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
(27880, 3040, 22857, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:43:51', '2021-06-22 09:43:51'),
(27881, 3040, 22857, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Hello,   Please advise me the enrollment status for the below mentioned provider in Tricare in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:    Provider Name: Stephen, Ani   Provider NPI# 1588959118    Provider 2:    Provider Name: Brown, Brittany  Provider NPI# 1275163537    Provider 3:     Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 4:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.     Thank you   ', NULL, NULL, '2021-07-12 13:56:51', '2021-07-12 13:56:51'),
(27882, 11056, 22857, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you!  Have a great day!', NULL, NULL, '2021-08-11 13:23:31', '2021-08-11 13:23:31'),
(27883, 10057, 22857, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  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 Primary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-06 13:50:48', '2021-10-06 13:50:48'),
(27884, 10057, 22857, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon!  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Joseph, Molly	1396380077 PAUL, SIGI	1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956  Please get back to me as soon as you have time!  Thanks & Regards,', NULL, NULL, '2021-10-14 11:43:46', '2021-10-14 11:43:46'),
(27885, 10057, 22857, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:28:48', '2021-11-11 17:28:48'),
(27886, 10057, 22857, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning,  Hope this email finds you well. Could you please let me know the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 09:49:00', '2021-12-02 09:49:00'),
(27887, 10057, 22857, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Steve,  The status is listed below. You can check status by using the self-service Provider Portal.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt, TRICARE Community Liaison II Humana Military', NULL, NULL, '2021-12-15 13:26:22', '2021-12-15 13:26:22'),
(27888, 10057, 22857, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Thank you for reaching out. Unfortunately, we do not have access to the provider self service portal. Is there any way that we can get the status for below mentioned providers enrollment status?  Your earliest response will be highly appreciated.  Kind Regards, Steve Albert ', NULL, NULL, '2021-12-21 15:13:16', '2021-12-21 15:13:16'),
(27889, 10057, 22857, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  We are requesting Providers to create a log in on the Provider Portal highlighted below is the link', NULL, NULL, '2021-12-29 13:08:35', '2021-12-29 13:08:35'),
(27890, 20067, 22857, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to:   Sub:   Good afternoon,  Hope this email finds you well, Kindly see the attachment of the Provider Self-Service portal. Provider Jeny John is in one more location of Normandy Urgent Care Center which is not listed on your directory.  Location: 16272 IMPERIAL VALLEY DR STEK, Houston, TX 77060 Tax ID: 270796429 NPI:1407171077  Kindly add this location.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 10:00:02', '2022-01-18 10:00:02'),
(27891, 20067, 22857, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Sub: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare   Good Morning Syed,     I have submitted a request to Provider network to update Jeny John to display on the Provider Portal as network. This process can take up to ten business days.     In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Thanks,  Yvonne W. Wyatt,  TRICARE Community Liaison II  Humana Military     502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com     HumanaMilitary.com  Additional Resources:', NULL, NULL, '2022-01-18 10:00:17', '2022-01-18 10:00:17'),
(27892, 20067, 22857, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Re: Secured: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare   Good Morning,  Thanks for the update. Once the provider is credentialed kindly send me the welcome letter.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-18 10:00:29', '2022-01-18 10:00:29'),
(27893, 20067, 22857, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email  received from: ywyatt@humana.com  Sub:  RE: Secured: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Syed,  Credentialing will send you an approval letter. You can also check the Provider Portal and it will show complete.  Thanks, Yvonne W. Wyatt,  TRICARE Community Liaison II Humana Military', NULL, NULL, '2022-01-18 10:00:50', '2022-01-18 10:00:50'),
(27894, 20067, 22857, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good afternoon, Hope this email finds you in good health. Can you please tell me the effective date for below mentioned request?  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-18 10:01:07', '2022-01-18 10:01:07'),
(27895, 20067, 22857, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning!  Hope you had a great weekend. I haven\'t received the welcome packet yet. Please do the needful.  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-24 09:52:39', '2022-01-24 09:52:39'),
(27896, 20067, 22857, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Enrollment Status Query - NUCC - IVUC - Tricare   Good Afternoon!  Hope this email finds you in good condition. I would like to know the enrollment status of the below mentioned group and the providers  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Ani Stephen	1588959118 Mini Chennemkara	1841755956 Molly Joseph	1396380077  Thanks,', NULL, NULL, '2022-03-01 15:55:48', '2022-03-01 15:55:48'),
(27897, 20067, 22857, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Enrollment Status Query - NUCC - IVUC - Tricare   Good Afternoon!  Hope you are doing great. Kindly update me on the provider\'s status for both locations.  Thank you', NULL, NULL, '2022-03-18 12:50:51', '2022-03-18 12:50:51'),
(27898, 22077, 22857, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: 	Re: Enrollment Status Query - NUCC - IVUC - Tricare  Hi,  I would like to know the enrollment status for the following group and provider,  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Address	799 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Address	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935 Ani Stephen	1588959118 Mini Chennemkara	1841755956 Molly Joseph	1396380077  Thanks & Regards.', NULL, NULL, '2022-04-19 15:24:49', '2022-04-19 15:24:49'),
(27899, 1006, 22858, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:32:49', '2021-03-17 16:32:49'),
(27900, 3040, 22858, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:07:36', '2021-06-02 16:07:36'),
(27901, 3040, 22858, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:43:48', '2021-06-22 09:43:48'),
(27902, 3040, 22858, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Need Effective Date || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers ||  Hello,   Hope you are doing well. As per your email the below mentioned providers are participating with Tricare in our group under the below locations. Can you please send the effective date.   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: Abraham, Glory (Need Effective Date) Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy (Need Effective Date) Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 14:41:32', '2021-07-09 14:41:32'),
(27903, 3040, 22858, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare || Provider 7:    Provider Name: Abraham, Glory- network all three locations  Provider NPI# 1194206490', NULL, NULL, '2021-07-12 13:29:23', '2021-07-12 13:29:23'),
(27904, 1006, 22859, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:32:50', '2021-03-17 16:32:50'),
(27905, 3040, 22859, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:07:40', '2021-06-02 16:07:40'),
(27906, 3040, 22859, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:43:46', '2021-06-22 09:43:46'),
(27907, 3040, 22859, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Hello,   Please advise me the enrollment status for the below mentioned provider in Tricare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 14:48:02', '2021-07-09 14:48:02'),
(27908, 11056, 22859, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you!  Have a great day!', NULL, NULL, '2021-08-11 13:23:23', '2021-08-11 13:23:23'),
(27909, 3040, 22859, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Greetings,  Hope you are doing well. Please find attached roster as per Yvonne Wyatt email to enroll the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-08-20 14:35:44', '2021-08-20 14:35:44'),
(27910, 10057, 22859, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon!  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Joseph, Molly	1396380077 PAUL, SIGI	1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956  Please get back to me as soon as you have time!  Thanks & Regards,', NULL, NULL, '2021-10-14 11:43:36', '2021-10-14 11:43:36'),
(27911, 10057, 22859, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:28:40', '2021-11-11 17:28:40'),
(27912, 10057, 22859, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Fwd: Need Copy of Welcome Letters & Updated Group Roster - Humana/Tricare - Houston  Good Morning  Alex,  I have attached a copy of the contract, the request to add Imperial Valley Urgent Care Center along with the roster for Normandy Urgent Care Center and Imperial Valley Urgent Care.  The Welcome letter was sent via email we do not keep a copy of the welcome letter.  We do not show we have a contract on file for Long point Medical Center.  Thanks, Yvonne W. Wyatt,', NULL, NULL, '2021-11-30 17:49:39', '2021-11-30 17:49:39'),
(27913, 10057, 22859, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Email Received From : ywyatt@humana.com  Sub : Fwd: Need Copy of Welcome Letters & Updated Group Roster - Humana/Tricare - Houston  Good Morning  Alex,  I have attached a copy of the contract, the request to add Imperial Valley Urgent Care Center along with the roster for Normandy Urgent Care Center and Imperial Valley Urgent Care.  The Welcome letter was sent via email we do not keep a copy of the welcome letter.  We do not show we have a contract on file for Long point Medical Center.  Thanks, Yvonne W. Wyatt,', NULL, NULL, '2021-11-30 17:50:31', '2021-11-30 17:50:31'),
(27914, 1006, 22860, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:32:51', '2021-03-17 16:32:51'),
(27915, 3040, 22860, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:07:44', '2021-06-02 16:07:44'),
(27916, 3040, 22860, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:43:43', '2021-06-22 09:43:43'),
(27917, 3040, 22860, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Hello,   Please advise me the enrollment status for the below mentioned provider in Tricare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 14:48:04', '2021-07-09 14:48:04'),
(27918, 11056, 22860, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you!  Have a great day!', NULL, NULL, '2021-08-11 13:23:14', '2021-08-11 13:23:14'),
(27919, 3040, 22860, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Ahmed,  Please submit your request for network Group tax id / Providers to the HGB Roster Team email via spreadsheet first, the HGB Roster team has an automatic processing system, they will send you the status once it is complete. You may reach out to me if there is no resolution from the HGB Roster team. HGB Roster team has up to 60 days to process a request.  Here is the status:  Provider Name: Thomas, Cini, Provider NPI# 1134777238 – we show this Provider has been added , I will submit a request to Provider network to display on the Provider Portal  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956, -  we show this Provider has been added , I will submit a request to Provider network to display on the Provider Portal  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-08-20 14:38:22', '2021-08-20 14:38:22'),
(27920, 10057, 22860, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon!  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Joseph, Molly	1396380077 PAUL, SIGI	1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956  Please get back to me as soon as you have time!  Thanks & Regards,', NULL, NULL, '2021-10-14 11:43:26', '2021-10-14 11:43:26'),
(27921, 10057, 22860, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:28:31', '2021-11-11 17:28:31'),
(27922, 10057, 22860, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Email Received From : ywyatt@humana.com  Sub : Fwd: Need Copy of Welcome Letters & Updated Group Roster - Humana/Tricare - Houston  Good Morning  Alex,  I have attached a copy of the contract, the request to add Imperial Valley Urgent Care Center along with the roster for Normandy Urgent Care Center and Imperial Valley Urgent Care.  The Welcome letter was sent via email we do not keep a copy of the welcome letter.  We do not show we have a contract on file for Long point Medical Center.  Thanks, Yvonne W. Wyatt,', NULL, NULL, '2021-11-30 18:10:03', '2021-11-30 18:10:03'),
(27923, 1006, 22861, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:32:52', '2021-03-17 16:32:52'),
(27924, 3040, 22861, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:07:48', '2021-06-02 16:07:48'),
(27925, 3040, 22861, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:43:41', '2021-06-22 09:43:41'),
(27926, 3040, 22861, NULL, '2021-07-19 00:00:00.000', 'Not Eligible', 'provider is no longer working with practice. ', NULL, NULL, '2021-07-12 13:54:52', '2021-07-12 13:54:52'),
(27927, 1006, 22862, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:32:53', '2021-03-17 16:32:53');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(27928, 3040, 22862, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:07:51', '2021-06-02 16:07:51'),
(27929, 3040, 22862, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:43:38', '2021-06-22 09:43:38'),
(27930, 3040, 22862, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Hello,   Please advise me the enrollment status for the below mentioned provider in Tricare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 14:48:05', '2021-07-09 14:48:05'),
(27931, 11056, 22862, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you!  Have a great day!', NULL, NULL, '2021-08-11 13:23:06', '2021-08-11 13:23:06'),
(27932, 3040, 22862, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Greetings,  Hope you are doing well. Please find attached roster as per Yvonne Wyatt email to enroll the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-08-20 14:35:41', '2021-08-20 14:35:41'),
(27933, 10057, 22862, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon!  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Joseph, Molly	1396380077 PAUL, SIGI	1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956  Please get back to me as soon as you have time!  Thanks & Regards,', NULL, NULL, '2021-10-14 11:42:48', '2021-10-14 11:42:48'),
(27934, 10057, 22862, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-23 17:30:51', '2021-11-23 17:30:51'),
(27935, 10057, 22862, NULL, '2021-12-07 00:00:00.000', 'Approved', '	 Email Received From : ywyatt@humana.com  Sub : Fwd: Need Copy of Welcome Letters & Updated Group Roster - Humana/Tricare - Houston  Good Morning  Alex,  I have attached a copy of the contract, the request to add Imperial Valley Urgent Care Center along with the roster for Normandy Urgent Care Center and Imperial Valley Urgent Care.  The Welcome letter was sent via email we do not keep a copy of the welcome letter.  We do not show we have a contract on file for Long point Medical Center.  Thanks, Yvonne W. Wyatt,', NULL, NULL, '2021-11-30 17:56:15', '2021-11-30 17:56:15'),
(27936, 1006, 22863, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:32:54', '2021-03-17 16:32:54'),
(27937, 3040, 22863, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:07:55', '2021-06-02 16:07:55'),
(27938, 3040, 22863, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:41:41', '2021-06-22 09:41:41'),
(27939, 3040, 22863, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||   Provider 9:    Provider Name: Rauf, Abdur Network to two locations need to submit a request to add her to the Imperial Valley  Provider NPI# 1497726202', NULL, NULL, '2021-07-12 13:35:07', '2021-07-12 13:35:07'),
(27940, 1006, 22864, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:32:55', '2021-03-17 16:32:55'),
(27941, 3040, 22864, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:07:59', '2021-06-02 16:07:59'),
(27942, 3040, 22864, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:41:38', '2021-06-22 09:41:38'),
(27943, 3040, 22864, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Hello,   Please advise me the enrollment status for the below mentioned provider in Tricare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 14:48:00', '2021-07-09 14:48:00'),
(27944, 11056, 22864, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you!  Have a great day!', NULL, NULL, '2021-08-11 13:25:05', '2021-08-11 13:25:05'),
(27945, 3040, 22864, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Greetings,  Hope you are doing well. Please find attached roster as per Yvonne Wyatt email to enroll the below mentioned providers in Tricare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-08-20 14:35:43', '2021-08-20 14:35:43'),
(27946, 10057, 22864, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon,  Any update on the following request?  Thanks & Regards,', NULL, NULL, '2021-10-14 11:33:15', '2021-10-14 11:33:15'),
(27947, 10057, 22864, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:25:52', '2021-11-11 17:25:52'),
(27948, 10057, 22864, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning,  Hope this email finds you well. Could you please let me know the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 09:48:52', '2021-12-02 09:48:52'),
(27949, 10057, 22864, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Steve,  The status is listed below. You can check status by using the self-service Provider Portal.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt, TRICARE Community Liaison II Humana Military', NULL, NULL, '2021-12-15 13:26:10', '2021-12-15 13:26:10'),
(27950, 10057, 22864, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Thank you for reaching out. Unfortunately, we do not have access to the provider self service portal. Is there any way that we can get the status for below mentioned providers enrollment status?  Your earliest response will be highly appreciated.  Kind Regards, Steve Albert ', NULL, NULL, '2021-12-21 15:13:07', '2021-12-21 15:13:07'),
(27951, 10057, 22864, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  We are requesting Providers to create a log in on the Provider Portal highlighted below is the link', NULL, NULL, '2021-12-29 13:08:30', '2021-12-29 13:08:30'),
(27952, 20067, 22864, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to:  ywyatt@humana.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon, Hope this email finds you well. I would like to know the enrollment status of the below-mentioned provider under these locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:21:15', '2022-01-12 14:21:15'),
(27953, 20067, 22864, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning!  Hope you had a great weekend. I haven\'t received the welcome packet yet. Please do the needful.  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-24 09:52:28', '2022-01-24 09:52:28'),
(27954, 20067, 22864, NULL, '2022-02-10 00:00:00.000', 'In Process', 'Called Tricare and spoke to Rikki  NUCC: Effective Date: 11/02/2021 Expired on: 01/31/2022. IVUC: Effective Date: 11/03/2021 Expired on: 01/31/2022 LPMC: Effective Date: 11/03/2021 Expired on: 01/31/2022  Ref# 15097314', NULL, NULL, '2022-02-03 13:12:46', '2022-02-03 13:12:46'),
(27955, 20067, 22864, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Enrollment Status Query - NUCC - IVUC - Tricare   Good Afternoon!  Hope this email finds you in good condition. I would like to know the enrollment status of the below mentioned group and the providers  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Ani Stephen	1588959118 Mini Chennemkara	1841755956 Molly Joseph	1396380077  Thanks,', NULL, NULL, '2022-03-01 15:55:55', '2022-03-01 15:55:55'),
(27956, 20067, 22864, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Sub: Enrollment Status Query - NUCC - IVUC - Tricare   Good Afternoon!  Hope you are doing great. Kindly update me on the provider\'s status for both locations.  Thank you', NULL, NULL, '2022-03-18 12:50:44', '2022-03-18 12:50:44'),
(27957, 22077, 22864, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: 	Re: Enrollment Status Query - NUCC - IVUC - Tricare  Hi,  I would like to know the enrollment status for the following group and provider,  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Address	799 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Address	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935 Ani Stephen	1588959118 Mini Chennemkara	1841755956 Molly Joseph	1396380077  Thanks & Regards.', NULL, NULL, '2022-04-19 15:26:04', '2022-04-19 15:26:04'),
(27958, 19067, 22864, NULL, '2022-04-29 00:00:00.000', 'Not Eligible', 'The provider is no longer with the group.', NULL, NULL, '2022-04-22 11:27:09', '2022-04-22 11:27:09'),
(27959, 3046, 22865, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:21', '2021-03-17 16:33:21'),
(27960, 3040, 22865, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:04', '2021-05-26 15:46:04'),
(27961, 3040, 22865, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:54:00', '2021-06-03 08:54:00'),
(27962, 3046, 22866, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:23', '2021-03-17 16:33:23'),
(27963, 3040, 22866, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:08', '2021-05-26 15:46:08'),
(27964, 3040, 22866, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:54:04', '2021-06-03 08:54:04'),
(27965, 3046, 22867, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:24', '2021-03-17 16:33:24'),
(27966, 3040, 22867, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:12', '2021-05-26 15:46:12'),
(27967, 3040, 22867, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:54:08', '2021-06-03 08:54:08'),
(27968, 3046, 22868, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:26', '2021-03-17 16:33:26'),
(27969, 3040, 22868, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:16', '2021-05-26 15:46:16'),
(27970, 3040, 22868, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:54:12', '2021-06-03 08:54:12'),
(27971, 3046, 22869, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:27', '2021-03-17 16:33:27'),
(27972, 3040, 22869, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:20', '2021-05-26 15:46:20'),
(27973, 3040, 22869, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:54:17', '2021-06-03 08:54:17'),
(27974, 3046, 22870, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:29', '2021-03-17 16:33:29'),
(27975, 3040, 22870, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:24', '2021-05-26 15:46:24'),
(27976, 3040, 22870, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:54:21', '2021-06-03 08:54:21'),
(27977, 3046, 22871, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:32', '2021-03-17 16:33:32');
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
(27978, 3040, 22871, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:28', '2021-05-26 15:46:28'),
(27979, 3040, 22871, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:54:31', '2021-06-03 08:54:31'),
(27980, 3046, 22872, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:34', '2021-03-17 16:33:34'),
(27981, 3040, 22872, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:32', '2021-05-26 15:46:32'),
(27982, 3040, 22872, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:54:35', '2021-06-03 08:54:35'),
(27983, 3046, 22873, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:36', '2021-03-17 16:33:36'),
(27984, 3040, 22873, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:35', '2021-05-26 15:46:35'),
(27985, 3040, 22873, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:54:40', '2021-06-03 08:54:40'),
(27986, 3046, 22874, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:38', '2021-03-17 16:33:38'),
(27987, 3040, 22874, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:40', '2021-05-26 15:46:40'),
(27988, 3040, 22874, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:54:44', '2021-06-03 08:54:44'),
(27989, 3046, 22875, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:40', '2021-03-17 16:33:40'),
(27990, 3040, 22875, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:44', '2021-05-26 15:46:44'),
(27991, 3040, 22875, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:54:49', '2021-06-03 08:54:49'),
(27992, 3046, 22876, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:41', '2021-03-17 16:33:41'),
(27993, 3040, 22876, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:48', '2021-05-26 15:46:48'),
(27994, 3040, 22876, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:55:06', '2021-06-03 08:55:06'),
(27995, 3046, 22877, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:43', '2021-03-17 16:33:43'),
(27996, 3040, 22877, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:52', '2021-05-26 15:46:52'),
(27997, 3040, 22877, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:55:12', '2021-06-03 08:55:12'),
(27998, 3046, 22878, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:45', '2021-03-17 16:33:45'),
(27999, 3040, 22878, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:46:56', '2021-05-26 15:46:56'),
(28000, 3040, 22878, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:55:17', '2021-06-03 08:55:17'),
(28001, 3046, 22879, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:46', '2021-03-17 16:33:46'),
(28002, 3040, 22879, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:47:01', '2021-05-26 15:47:01'),
(28003, 3040, 22879, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:55:22', '2021-06-03 08:55:22'),
(28004, 3046, 22880, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:33:48', '2021-03-17 16:33:48'),
(28005, 3040, 22880, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:47:05', '2021-05-26 15:47:05'),
(28006, 3040, 22880, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:55:26', '2021-06-03 08:55:26'),
(28007, 3046, 22881, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:26', '2021-03-17 16:42:26'),
(28008, 3040, 22881, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:14:15', '2021-05-31 14:14:15'),
(28009, 3040, 22881, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 4:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5: Provider Name: George, Jeemol Provider NPI# 1497219067  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 11:39:29', '2021-06-18 11:39:29'),
(28010, 3040, 22881, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:21', '2021-07-08 09:49:21'),
(28011, 11056, 22881, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:44:20', '2021-08-09 14:44:20'),
(28012, 10057, 22881, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good Morning,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Abraham, Jeena	1467901587 Rauf, Abdur	1497726202 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Kourouma , Odette Tiranke	1134525868 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemo	1497219067 Joseph, Molly	1073019493 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189  Your early response will be highly appreciated and for any questions please feel free to reach out to me.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:19:21', '2021-10-08 10:19:21'),
(28013, 10057, 22881, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From: SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Good Morning,  We have received your Demographic Update requests for Imperial Valley Urgent Care Center TIN: 270796429 to enroll the following providers:  Joseph Vibitha N/A 1952931560  Rauf Abdur N/A 1497726202  Thomas Cini N/A 1134777238  Unfortunately the request that was submitted was for a demographic update, not to enroll the providers. However, we did find that the providers are reflecting as active in our system. Can you please verify if these request are really to enroll the providers or is this an actual address change?    Thank you,  Jennifer Pitts', NULL, NULL, '2021-11-17 13:14:36', '2021-11-17 13:14:36'),
(28014, 10057, 22881, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Good Afternoon Jennifer,  Hope this email finds you well. We have forwarded a request to link the secondary location Imperial Valley Urgent Care Center with TIN  270796429. Since Primary location Normandy Urgent Care is already done.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Rauf, Abdur	1497726202 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 George, Jeemol	1497219067  Furthermore, we already submitted forms via your website to enroll the above mentioned providers. Please get back to me with the latest updates.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 13:33:42', '2021-11-17 13:33:42'),
(28015, 10057, 22881, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Hello,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned request.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-11-30 14:52:06', '2021-11-30 14:52:06'),
(28016, 10057, 22881, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good afternoon,  Hope you are doing great. Could you please provide me with the latest update on below mentioned providers & group enrollment status?  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 13:56:37', '2021-12-07 13:56:37'),
(28017, 10057, 22881, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Hello,  Below is a snip it of the plans that the provider(s) in question is contracted for under TIN: 27-0796429  Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-12-16 13:20:20', '2021-12-16 13:20:20'),
(28018, 10057, 22881, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Thank you for your response. i just want to let you know that below mentioned providers are still not listed with Imperial Valley Urgent Care Center. How long will it take to link in with that location?  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Jose, Julie	1447883061 George, Jeemol	1497219067  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-22 13:43:53', '2021-12-22 13:43:53'),
(28019, 10057, 22881, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good morning,  When did you send in the request to add the new location?', NULL, NULL, '2021-12-29 11:59:44', '2021-12-29 11:59:44'),
(28020, 20067, 22881, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Application initiated through portal. Kindly see the attachments.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 44789aeb-392d-4511-ad2b-364f93f40d22 ', NULL, NULL, '2022-01-18 10:34:29', '2022-01-18 10:34:29'),
(28021, 20067, 22881, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Will check status next week because the application was submitted previous week.', NULL, NULL, '2022-01-18 17:57:53', '2022-01-18 17:57:53'),
(28022, 20067, 22881, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Will check status on 02/12/2022 because the attachment says allow 30-45 days before checking status.', NULL, NULL, '2022-01-28 11:50:34', '2022-01-28 11:50:34'),
(28023, 20067, 22881, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Sub: Enroll Group & Providers || NUCC & IVUC || Scott & White ||  Good Morning!  Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers.  Group Name	Normandy Urgent Care Center Tax ID	270796429 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 Provider Name	NPI Jeemol George	1497219067 Julie Jose	1447883061  Thank you,', NULL, NULL, '2022-03-02 10:34:58', '2022-03-02 10:34:58'),
(28024, 20067, 22881, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: HPREGION2@BSWHealth.org  Sub: RE:  Enroll Group & Providers || NUCC & IVUC || Scott & White ||  Good Afternoon!    Can you please confirm that the Secondary location was added to both providers profile?  Thank you, ', NULL, NULL, '2022-03-21 13:13:34', '2022-03-21 13:13:34'),
(28025, 3046, 22882, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:27', '2021-03-17 16:42:27'),
(28026, 3040, 22882, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:14:18', '2021-05-31 14:14:18'),
(28027, 3040, 22882, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Success! Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: deaca253-4358-49b1-9b0b-108f440e8b42', NULL, NULL, '2021-06-18 11:31:15', '2021-06-18 11:31:15'),
(28028, 3040, 22882, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:20', '2021-07-08 09:49:20'),
(28029, 3040, 22882, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  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 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  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 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:39', '2021-07-28 16:43:39');
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
(28030, 11056, 22882, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:44:42', '2021-08-09 14:44:42'),
(28031, 3040, 22882, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Email rcvd from: SWHPEXPEDITES@bswhealth.org  Subject: To add Joseph, Stephen, Piccione, Paul, Jacob, Fernandus, Chennemkara, Brown, Abraham, Abraham and John to Normandy Urgent Care Center  The provider information for Molly Joseph, Ani Stephen, James Piccione, Sigi Paul, Jaya Jacob, Limy Fernandus, Mini Chennemkara, Brittany Brown, Jeena Abraham, Glory Abraham and Jeny John to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 9/7/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.  Note:  For the RightCare (Medicaid) line of business:  If an active/attested TPI is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicaid RightCare Members until one is provided.    For the Medicare line of business: If an active Medicare/PTAN is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicare Members until one is provided.  Please email the Medicare/TPI once available to:  SWHPEXPEDITES@BSWHealth.org     Thank you and have a great day. Provider Services', NULL, NULL, '2021-08-25 08:44:04', '2021-08-25 08:44:04'),
(28032, 3046, 22883, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:29', '2021-03-17 16:42:29'),
(28033, 3040, 22883, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:14:27', '2021-05-31 14:14:27'),
(28034, 3040, 22883, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Success! Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: a981554b-fa80-4bbc-b5f6-73fef2845b51', NULL, NULL, '2021-06-18 11:30:51', '2021-06-18 11:30:51'),
(28035, 3040, 22883, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:20', '2021-07-08 09:49:20'),
(28036, 3040, 22883, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  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 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  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 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:42', '2021-07-28 16:43:42'),
(28037, 11056, 22883, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:44:49', '2021-08-09 14:44:49'),
(28038, 3040, 22883, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Email rcvd from: SWHPEXPEDITES@bswhealth.org  Subject: To add Joseph, Stephen, Piccione, Paul, Jacob, Fernandus, Chennemkara, Brown, Abraham, Abraham and John to Normandy Urgent Care Center  The provider information for Molly Joseph, Ani Stephen, James Piccione, Sigi Paul, Jaya Jacob, Limy Fernandus, Mini Chennemkara, Brittany Brown, Jeena Abraham, Glory Abraham and Jeny John to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 9/7/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.  Note:  For the RightCare (Medicaid) line of business:  If an active/attested TPI is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicaid RightCare Members until one is provided.    For the Medicare line of business: If an active Medicare/PTAN is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicare Members until one is provided.  Please email the Medicare/TPI once available to:  SWHPEXPEDITES@BSWHealth.org     Thank you and have a great day. Provider Services', NULL, NULL, '2021-08-25 08:44:03', '2021-08-25 08:44:03'),
(28039, 3046, 22884, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:30', '2021-03-17 16:42:30'),
(28040, 3040, 22884, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:14:32', '2021-05-31 14:14:32'),
(28041, 3040, 22884, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Success! Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 823bcc89-9ca9-4345-bd1f-55a83ea33bd6', NULL, NULL, '2021-06-18 11:29:50', '2021-06-18 11:29:50'),
(28042, 3040, 22884, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:19', '2021-07-08 09:49:19'),
(28043, 3040, 22884, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  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 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  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 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:37', '2021-07-28 16:43:37'),
(28044, 11056, 22884, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:44:58', '2021-08-09 14:44:58'),
(28045, 3040, 22884, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Email rcvd from: SWHPEXPEDITES@bswhealth.org  Subject: To add Joseph, Stephen, Piccione, Paul, Jacob, Fernandus, Chennemkara, Brown, Abraham, Abraham and John to Normandy Urgent Care Center  The provider information for Molly Joseph, Ani Stephen, James Piccione, Sigi Paul, Jaya Jacob, Limy Fernandus, Mini Chennemkara, Brittany Brown, Jeena Abraham, Glory Abraham and Jeny John to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 9/7/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.  Note:  For the RightCare (Medicaid) line of business:  If an active/attested TPI is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicaid RightCare Members until one is provided.    For the Medicare line of business: If an active Medicare/PTAN is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicare Members until one is provided.  Please email the Medicare/TPI once available to:  SWHPEXPEDITES@BSWHealth.org     Thank you and have a great day. Provider Services', NULL, NULL, '2021-08-25 08:44:02', '2021-08-25 08:44:02'),
(28046, 3046, 22885, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:31', '2021-03-17 16:42:31'),
(28047, 3040, 22885, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:14:35', '2021-05-31 14:14:35'),
(28048, 3040, 22885, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Success! Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 3fc96c62-a06c-4b02-9947-4173a22eb05e ', NULL, NULL, '2021-06-18 11:29:15', '2021-06-18 11:29:15'),
(28049, 3040, 22885, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:18', '2021-07-08 09:49:18'),
(28050, 3040, 22885, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  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 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  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 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:38', '2021-07-28 16:43:38'),
(28051, 11056, 22885, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:45:08', '2021-08-09 14:45:08'),
(28052, 3040, 22885, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Email rcvd from: SWHPEXPEDITES@bswhealth.org  Subject: To add Joseph, Stephen, Piccione, Paul, Jacob, Fernandus, Chennemkara, Brown, Abraham, Abraham and John to Normandy Urgent Care Center  The provider information for Molly Joseph, Ani Stephen, James Piccione, Sigi Paul, Jaya Jacob, Limy Fernandus, Mini Chennemkara, Brittany Brown, Jeena Abraham, Glory Abraham and Jeny John to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 9/7/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.  Note:  For the RightCare (Medicaid) line of business:  If an active/attested TPI is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicaid RightCare Members until one is provided.    For the Medicare line of business: If an active Medicare/PTAN is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicare Members until one is provided.  Please email the Medicare/TPI once available to:  SWHPEXPEDITES@BSWHealth.org     Thank you and have a great day. Provider Services', NULL, NULL, '2021-08-25 08:44:01', '2021-08-25 08:44:01'),
(28053, 3046, 22886, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:32', '2021-03-17 16:42:32'),
(28054, 3040, 22886, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:14:39', '2021-05-31 14:14:39'),
(28055, 3040, 22886, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Success! Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 9149de7f-ee77-4e96-b330-6a13cfe95a6b', NULL, NULL, '2021-06-18 11:28:35', '2021-06-18 11:28:35'),
(28056, 3040, 22886, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:17', '2021-07-08 09:49:17'),
(28057, 3040, 22886, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  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 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  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 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:40', '2021-07-28 16:43:40'),
(28058, 11056, 22886, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:45:15', '2021-08-09 14:45:15'),
(28059, 3040, 22886, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Email rcvd from: SWHPEXPEDITES@bswhealth.org  Subject: To add Joseph, Stephen, Piccione, Paul, Jacob, Fernandus, Chennemkara, Brown, Abraham, Abraham and John to Normandy Urgent Care Center  The provider information for Molly Joseph, Ani Stephen, James Piccione, Sigi Paul, Jaya Jacob, Limy Fernandus, Mini Chennemkara, Brittany Brown, Jeena Abraham, Glory Abraham and Jeny John to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 9/7/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.  Note:  For the RightCare (Medicaid) line of business:  If an active/attested TPI is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicaid RightCare Members until one is provided.    For the Medicare line of business: If an active Medicare/PTAN is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicare Members until one is provided.  Please email the Medicare/TPI once available to:  SWHPEXPEDITES@BSWHealth.org     Thank you and have a great day. Provider Services', NULL, NULL, '2021-08-25 08:44:01', '2021-08-25 08:44:01'),
(28060, 3046, 22887, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:34', '2021-03-17 16:42:34'),
(28061, 3040, 22887, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:14:42', '2021-05-31 14:14:42'),
(28062, 3040, 22887, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 4:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5: Provider Name: George, Jeemol Provider NPI# 1497219067  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 11:39:25', '2021-06-18 11:39:25'),
(28063, 3040, 22887, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:17', '2021-07-08 09:49:17'),
(28064, 3040, 22887, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  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 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  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 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:32', '2021-07-28 16:43:32'),
(28065, 11056, 22887, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:45:35', '2021-08-09 14:45:35'),
(28066, 10057, 22887, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good Morning,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Abraham, Jeena	1467901587 Rauf, Abdur	1497726202 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Kourouma , Odette Tiranke	1134525868 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemo	1497219067 Joseph, Molly	1073019493 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189  Your early response will be highly appreciated and for any questions please feel free to reach out to me.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:19:09', '2021-10-08 10:19:09'),
(28067, 10057, 22887, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From: SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Good Morning,  We have received your Demographic Update requests for Imperial Valley Urgent Care Center TIN: 270796429 to enroll the following providers:  Joseph Vibitha N/A 1952931560  Rauf Abdur N/A 1497726202  Thomas Cini N/A 1134777238  Unfortunately the request that was submitted was for a demographic update, not to enroll the providers. However, we did find that the providers are reflecting as active in our system. Can you please verify if these request are really to enroll the providers or is this an actual address change?    Thank you,  Jennifer Pitts', NULL, NULL, '2021-11-17 13:14:30', '2021-11-17 13:14:30'),
(28068, 10057, 22887, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Good Afternoon Jennifer,  Hope this email finds you well. We have forwarded a request to link the secondary location Imperial Valley Urgent Care Center with TIN  270796429. Since Primary location Normandy Urgent Care is already done.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Rauf, Abdur	1497726202 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 George, Jeemol	1497219067  Furthermore, we already submitted forms via your website to enroll the above mentioned providers. Please get back to me with the latest updates.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 13:33:34', '2021-11-17 13:33:34'),
(28069, 10057, 22887, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Hello,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned request.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-11-30 14:52:06', '2021-11-30 14:52:06'),
(28070, 10057, 22887, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Hello,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned request.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-11-30 14:52:06', '2021-11-30 14:52:06'),
(28071, 10057, 22887, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Hello,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned request.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-11-30 14:52:06', '2021-11-30 14:52:06'),
(28072, 10057, 22887, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good afternoon,  Hope you are doing great. Could you please provide me with the latest update on below mentioned providers & group enrollment status?  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 13:56:28', '2021-12-07 13:56:28');
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
(28073, 10057, 22887, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Hello,  Below is a snip it of the plans that the provider(s) in question is contracted for under TIN: 27-0796429  Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-12-16 13:20:12', '2021-12-16 13:20:12'),
(28074, 10057, 22887, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Thank you for your response. i just want to let you know that below mentioned providers are still not listed with Imperial Valley Urgent Care Center. How long will it take to link in with that location?  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Jose, Julie	1447883061 George, Jeemol	1497219067  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-22 13:43:48', '2021-12-22 13:43:48'),
(28075, 10057, 22887, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good morning,  When did you send in the request to add the new location?', NULL, NULL, '2021-12-29 11:59:39', '2021-12-29 11:59:39'),
(28076, 20067, 22887, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Application initiated through portal. Kindly see the attachments.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 44789aeb-392d-4511-ad2b-364f93f40d22  ', NULL, NULL, '2022-01-12 17:28:57', '2022-01-12 17:28:57'),
(28077, 20067, 22887, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Will check status next week because the application was submitted previous week.', NULL, NULL, '2022-01-18 17:57:44', '2022-01-18 17:57:44'),
(28078, 20067, 22887, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Will check status on 02/12/2022 because the attachment says allow 30-45 days before checking status.', NULL, NULL, '2022-01-28 11:50:28', '2022-01-28 11:50:28'),
(28079, 20067, 22887, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Sub: Enroll Group & Providers || NUCC & IVUC || Scott & White ||  Good Morning!  Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers.  Group Name	Normandy Urgent Care Center Tax ID	270796429 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 Provider Name	NPI Jeemol George	1497219067 Julie Jose	1447883061  Thank you,', NULL, NULL, '2022-03-02 10:35:09', '2022-03-02 10:35:09'),
(28080, 20067, 22887, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: HPREGION2@BSWHealth.org  Sub: RE:  Enroll Group & Providers || NUCC & IVUC || Scott & White ||  Good Afternoon!    Can you please confirm that the Secondary location was added to both providers profile?  Thank you,', NULL, NULL, '2022-03-21 13:12:31', '2022-03-21 13:12:31'),
(28081, 20067, 22887, NULL, '2022-03-28 00:00:00.000', 'Approved', 'Secure email received from: HPREGION2@BSWHealth.org  Sub: RE: RE: Enroll Group & Providers || NUCC & IVUC || Scott & White ||  Good afternoon,     Please see the address below listed for the providers:   ', NULL, NULL, '2022-03-21 13:46:49', '2022-03-21 13:46:49'),
(28082, 3046, 22888, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:35', '2021-03-17 16:42:35'),
(28083, 3040, 22888, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:14:46', '2021-05-31 14:14:46'),
(28084, 3040, 22888, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Success! Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: abdd3ad1-2990-4c4a-a21e-5cc4bbeea77b ', NULL, NULL, '2021-06-18 11:27:09', '2021-06-18 11:27:09'),
(28085, 3040, 22888, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:14', '2021-07-08 09:49:14'),
(28086, 11056, 22888, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:45:45', '2021-08-09 14:45:45'),
(28087, 11056, 22888, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:46:43', '2021-08-09 14:46:43'),
(28088, 3040, 22888, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Email rcvd from: SWHPEXPEDITES@bswhealth.org  Subject: To add Joseph, Stephen, Piccione, Paul, Jacob, Fernandus, Chennemkara, Brown, Abraham, Abraham and John to Normandy Urgent Care Center  The provider information for Molly Joseph, Ani Stephen, James Piccione, Sigi Paul, Jaya Jacob, Limy Fernandus, Mini Chennemkara, Brittany Brown, Jeena Abraham, Glory Abraham and Jeny John to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 9/7/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.  Note:  For the RightCare (Medicaid) line of business:  If an active/attested TPI is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicaid RightCare Members until one is provided.    For the Medicare line of business: If an active Medicare/PTAN is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicare Members until one is provided.  Please email the Medicare/TPI once available to:  SWHPEXPEDITES@BSWHealth.org     Thank you and have a great day. Provider Services', NULL, NULL, '2021-08-25 08:43:59', '2021-08-25 08:43:59'),
(28089, 3046, 22889, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:37', '2021-03-17 16:42:37'),
(28090, 3040, 22889, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:14:50', '2021-05-31 14:14:50'),
(28091, 3040, 22889, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 4:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5: Provider Name: George, Jeemol Provider NPI# 1497219067  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 11:39:19', '2021-06-18 11:39:19'),
(28092, 3040, 22889, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:12', '2021-07-08 09:49:12'),
(28093, 3040, 22889, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  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 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  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 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:34', '2021-07-28 16:43:34'),
(28094, 11056, 22889, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:46:55', '2021-08-09 14:46:55'),
(28095, 10057, 22889, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good Morning,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Abraham, Jeena	1467901587 Rauf, Abdur	1497726202 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Kourouma , Odette Tiranke	1134525868 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemo	1497219067 Joseph, Molly	1073019493 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189  Your early response will be highly appreciated and for any questions please feel free to reach out to me.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:18:59', '2021-10-08 10:18:59'),
(28096, 10057, 22889, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From: SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Good Morning,  We have received your Demographic Update requests for Imperial Valley Urgent Care Center TIN: 270796429 to enroll the following providers:  Joseph Vibitha N/A 1952931560  Rauf Abdur N/A 1497726202  Thomas Cini N/A 1134777238  Unfortunately the request that was submitted was for a demographic update, not to enroll the providers. However, we did find that the providers are reflecting as active in our system. Can you please verify if these request are really to enroll the providers or is this an actual address change?    Thank you,  Jennifer Pitts', NULL, NULL, '2021-11-17 13:14:24', '2021-11-17 13:14:24'),
(28097, 10057, 22889, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Good Afternoon Jennifer,  Hope this email finds you well. We have forwarded a request to link the secondary location Imperial Valley Urgent Care Center with TIN  270796429. Since Primary location Normandy Urgent Care is already done.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Rauf, Abdur	1497726202 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 George, Jeemol	1497219067  Furthermore, we already submitted forms via your website to enroll the above mentioned providers. Please get back to me with the latest updates.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 13:33:26', '2021-11-17 13:33:26'),
(28098, 10057, 22889, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Hello,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned request.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-11-30 14:52:06', '2021-11-30 14:52:06'),
(28099, 10057, 22889, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Hello,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned request.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-11-30 14:52:06', '2021-11-30 14:52:06'),
(28100, 10057, 22889, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Hello,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned request.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-11-30 14:52:06', '2021-11-30 14:52:06'),
(28101, 10057, 22889, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Hello,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned request.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-11-30 14:52:06', '2021-11-30 14:52:06'),
(28102, 10057, 22889, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Hello,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned request.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-11-30 14:52:06', '2021-11-30 14:52:06'),
(28103, 10057, 22889, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good afternoon,  Hope you are doing great. Could you please provide me with the latest update on below mentioned providers & group enrollment status?  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 13:56:20', '2021-12-07 13:56:20'),
(28104, 10057, 22889, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Hello,  Below is a snip it of the plans that the provider(s) in question is contracted for under TIN: 27-0796429  Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-12-16 13:19:56', '2021-12-16 13:19:56'),
(28105, 10057, 22889, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Thank you for your response. i just want to let you know that below mentioned providers are still not listed with Imperial Valley Urgent Care Center. How long will it take to link in with that location?  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Jose, Julie	1447883061 George, Jeemol	1497219067  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-22 13:43:43', '2021-12-22 13:43:43'),
(28106, 10057, 22889, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good morning,  When did you send in the request to add the new location?', NULL, NULL, '2021-12-29 11:59:34', '2021-12-29 11:59:34'),
(28107, 20067, 22889, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Application initiated through portal. Kindly see the attachment.  Please allow 30-45 days before checking on status.  Your form submission identifier is: c299eb5a-005c-4c1d-b6b8-0212f6811ba0  ', NULL, NULL, '2022-01-12 17:24:18', '2022-01-12 17:24:18'),
(28108, 20067, 22889, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Will check status next week because the application was submitted previous week.', NULL, NULL, '2022-01-18 17:57:29', '2022-01-18 17:57:29'),
(28109, 20067, 22889, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Will check status on 02/12/2022 because the attachment says allow 30-45 days before checking status.', NULL, NULL, '2022-01-28 11:50:21', '2022-01-28 11:50:21'),
(28110, 20067, 22889, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Sub: Enroll Group & Providers || NUCC & IVUC || Scott & White ||  Good Morning!  Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers.  Group Name	Normandy Urgent Care Center Tax ID	270796429 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 Provider Name	NPI Jeemol George	1497219067 Julie Jose	1447883061  Thank you,', NULL, NULL, '2022-03-02 10:35:16', '2022-03-02 10:35:16'),
(28111, 20067, 22889, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: HPREGION2@BSWHealth.org  Sub: RE:  Enroll Group & Providers || NUCC & IVUC || Scott & White ||  Good Afternoon!    Can you please confirm that the Secondary location was added to both providers profile?  Thank you,', NULL, NULL, '2022-03-21 13:12:23', '2022-03-21 13:12:23'),
(28112, 20067, 22889, NULL, '2022-03-28 00:00:00.000', 'Approved', 'Secure email received from: HPREGION2@BSWHealth.org  Sub: RE: RE: Enroll Group & Providers || NUCC & IVUC || Scott & White ||  Good afternoon,     Please see the address below listed for the providers:   ', NULL, NULL, '2022-03-21 13:46:08', '2022-03-21 13:46:08'),
(28113, 3046, 22890, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:38', '2021-03-17 16:42:38'),
(28114, 3040, 22890, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:14:54', '2021-05-31 14:14:54'),
(28115, 3040, 22890, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 4:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5: Provider Name: George, Jeemol Provider NPI# 1497219067  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 11:39:14', '2021-06-18 11:39:14'),
(28116, 3040, 22890, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:12', '2021-07-08 09:49:12'),
(28117, 3040, 22890, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  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 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  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 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:41', '2021-07-28 16:43:41'),
(28118, 11056, 22890, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:47:03', '2021-08-09 14:47:03'),
(28119, 10057, 22890, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good Morning,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Abraham, Jeena	1467901587 Rauf, Abdur	1497726202 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Kourouma , Odette Tiranke	1134525868 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemo	1497219067 Joseph, Molly	1073019493 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189  Your early response will be highly appreciated and for any questions please feel free to reach out to me.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:18:48', '2021-10-08 10:18:48'),
(28120, 10057, 22890, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From: SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Good Morning,  We have received your Demographic Update requests for Imperial Valley Urgent Care Center TIN: 270796429 to enroll the following providers:  Joseph Vibitha N/A 1952931560  Rauf Abdur N/A 1497726202  Thomas Cini N/A 1134777238  Unfortunately the request that was submitted was for a demographic update, not to enroll the providers. However, we did find that the providers are reflecting as active in our system. Can you please verify if these request are really to enroll the providers or is this an actual address change?    Thank you,  Jennifer Pitts', NULL, NULL, '2021-11-17 13:14:07', '2021-11-17 13:14:07'),
(28121, 10057, 22890, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Good Afternoon Jennifer,  Hope this email finds you well. We have forwarded a request to link the secondary location Imperial Valley Urgent Care Center with TIN  270796429. Since Primary location Normandy Urgent Care is already done.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Rauf, Abdur	1497726202 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 George, Jeemol	1497219067  Furthermore, we already submitted forms via your website to enroll the above mentioned providers. Please get back to me with the latest updates.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 13:33:13', '2021-11-17 13:33:13'),
(28122, 10057, 22890, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Hello,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned request.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-11-30 14:52:09', '2021-11-30 14:52:09'),
(28123, 10057, 22890, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good afternoon,  Hope you are doing great. Could you please provide me with the latest update on below mentioned providers & group enrollment status?  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 13:56:10', '2021-12-07 13:56:10'),
(28124, 10057, 22890, NULL, '2021-12-16 00:00:00.000', 'Approved', 'Email Received From : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Hello,  Below is a snip it of the locations that the provider(s) in question is contracted for under TIN: 27-0796429.  Thanks', NULL, NULL, '2021-12-09 14:00:15', '2021-12-09 14:00:15'),
(28125, 3046, 22891, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:40', '2021-03-17 16:42:40'),
(28126, 3040, 22891, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:14:59', '2021-05-31 14:14:59'),
(28127, 3040, 22891, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 4:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5: Provider Name: George, Jeemol Provider NPI# 1497219067  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 11:39:09', '2021-06-18 11:39:09'),
(28128, 3040, 22891, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:11', '2021-07-08 09:49:11'),
(28129, 3040, 22891, NULL, '2021-08-04 00:00:00.000', 'Approved', 'As per email rcvd from SWHPREGION2@bswhealth.org provider is participating with Scott and White. Effective date: 02/19/2021', NULL, NULL, '2021-07-28 16:35:18', '2021-07-28 16:35:18'),
(28130, 3046, 22892, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:42', '2021-03-17 16:42:42'),
(28131, 3040, 22892, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:15:03', '2021-05-31 14:15:03'),
(28132, 3040, 22892, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Success! Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: b267b701-b098-4aae-ad9c-0831d1e1c1a8', NULL, NULL, '2021-06-18 11:26:23', '2021-06-18 11:26:23');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(28133, 3040, 22892, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:11', '2021-07-08 09:49:11'),
(28134, 3040, 22892, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  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 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  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 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:43', '2021-07-28 16:43:43'),
(28135, 11056, 22892, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:49:26', '2021-08-09 14:49:26'),
(28136, 3040, 22892, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Email rcvd from: SWHPEXPEDITES@bswhealth.org  Subject: To add Joseph, Stephen, Piccione, Paul, Jacob, Fernandus, Chennemkara, Brown, Abraham, Abraham and John to Normandy Urgent Care Center  The provider information for Molly Joseph, Ani Stephen, James Piccione, Sigi Paul, Jaya Jacob, Limy Fernandus, Mini Chennemkara, Brittany Brown, Jeena Abraham, Glory Abraham and Jeny John to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 9/7/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.  Note:  For the RightCare (Medicaid) line of business:  If an active/attested TPI is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicaid RightCare Members until one is provided.    For the Medicare line of business: If an active Medicare/PTAN is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicare Members until one is provided.  Please email the Medicare/TPI once available to:  SWHPEXPEDITES@BSWHealth.org     Thank you and have a great day. Provider Services', NULL, NULL, '2021-08-25 08:43:58', '2021-08-25 08:43:58'),
(28137, 3046, 22893, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:43', '2021-03-17 16:42:43'),
(28138, 3040, 22893, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:15:07', '2021-05-31 14:15:07'),
(28139, 3040, 22893, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Success! Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 357c6584-05c0-4781-a10d-58ca4bc40db1', NULL, NULL, '2021-06-18 11:26:01', '2021-06-18 11:26:01'),
(28140, 3040, 22893, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:10', '2021-07-08 09:49:10'),
(28141, 3040, 22893, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  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 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  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 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:35', '2021-07-28 16:43:35'),
(28142, 11056, 22893, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:49:07', '2021-08-09 14:49:07'),
(28143, 3040, 22893, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Email rcvd from: SWHPEXPEDITES@bswhealth.org  Subject: To add Joseph, Stephen, Piccione, Paul, Jacob, Fernandus, Chennemkara, Brown, Abraham, Abraham and John to Normandy Urgent Care Center  The provider information for Molly Joseph, Ani Stephen, James Piccione, Sigi Paul, Jaya Jacob, Limy Fernandus, Mini Chennemkara, Brittany Brown, Jeena Abraham, Glory Abraham and Jeny John to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 9/7/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.  Note:  For the RightCare (Medicaid) line of business:  If an active/attested TPI is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicaid RightCare Members until one is provided.    For the Medicare line of business: If an active Medicare/PTAN is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicare Members until one is provided.  Please email the Medicare/TPI once available to:  SWHPEXPEDITES@BSWHealth.org     Thank you and have a great day. Provider Services', NULL, NULL, '2021-08-25 08:43:58', '2021-08-25 08:43:58'),
(28144, 3046, 22894, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:45', '2021-03-17 16:42:45'),
(28145, 3040, 22894, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:15:11', '2021-05-31 14:15:11'),
(28146, 3040, 22894, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Success! Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 5fa4f401-1036-491a-bae3-dce2adf20e30', NULL, NULL, '2021-06-18 11:25:33', '2021-06-18 11:25:33'),
(28147, 3040, 22894, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:10', '2021-07-08 09:49:10'),
(28148, 3040, 22894, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  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 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  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 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:40', '2021-07-28 16:43:40'),
(28149, 11056, 22894, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:48:57', '2021-08-09 14:48:57'),
(28150, 10057, 22894, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good Morning,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Abraham, Jeena	1467901587 Rauf, Abdur	1497726202 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Kourouma , Odette Tiranke	1134525868 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemo	1497219067 Joseph, Molly	1073019493 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189  Your early response will be highly appreciated and for any questions please feel free to reach out to me.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:18:38', '2021-10-08 10:18:38'),
(28151, 10057, 22894, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From: SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Good Morning,  We have received your Demographic Update requests for Imperial Valley Urgent Care Center TIN: 270796429 to enroll the following providers:  Joseph Vibitha N/A 1952931560  Rauf Abdur N/A 1497726202  Thomas Cini N/A 1134777238  Unfortunately the request that was submitted was for a demographic update, not to enroll the providers. However, we did find that the providers are reflecting as active in our system. Can you please verify if these request are really to enroll the providers or is this an actual address change?    Thank you,  Jennifer Pitts', NULL, NULL, '2021-11-17 13:14:01', '2021-11-17 13:14:01'),
(28152, 10057, 22894, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Good Afternoon Jennifer,  Hope this email finds you well. We have forwarded a request to link the secondary location Imperial Valley Urgent Care Center with TIN  270796429. Since Primary location Normandy Urgent Care is already done.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Rauf, Abdur	1497726202 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 George, Jeemol	1497219067  Furthermore, we already submitted forms via your website to enroll the above mentioned providers. Please get back to me with the latest updates.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 13:32:45', '2021-11-17 13:32:45'),
(28153, 10057, 22894, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Hello,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned request.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-11-30 14:51:25', '2021-11-30 14:51:25'),
(28154, 10057, 22894, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good afternoon,  Hope you are doing great. Could you please provide me with the latest update on below mentioned providers & group enrollment status?  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 13:56:02', '2021-12-07 13:56:02'),
(28155, 10057, 22894, NULL, '2021-12-16 00:00:00.000', 'Approved', 'Email Received From : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Hello,  Below is a snip it of the locations that the provider(s) in question is contracted for under TIN: 27-0796429.  Thanks', NULL, NULL, '2021-12-09 13:58:30', '2021-12-09 13:58:30'),
(28156, 3046, 22895, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:47', '2021-03-17 16:42:47'),
(28157, 3040, 22895, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:15:15', '2021-05-31 14:15:15'),
(28158, 3040, 22895, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Success! Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 5a86887f-0ccf-42b6-8f99-4e3b3f30aaee', NULL, NULL, '2021-06-18 11:25:07', '2021-06-18 11:25:07'),
(28159, 3040, 22895, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:09', '2021-07-08 09:49:09'),
(28160, 3040, 22895, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  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 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  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 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:46', '2021-07-28 16:43:46'),
(28161, 11056, 22895, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:48:42', '2021-08-09 14:48:42'),
(28162, 3040, 22895, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Email rcvd from: SWHPEXPEDITES@bswhealth.org  Subject: To add Joseph, Stephen, Piccione, Paul, Jacob, Fernandus, Chennemkara, Brown, Abraham, Abraham and John to Normandy Urgent Care Center  The provider information for Molly Joseph, Ani Stephen, James Piccione, Sigi Paul, Jaya Jacob, Limy Fernandus, Mini Chennemkara, Brittany Brown, Jeena Abraham, Glory Abraham and Jeny John to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 9/7/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.  Note:  For the RightCare (Medicaid) line of business:  If an active/attested TPI is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicaid RightCare Members until one is provided.    For the Medicare line of business: If an active Medicare/PTAN is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicare Members until one is provided.  Please email the Medicare/TPI once available to:  SWHPEXPEDITES@BSWHealth.org     Thank you and have a great day. Provider Services', NULL, NULL, '2021-08-25 09:34:24', '2021-08-25 09:34:24'),
(28163, 3046, 22896, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:42:49', '2021-03-17 16:42:49'),
(28164, 3040, 22896, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: 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, '2021-05-31 14:15:20', '2021-05-31 14:15:20'),
(28165, 3040, 22896, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 4:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5: Provider Name: George, Jeemol Provider NPI# 1497219067  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 11:39:04', '2021-06-18 11:39:04'),
(28166, 3040, 22896, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:09', '2021-07-08 09:49:09'),
(28167, 3040, 22896, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  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 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  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 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:41', '2021-07-28 16:43:41'),
(28168, 11056, 22896, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:48:07', '2021-08-09 14:48:07'),
(28169, 10057, 22896, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good Morning,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Abraham, Jeena	1467901587 Rauf, Abdur	1497726202 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Kourouma , Odette Tiranke	1134525868 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemo	1497219067 Joseph, Molly	1073019493 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189  Your early response will be highly appreciated and for any questions please feel free to reach out to me.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:19:47', '2021-10-08 10:19:47'),
(28170, 10057, 22896, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From: SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Good Morning,  We have received your Demographic Update requests for Imperial Valley Urgent Care Center TIN: 270796429 to enroll the following providers:  Joseph Vibitha N/A 1952931560  Rauf Abdur N/A 1497726202  Thomas Cini N/A 1134777238  Unfortunately the request that was submitted was for a demographic update, not to enroll the providers. However, we did find that the providers are reflecting as active in our system. Can you please verify if these request are really to enroll the providers or is this an actual address change?    Thank you,  Jennifer Pitts', NULL, NULL, '2021-11-17 13:13:55', '2021-11-17 13:13:55'),
(28171, 10057, 22896, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Good Afternoon Jennifer,  Hope this email finds you well. We have forwarded a request to link the secondary location Imperial Valley Urgent Care Center with TIN  270796429. Since Primary location Normandy Urgent Care is already done.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Rauf, Abdur	1497726202 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 George, Jeemol	1497219067  Furthermore, we already submitted forms via your website to enroll the above mentioned providers. Please get back to me with the latest updates.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 13:27:54', '2021-11-17 13:27:54'),
(28172, 10057, 22896, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : SWHPPROVSERVICES@bswhealth.org  Sub : Demographic Update Request  Hello,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned request.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-11-30 14:51:19', '2021-11-30 14:51:19'),
(28173, 10057, 22896, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Good afternoon,  Hope you are doing great. Could you please provide me with the latest update on below mentioned providers & group enrollment status?  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 13:55:53', '2021-12-07 13:55:53'),
(28174, 10057, 22896, NULL, '2021-12-16 00:00:00.000', 'Approved', 'Email Received From : SWHPREGION2@bswhealth.org  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White |  Hello,  Below is a snip it of the locations that the provider(s) in question is contracted for under TIN: 27-0796429.  Thanks', NULL, NULL, '2021-12-09 14:01:41', '2021-12-09 14:01:41'),
(28175, 1006, 22897, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:43:23', '2021-03-17 16:43:23'),
(28176, 1006, 22897, NULL, '2021-05-26 00:00:00.000', 'Approved', 'The provider is enrolled with UHC as of 01/09/2017, approval and location confirmation are attached. ', NULL, NULL, '2021-05-19 09:16:41', '2021-05-19 09:16:41'),
(28177, 1006, 22898, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:43:24', '2021-03-17 16:43:24'),
(28178, 1006, 22898, NULL, '2021-05-26 00:00:00.000', 'Approved', 'The provider is enrolled with UHC as of 08/01/2016, approval & location confirmation is attached for reference.', NULL, NULL, '2021-05-19 09:54:09', '2021-05-19 09:54:09'),
(28179, 1006, 22899, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:43:25', '2021-03-17 16:43:25'),
(28180, 1006, 22899, NULL, '2021-05-26 00:00:00.000', 'Approved', 'The provider is enrolled in UHC as of 01/23/2020, approval confirmation and location confirmation is attached for reference.', NULL, NULL, '2021-05-19 09:55:21', '2021-05-19 09:55:21'),
(28181, 3046, 22900, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:28', '2021-03-17 16:45:28'),
(28182, 3040, 22900, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:08:00', '2021-05-26 17:08:00'),
(28183, 3046, 22901, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:30', '2021-03-17 16:45:30'),
(28184, 3040, 22901, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our provider is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:08:31', '2021-05-26 17:08:31');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(28185, 3046, 22902, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:31', '2021-03-17 16:45:31'),
(28186, 3040, 22902, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:08:47', '2021-05-26 17:08:47'),
(28187, 3046, 22903, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:32', '2021-03-17 16:45:32'),
(28188, 3040, 22903, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:08:57', '2021-05-26 17:08:57'),
(28189, 3046, 22904, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:34', '2021-03-17 16:45:34'),
(28190, 3040, 22904, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:09:07', '2021-05-26 17:09:07'),
(28191, 3046, 22905, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:36', '2021-03-17 16:45:36'),
(28192, 3040, 22905, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:09:12', '2021-05-26 17:09:12'),
(28193, 3046, 22906, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:37', '2021-03-17 16:45:37'),
(28194, 3040, 22906, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:09:26', '2021-05-26 17:09:26'),
(28195, 3046, 22907, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:39', '2021-03-17 16:45:39'),
(28196, 3040, 22907, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:09:30', '2021-05-26 17:09:30'),
(28197, 3046, 22908, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:40', '2021-03-17 16:45:40'),
(28198, 3040, 22908, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:09:44', '2021-05-26 17:09:44'),
(28199, 3046, 22909, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:42', '2021-03-17 16:45:42'),
(28200, 3040, 22909, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:09:56', '2021-05-26 17:09:56'),
(28201, 3046, 22910, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:44', '2021-03-17 16:45:44'),
(28202, 3040, 22910, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:10:08', '2021-05-26 17:10:08'),
(28203, 3046, 22911, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:46', '2021-03-17 16:45:46'),
(28204, 3040, 22911, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:10:19', '2021-05-26 17:10:19'),
(28205, 3046, 22912, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:47', '2021-03-17 16:45:47'),
(28206, 3040, 22912, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:10:25', '2021-05-26 17:10:25'),
(28207, 3046, 22913, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:49', '2021-03-17 16:45:49'),
(28208, 3040, 22913, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:10:38', '2021-05-26 17:10:38'),
(28209, 3046, 22914, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:51', '2021-03-17 16:45:51'),
(28210, 3040, 22914, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:10:45', '2021-05-26 17:10:45'),
(28211, 3046, 22915, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:45:53', '2021-03-17 16:45:53'),
(28212, 3040, 22915, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-05-26 17:11:00', '2021-05-26 17:11:00'),
(28213, 1006, 22916, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:01', '2021-03-17 16:46:01'),
(28214, 3040, 22916, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:07:28', '2021-05-24 15:07:28'),
(28215, 3040, 22916, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 15:49:54', '2021-06-10 15:49:54'),
(28216, 3040, 22916, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please find the attached requested form as per above email along with the W9.   If you need further information please let me know. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-10 15:50:19', '2021-06-10 15:50:19'),
(28217, 3040, 22916, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hello,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-29 09:38:19', '2021-06-29 09:38:19'),
(28218, 3040, 22916, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Email rcvd from: jmaligaya@anci-care.com  Subject: Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Anci Care||  Hello,  Both locations have been added.  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, '2021-07-13 11:30:15', '2021-07-13 11:30:15'),
(28219, 1006, 22917, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:02', '2021-03-17 16:46:02'),
(28220, 3040, 22917, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:07:34', '2021-05-24 15:07:34'),
(28221, 3040, 22917, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from:  mdiprsupport@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,  01- Please see the following Providers with effective dates.  Provider Name                          Effective Date   GEORGE, JEEMOL                      03/11/2020   Julie Jose, NP                              07/01/2020   James M Piccione, MD              12/01/2018   Brittany Brown, NP                   05/01/2020   Glory Abraham, NP                   09/01/2019   Fernandus Limy Np                   12/01/2020   Abdur Rauf, MD                          02/01/2018   KOUROUMA, ODETTE T             10/28/2019   JOSEPH, VIBITHA                         02/05/2020   Cini Thomas, NP                         02/01/2020   JEENA ABRAHAM, NP                 02/01/2018   ', NULL, NULL, '2021-06-10 14:58:36', '2021-06-10 14:58:36'),
(28222, 1006, 22918, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:04', '2021-03-17 16:46:04'),
(28223, 3040, 22918, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:07:38', '2021-05-24 15:07:38'),
(28224, 3040, 22918, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from:  mdiprsupport@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,  01- Please see the following Providers with effective dates.  Provider Name                          Effective Date   GEORGE, JEEMOL                      03/11/2020   Julie Jose, NP                              07/01/2020   James M Piccione, MD              12/01/2018   Brittany Brown, NP                   05/01/2020   Glory Abraham, NP                   09/01/2019   Fernandus Limy Np                   12/01/2020   Abdur Rauf, MD                          02/01/2018   KOUROUMA, ODETTE T             10/28/2019   JOSEPH, VIBITHA                         02/05/2020   Cini Thomas, NP                         02/01/2020   JEENA ABRAHAM, NP                 02/01/2018   ', NULL, NULL, '2021-06-10 14:58:31', '2021-06-10 14:58:31'),
(28225, 1006, 22919, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:05', '2021-03-17 16:46:05'),
(28226, 3040, 22919, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:07:43', '2021-05-24 15:07:43'),
(28227, 3040, 22919, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from:  mdiprsupport@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,  01- Please see the following Providers with effective dates.  Provider Name                          Effective Date   GEORGE, JEEMOL                      03/11/2020   Julie Jose, NP                              07/01/2020   James M Piccione, MD              12/01/2018   Brittany Brown, NP                   05/01/2020   Glory Abraham, NP                   09/01/2019   Fernandus Limy Np                   12/01/2020   Abdur Rauf, MD                          02/01/2018   KOUROUMA, ODETTE T             10/28/2019   JOSEPH, VIBITHA                         02/05/2020   Cini Thomas, NP                         02/01/2020   JEENA ABRAHAM, NP                 02/01/2018   ', NULL, NULL, '2021-06-10 14:58:27', '2021-06-10 14:58:27'),
(28228, 1006, 22920, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:06', '2021-03-17 16:46:06'),
(28229, 3040, 22920, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:07:46', '2021-05-24 15:07:46'),
(28230, 3040, 22920, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:33', '2021-06-10 14:42:33'),
(28231, 3040, 22920, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:35', '2021-06-10 14:42:35'),
(28232, 3040, 22920, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please find the attached requested form as per above email along with the W9.   If you need further information please let me know. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-10 14:44:55', '2021-06-10 14:44:55'),
(28233, 3040, 22920, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hello,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-29 09:37:15', '2021-06-29 09:37:15'),
(28234, 3040, 22920, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual provider. Please see group task. ', NULL, NULL, '2021-07-13 11:36:12', '2021-07-13 11:36:12'),
(28235, 1006, 22921, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:07', '2021-03-17 16:46:07'),
(28236, 3040, 22921, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:07:51', '2021-05-24 15:07:51'),
(28237, 3040, 22921, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from:  mdiprsupport@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,  01- Please see the following Providers with effective dates.  Provider Name                          Effective Date   GEORGE, JEEMOL                      03/11/2020   Julie Jose, NP                              07/01/2020   James M Piccione, MD              12/01/2018   Brittany Brown, NP                   05/01/2020   Glory Abraham, NP                   09/01/2019   Fernandus Limy Np                   12/01/2020   Abdur Rauf, MD                          02/01/2018   KOUROUMA, ODETTE T             10/28/2019   JOSEPH, VIBITHA                         02/05/2020   Cini Thomas, NP                         02/01/2020   JEENA ABRAHAM, NP                 02/01/2018   ', NULL, NULL, '2021-06-10 14:58:24', '2021-06-10 14:58:24'),
(28238, 1006, 22922, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:08', '2021-03-17 16:46:08'),
(28239, 3040, 22922, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:07:56', '2021-05-24 15:07:56'),
(28240, 3040, 22922, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from:  mdiprsupport@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,  01- Please see the following Providers with effective dates.  Provider Name                          Effective Date   GEORGE, JEEMOL                      03/11/2020   Julie Jose, NP                              07/01/2020   James M Piccione, MD              12/01/2018   Brittany Brown, NP                   05/01/2020   Glory Abraham, NP                   09/01/2019   Fernandus Limy Np                   12/01/2020   Abdur Rauf, MD                          02/01/2018   KOUROUMA, ODETTE T             10/28/2019   JOSEPH, VIBITHA                         02/05/2020   Cini Thomas, NP                         02/01/2020   JEENA ABRAHAM, NP                 02/01/2018   ', NULL, NULL, '2021-06-10 14:58:20', '2021-06-10 14:58:20'),
(28241, 1006, 22923, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:09', '2021-03-17 16:46:09'),
(28242, 3040, 22923, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:08:07', '2021-05-24 15:08:07'),
(28243, 3040, 22923, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:35', '2021-06-10 14:42:35'),
(28244, 3040, 22923, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:36', '2021-06-10 14:42:36'),
(28245, 3040, 22923, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please find the attached requested form as per above email along with the W9.   If you need further information please let me know. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-10 14:44:39', '2021-06-10 14:44:39'),
(28246, 3040, 22923, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hello,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-29 09:37:20', '2021-06-29 09:37:20'),
(28247, 3040, 22923, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual provider. Please see group task. ', NULL, NULL, '2021-07-13 11:36:12', '2021-07-13 11:36:12'),
(28248, 1006, 22924, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:10', '2021-03-17 16:46:10'),
(28249, 3040, 22924, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:08:11', '2021-05-24 15:08:11'),
(28250, 3040, 22924, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from:  mdiprsupport@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,  01- Please see the following Providers with effective dates.  Provider Name                          Effective Date   GEORGE, JEEMOL                      03/11/2020   Julie Jose, NP                              07/01/2020   James M Piccione, MD              12/01/2018   Brittany Brown, NP                   05/01/2020   Glory Abraham, NP                   09/01/2019   Fernandus Limy Np                   12/01/2020   Abdur Rauf, MD                          02/01/2018   KOUROUMA, ODETTE T             10/28/2019   JOSEPH, VIBITHA                         02/05/2020   Cini Thomas, NP                         02/01/2020   JEENA ABRAHAM, NP                 02/01/2018   ', NULL, NULL, '2021-06-10 14:58:16', '2021-06-10 14:58:16'),
(28251, 1006, 22925, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:11', '2021-03-17 16:46:11'),
(28252, 3040, 22925, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:08:15', '2021-05-24 15:08:15'),
(28253, 3040, 22925, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from:  mdiprsupport@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,  01- Please see the following Providers with effective dates.  Provider Name                          Effective Date   GEORGE, JEEMOL                      03/11/2020   Julie Jose, NP                              07/01/2020   James M Piccione, MD              12/01/2018   Brittany Brown, NP                   05/01/2020   Glory Abraham, NP                   09/01/2019   Fernandus Limy Np                   12/01/2020   Abdur Rauf, MD                          02/01/2018   KOUROUMA, ODETTE T             10/28/2019   JOSEPH, VIBITHA                         02/05/2020   Cini Thomas, NP                         02/01/2020   JEENA ABRAHAM, NP                 02/01/2018   ', NULL, NULL, '2021-06-10 14:58:12', '2021-06-10 14:58:12'),
(28254, 1006, 22926, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:12', '2021-03-17 16:46:12'),
(28255, 3040, 22926, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:08:19', '2021-05-24 15:08:19');
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
(28256, 3040, 22926, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from:  mdiprsupport@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,  01- Please see the following Providers with effective dates.  Provider Name                          Effective Date   GEORGE, JEEMOL                      03/11/2020   Julie Jose, NP                              07/01/2020   James M Piccione, MD              12/01/2018   Brittany Brown, NP                   05/01/2020   Glory Abraham, NP                   09/01/2019   Fernandus Limy Np                   12/01/2020   Abdur Rauf, MD                          02/01/2018   KOUROUMA, ODETTE T             10/28/2019   JOSEPH, VIBITHA                         02/05/2020   Cini Thomas, NP                         02/01/2020   JEENA ABRAHAM, NP                 02/01/2018   ', NULL, NULL, '2021-06-10 14:58:08', '2021-06-10 14:58:08'),
(28257, 1006, 22927, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:13', '2021-03-17 16:46:13'),
(28258, 3040, 22927, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:08:23', '2021-05-24 15:08:23'),
(28259, 3040, 22927, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:35', '2021-06-10 14:42:35'),
(28260, 3040, 22927, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:41', '2021-06-10 14:42:41'),
(28261, 3040, 22927, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please find the attached requested form as per above email along with the W9.   If you need further information please let me know. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-10 14:44:27', '2021-06-10 14:44:27'),
(28262, 3040, 22927, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hello,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-29 09:37:25', '2021-06-29 09:37:25'),
(28263, 3040, 22927, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual provider. Please see group task. ', NULL, NULL, '2021-07-13 11:36:13', '2021-07-13 11:36:13'),
(28264, 1006, 22928, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:14', '2021-03-17 16:46:14'),
(28265, 3040, 22928, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:08:28', '2021-05-24 15:08:28'),
(28266, 3040, 22928, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from:  mdiprsupport@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,  01- Please see the following Providers with effective dates.  Provider Name                          Effective Date   GEORGE, JEEMOL                      03/11/2020   Julie Jose, NP                              07/01/2020   James M Piccione, MD              12/01/2018   Brittany Brown, NP                   05/01/2020   Glory Abraham, NP                   09/01/2019   Fernandus Limy Np                   12/01/2020   Abdur Rauf, MD                          02/01/2018   KOUROUMA, ODETTE T             10/28/2019   JOSEPH, VIBITHA                         02/05/2020   Cini Thomas, NP                         02/01/2020   JEENA ABRAHAM, NP                 02/01/2018   ', NULL, NULL, '2021-06-10 14:58:05', '2021-06-10 14:58:05'),
(28267, 1006, 22929, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:15', '2021-03-17 16:46:15'),
(28268, 3040, 22929, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:08:35', '2021-05-24 15:08:35'),
(28269, 3040, 22929, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from:  mdiprsupport@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,  01- Please see the following Providers with effective dates.  Provider Name                          Effective Date   GEORGE, JEEMOL                      03/11/2020   Julie Jose, NP                              07/01/2020   James M Piccione, MD              12/01/2018   Brittany Brown, NP                   05/01/2020   Glory Abraham, NP                   09/01/2019   Fernandus Limy Np                   12/01/2020   Abdur Rauf, MD                          02/01/2018   KOUROUMA, ODETTE T             10/28/2019   JOSEPH, VIBITHA                         02/05/2020   Cini Thomas, NP                         02/01/2020   JEENA ABRAHAM, NP                 02/01/2018   ', NULL, NULL, '2021-06-10 14:57:59', '2021-06-10 14:57:59'),
(28270, 1006, 22930, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:16', '2021-03-17 16:46:16'),
(28271, 3040, 22930, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:08:39', '2021-05-24 15:08:39'),
(28272, 3040, 22930, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:34', '2021-06-10 14:42:34'),
(28273, 3040, 22930, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:34', '2021-06-10 14:42:34'),
(28274, 3040, 22930, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:34', '2021-06-10 14:42:34'),
(28275, 3040, 22930, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:34', '2021-06-10 14:42:34'),
(28276, 3040, 22930, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:34', '2021-06-10 14:42:34'),
(28277, 3040, 22930, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:34', '2021-06-10 14:42:34'),
(28278, 3040, 22930, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:36', '2021-06-10 14:42:36'),
(28279, 3040, 22930, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:38', '2021-06-10 14:42:38'),
(28280, 3040, 22930, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:38', '2021-06-10 14:42:38'),
(28281, 3040, 22930, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Hi,  01- Please see the following Providers with effective dates.  Provider Name                       Effective Date   GEORGE, JEEMOL                    03/11/2020   Julie Jose, NP                            07/01/2020   James M Piccione, MD            12/01/2018   Brittany Brown, NP                 05/01/2020   Glory Abraham, NP                 09/01/2019   Fernandus Limy Np                12/01/2020   Abdur Rauf, MD                      02/01/2018   KOUROUMA, ODETTE T         10/28/2019   JOSEPH, VIBITHA                     02/05/2020   Cini Thomas, NP                     02/01/2020   JEENA ABRAHAM, NP              02/01/2018    02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name   Stephen, Ani   Chennemkara, Mini Philip    03- We currently show the following provider(s) credentialed with HealthSmart.  Please complete the attached demographic information form and return so we may add your group information to the provider’s record.  Provider Name   PAUL, SIGI   Jacob, Jaya NP    All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-10 14:42:40', '2021-06-10 14:42:40'),
(28282, 3040, 22930, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well. Please find the attached requested form as per above email along with the W9.   If you need further information please let me know. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-10 14:44:10', '2021-06-10 14:44:10'),
(28283, 3040, 22930, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hello,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-29 09:37:02', '2021-06-29 09:37:02'),
(28284, 3040, 22930, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual provider. Please see group task. ', NULL, NULL, '2021-07-13 11:36:13', '2021-07-13 11:36:13'),
(28285, 1006, 22931, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:46:17', '2021-03-17 16:46:17'),
(28286, 3040, 22931, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com, pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-05-24 15:08:43', '2021-05-24 15:08:43'),
(28287, 3040, 22931, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Email rcvd from:  mdiprsupport@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,  01- Please see the following Providers with effective dates.  Provider Name                          Effective Date   GEORGE, JEEMOL                      03/11/2020   Julie Jose, NP                              07/01/2020   James M Piccione, MD              12/01/2018   Brittany Brown, NP                   05/01/2020   Glory Abraham, NP                   09/01/2019   Fernandus Limy Np                   12/01/2020   Abdur Rauf, MD                          02/01/2018   KOUROUMA, ODETTE T             10/28/2019   JOSEPH, VIBITHA                         02/05/2020   Cini Thomas, NP                         02/01/2020   JEENA ABRAHAM, NP                 02/01/2018   ', NULL, NULL, '2021-06-10 14:57:53', '2021-06-10 14:57:53'),
(28288, 1006, 22932, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:47:59', '2021-03-17 16:47:59'),
(28289, 3040, 22932, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:44:37', '2021-05-26 15:44:37'),
(28290, 3040, 22932, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:52:13', '2021-06-03 08:52:13'),
(28291, 1006, 22933, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:00', '2021-03-17 16:48:00'),
(28292, 3040, 22933, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:44:42', '2021-05-26 15:44:42'),
(28293, 3040, 22933, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:50:00', '2021-06-03 08:50:00'),
(28294, 1006, 22934, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:02', '2021-03-17 16:48:02'),
(28295, 3040, 22934, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:44:46', '2021-05-26 15:44:46'),
(28296, 3040, 22934, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:50:03', '2021-06-03 08:50:03'),
(28297, 1006, 22935, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:03', '2021-03-17 16:48:03'),
(28298, 3040, 22935, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:44:51', '2021-05-26 15:44:51'),
(28299, 3040, 22935, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:50:10', '2021-06-03 08:50:10'),
(28300, 1006, 22936, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:04', '2021-03-17 16:48:04'),
(28301, 3040, 22936, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:44:55', '2021-05-26 15:44:55'),
(28302, 3040, 22936, NULL, '2021-06-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-03 08:50:14', '2021-06-03 08:50:14');
