spam folder and respond within a timely manner.  If I may be of assistance, please do not hesitate to contact me.  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA', NULL, NULL, '2021-09-01 09:59:39', '2021-09-01 09:59:39'),
(46393, 12062, 31377, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email received from : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  & replied to SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Fwd: [SECURE] Add a provider- JUAN ALONSO HERNANDEZ   Dear Provider,  We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.             Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com  for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.          To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/     For Re-Credentialing, please email your information to credentialing@centene.com.     Samantha Cazares Superior Health Plan | Network Operations  I have replied to this email with a completed add provide application form   Attached form for your reference.   ', NULL, NULL, '2021-09-09 13:53:12', '2021-09-09 13:53:12'),
(46394, 10057, 31377, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com, SHP.NetworkDevelopment@superiorhealthplan.com  Sub : [SECURE] Add a provider- JUAN ALONSO HERNANDEZ & Luyando, Mariana || Superior Health ||  Good Evening,  Hope this email finds you well. I wanted to follow up regarding the enrollment status for the below mentioned providers in Superior Healthplan in our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Hernandez, Juan	1225617558 Luyando, Mariana	1700960556  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-21 16:24:51', '2021-10-21 16:24:51'),
(46395, 10057, 31377, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: [SECURE] Add a provider- JUAN ALONSO HERNANDEZ & Luyando, Mariana || Superior Health ||  Good afternoon,  Here is the status for the requested providers-  MARIANA LUYANDO- We received your completed application on 09/24/2021.  Your effective date is 11/01/2021 and you will be receiving a welcome packet shortly.  JUAN HERNANDEZ-  We received your completed application on 09/13/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you, Samantha Cazares  Contracts Coordinator, Contracting & Network Development', NULL, NULL, '2021-10-22 08:56:22', '2021-10-22 08:56:22'),
(46396, 10057, 31377, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning,  Hope this email finds you in good health. Could you please help me out to get the latest enrollment status for below mentioned providers under TIN including all given locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Wert, Jeniece K	1659919702  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-16 09:32:56', '2021-11-16 09:32:56'),
(46397, 10057, 31377, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good morning,  Here are the statuses below-  Juan Hernandez- We received your completed application on 09/13/21.  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Jeniece Wert- We received your completed application on 06/24/2021.  Your effective date is 12/01/2021 and you will be receiving a welcome packet shortly.  Thank you,  Samantha Cazares  Contracts Coordinator', NULL, NULL, '2021-11-16 13:50:17', '2021-11-16 13:50:17'),
(46398, 10057, 31377, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Greetings!  Thank you for your prompt response. Have a great day!  Regards,', NULL, NULL, '2021-11-30 15:08:03', '2021-11-30 15:08:03'),
(46399, 10057, 31377, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Greetings!  Thank you for your prompt response. Have a great day!  Regards,', NULL, NULL, '2021-11-30 15:08:03', '2021-11-30 15:08:03'),
(46400, 10057, 31377, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com Daniel.Velez@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Afternoon,  Hope this email finds you well. I\'m writing this email to get the welcome packets. Your earliest response will be highly appreciated.   Thanks & Regards,', NULL, NULL, '2021-12-07 14:11:25', '2021-12-07 14:11:25'),
(46401, 10057, 31377, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good afternoon,  I have requested the welcome packet for Jeniece Wert and you should be receiving it shortly.  JUAN ALONSO HERNANDEZ- is currently still in credentialing. We appreciate your patience as credentialing can take up to 90 days.', NULL, NULL, '2021-12-14 13:31:20', '2021-12-14 13:31:20'),
(46402, 10057, 31377, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : ECMExecutionTeam@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good morning Steve,  Here is the Welcome Packet for Jeniece Wert is attached.  Thank you,  Richard Salas', NULL, NULL, '2021-12-21 13:22:47', '2021-12-21 13:22:47'),
(46403, 10057, 31377, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : ECMExecutionTeam@superiorhealthplan.com & SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Thank you for your response. Is there any update on JUAN ALONSO HERNANDEZ request. Please let me know.  Have a great day ahead!  Regards,', NULL, NULL, '2021-12-28 15:22:47', '2021-12-28 15:22:47'),
(46404, 20067, 31377, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com, SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health   Good Afternoon,  Hope you are doing well. I would like to know the enrollment status of the below-mentioned providers, and if any provider is enrolled kindly send me their welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Edna Michi	1992293906 Nubia Olivama Benavides	1801371935  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-05 16:02:25', '2022-01-05 16:02:25'),
(46405, 20067, 31377, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good afternoon, Hope you are doing well. I would like to know the enrollment status of the below-mentioned providers and if any of them is enrolled kindly send me their welcome kit.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 12:44:16', '2022-01-11 12:44:16'),
(46406, 20067, 31377, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from:   Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Hi there –     The below provider is still undergoing credentialing once completed a welcome letter will be sent.     Juan hernandez  1225617558     A forwarded copy of the welcome letter for the other listed provider has been resent.     Thank you', NULL, NULL, '2022-01-12 17:53:19', '2022-01-12 17:53:19'),
(46407, 20067, 31377, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning! Hope you are doing great. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 13:44:27', '2022-01-18 13:44:27'),
(46408, 20067, 31377, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Morning!  I would like to know the enrollment status of Juan Hernandez 1225617558 and also I would like to add the secondary and tertiary locations for provider Jeniece Wert 1659919702, Locations are listed below:  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-31 11:41:36', '2022-01-31 11:41:36'),
(46409, 20067, 31377, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Re: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health   Hello Syed,     Provider Juan Alonso Hernandez NPI 1225617558 TIN: 815123542 displays an effective date of 3/1/2022.     Respectfully,', NULL, NULL, '2022-02-17 13:01:56', '2022-02-17 13:01:56'),
(46410, 20067, 31377, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Good Afternoon Daniel!  Hope you are doing well. Kindly send me the welcome letter for Juan Hernandez. And what about Jeniece K Wert? Kindly update me.  Thank you, ', NULL, NULL, '2022-02-24 10:17:35', '2022-02-24 10:17:35'),
(46411, 20067, 31377, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Status || VMUC || JUAN ALONSO HERNANDEZ & JENIECE K WERT || Superior Health  Hello Syed,     Provider: JENIECE K WERT NPI: 1659919702 TIN: 815123542 displays an effective date 12/1/2021.     A request was sent to our contracting department to send the Welcome Letters.     Please allow time to process and be sent.', NULL, NULL, '2022-02-24 10:18:30', '2022-02-24 10:18:30'),
(46412, 20067, 31377, NULL, '2022-03-15 00:00:00.000', 'Approved', 'Email received from: ECMExecutionTeam@superiorhealthplan.com  Sub:JUAN ALONSO HERNANDEZ WELCOME LETTER  JUAN ALONSO HERNANDEZ  VALLEY MED URGENT CARE PLLC  VMUC@CLAIMSMEDINC.COM        Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:    03/01/2022                                                 C/ 56674  ', NULL, NULL, '2022-03-08 14:49:12', '2022-03-08 14:49:12'),
(46413, 1006, 31378, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46414, 3040, 31378, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent Certification application and other documents also by fax to (608) 221-7535 (Tricare) ', NULL, NULL, '2021-06-04 14:38:37', '2021-06-04 14:38:37'),
(46415, 3040, 31378, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC. We already sent the credentialing form through fax.  Practice Details: Practice Name: Valley Med Urgent Care PLLC  Practice Tax ID# 81-5123542  Practice NPI# 1518404631  Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166 Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558 If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-21 11:06:56', '2021-06-21 11:06:56'),
(46416, 3040, 31378, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || Tricare ||  Hello Katherine,  Please advise the enrollment status for the below mentioned provider in the Tricare for our group Valley Med Urgent Care PLLC. We already sent the credentialing form through fax.  Practice Details: Practice Name: Valley Med Urgent Care PLLC  Practice Tax ID# 81-5123542  Practice NPI# 1518404631  Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166 Provider 1: Provider Name: Hernandez, Juan Provider NPI# 1225617558 If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-07-09 11:30:30', '2021-07-09 11:30:30'),
(46417, 3040, 31378, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wert, Jeniece, Lira, Arturo & Hernandez, Juan || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 2: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 3: Provider Name: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-09 16:17:02', '2021-09-09 16:17:02'),
(46418, 10057, 31378, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:26:41', '2021-10-21 15:26:41'),
(46419, 10057, 31378, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Morning Steve,  Jacqueline Trenz can assist you with your request.    Brownsville and McAllen Texas is not in my area.  Thanks, Yvonne W. Wyatt,  Humana Military TRICARE Community Liaison II Houston/Galveston', NULL, NULL, '2021-11-23 17:35:01', '2021-11-23 17:35:01'),
(46420, 10057, 31378, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Yvonne,  Thank you for the update. Have a great day!  Regards,', NULL, NULL, '2021-12-01 16:24:01', '2021-12-01 16:24:01'),
(46421, 10057, 31378, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Jacqueline,  Hope this email finds you well. Could you please check and confirm once again, since I\'m unable to find the below mentioned providers on the Humana - Tricare directory.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Jeniece K Wert	1659919702 Homero Garcia	1730564857  Juan Hernandez we are still in contact to get his Malpractice.  Jeniece K Wert not showing for secondary and tertiary locations - previous email you have mentioned to fill out the roster, but there is no file attached.  Homero Garcia not showing in the directory.   Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-08 11:51:26', '2021-12-08 11:51:26'),
(46422, 10057, 31378, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Greetings!  Hope you are doing well. Can I get a quick response to the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-14 13:39:07', '2021-12-14 13:39:07'),
(46423, 10057, 31378, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello,  Any update on the below request. This is my SECOND REMINDER. Please get back to me with the latest update ASAP.  Regards,', NULL, NULL, '2021-12-21 13:39:05', '2021-12-21 13:39:05'),
(46424, 10057, 31378, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,  1) Juan Hernandez - We cannot move further on his application due to not having received his malpractice insurance certificate. Please see below.  2) Jeniece Wert – please see the attached Provider Roster to submit a request, to add a secondary & tertiary location.  Please email to HGBProviderRosters@humana.com.  3) Homero Garcia – provider profile is complete.  I have submitted a request to my data team to update the directory.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-28 15:28:59', '2021-12-28 15:28:59'),
(46425, 20067, 31378, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Garcia Homero	1730564857 Wert Jeniece	1659919702 Juan Hernandez	1225617558   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:10:49', '2022-01-05 17:10:49'),
(46426, 20067, 31378, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad ', NULL, NULL, '2022-01-18 14:09:14', '2022-01-18 14:09:14'),
(46427, 20067, 31378, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad', NULL, NULL, '2022-01-31 11:07:50', '2022-01-31 11:07:50'),
(46428, 20067, 31378, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good afternoon,     TRICARE does not send Welcome Kits or Letters.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE', NULL, NULL, '2022-02-16 17:30:04', '2022-02-16 17:30:04');
