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
(39195, 1019, 29825, NULL, '2021-06-22 00:00:00.000', 'Initiated', 'Received the following email from customerservice-donotreply@cms.hhs.gov SUB: Medicare Enrollment Application Receipt Notification (Tracking ID: T060720210001129 ) This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T060720210001129        NPI: 1548843410        Medicare ID:         Name: CEMETRICE  MUHAMMED          State: RI        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.                 INDIANAPOLIS,IN,46207-7149   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.  Please retain this e-mail for your records.  This email message is an automated notification. Do not reply to this message as it is sent from an unmonitored account. If you have any questions about this application:  1.) Refer to the Web site at (https://pecos.cms.hhs.gov), or   2.) Contact your fee-for-service contractor listed above   Please note: The information provided in this application may be shared with and used by others only in accordance with the privacy notice to which you agreed at the time of the application. In addition, you agreed to keep Medicare updated with any changes to data listed on the enrollment application form within 30 days of the effective date of the change. If you are not the provider, you are required to inform the provider of the information in this e-mail. ', NULL, NULL, '2021-06-07 10:47:48', '2021-06-07 10:47:48'),
(39196, 1019, 29825, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Received the following Email from Customerservice-donotreply@cms.hhs.gov  SUB: Request for Corrections for Medicare Enrollment Application (Tracking ID: T060720210001129)    To:  cemetrice1984@gmail.com,snbc@claimsmedinc.com   Subject:  Request for Corrections for Medicare Enrollment Application (Tracking ID: T060720210001129)  Date:   06/10/2021 14:27 PM  This message is in response to your Medicare enrollment application that was submitted from https://pecos.cms.hhs.gov. You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T060720210001129. The information provided below indicates areas of your application requiring corrections as determined by your fee-for-service contractor.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T060720210001129   NPI ID: 1548843410   Medicare ID:    Name: CEMETRICE MUHAMMED   State: RI  Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Other Comments  Per requirements please provide verification documents of any applicable degrees/diplomas and certification. ', NULL, NULL, '2021-06-11 09:41:07', '2021-06-11 09:41:07'),
(39197, 1019, 29825, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Application has been resubmitted with Corrections, thru Pecos', NULL, NULL, '2021-06-11 09:41:43', '2021-06-11 09:41:43'),
(39198, 1019, 29825, NULL, '2021-06-21 00:00:00.000', 'Approved', 'Received the following email from customerservice-donotreply@cms.hhs.gov Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T060720210001129)  Date:  06/14/2021 12:56 PM  This message is in response to your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T060720210001129. The application listed below has reached a final status.  IMPORTANT NOTE: Please wait until you receive official notification from your Fee-for-Service Contractor before submitting claims. Claims submitted before official notification from your Fee-for-Service Contractor may be rejected.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T060720210001129   NPI ID: 1548843410   Medicare ID: U400755435   Name: CEMETRICE MUHAMMED  State: RI   Form Type: 855I  Date: 06/14/2021  Status: APPROVED  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  You will receive a notification letter from the Fee-For-Service Contractor listed above.  This letter will provide you with valuable information regarding your enrollment information. ', NULL, NULL, '2021-06-14 13:14:39', '2021-06-14 13:14:39'),
(39199, 1019, 29826, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-12 07:55:58', '2021-05-12 07:55:58'),
(39200, 1019, 29826, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Waiting for Cemetrice State license.', NULL, NULL, '2021-05-12 08:02:05', '2021-05-12 08:02:05'),
(39201, 1019, 29826, NULL, '2021-06-29 00:00:00.000', 'In Process', 'CAQH Application Faxed to (866) 612-7790 for Cemetrice. Attached is the copy of the CAQH application for ref.', NULL, NULL, '2021-06-14 16:21:04', '2021-06-14 16:21:04'),
(39202, 1019, 29826, NULL, '2021-06-29 00:00:00.000', 'Initiated', 'CAQH Application Faxed to (866) 612-7790 for Cemetrice. Attached is the copy of the CAQH application for ref. ', NULL, NULL, '2021-06-14 16:21:39', '2021-06-14 16:21:39'),
(39203, 1019, 29826, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:23:17', '2021-08-24 11:23:17'),
(39204, 1019, 29826, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer continue with SNBCARE. ', NULL, NULL, '2021-10-25 10:54:48', '2021-10-25 10:54:48'),
(39205, 1019, 29827, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-12 07:55:58', '2021-05-12 07:55:58'),
(39206, 1019, 29827, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Waiting for Cemetrice State license.', NULL, NULL, '2021-05-12 08:02:44', '2021-05-12 08:02:44'),
(39207, 1019, 29827, NULL, '2021-07-05 00:00:00.000', 'Initiated', 'Received the following confirmation for application submission from UBH.  Dear Provider,  Thank you for your request to join the Optum behavioral health network! The Network Participation Request Form for Cemetrice Muhammed has been received and will now proceed to Network Management for review. We will contact you if additional information is needed.  You can now easily track the status of your online submission using the new Credentialing Status Toolbar. To access the Toolbar, log into providerexpress.com using your Optum ID, click the Join our Network link in the upper right corner and then select Check Initial Credentialing Status. If you need assistance, please contact our Provider Express Support Center at 1-866-209-9320.  Regards,  Optum Network Services', NULL, NULL, '2021-06-18 08:47:43', '2021-06-18 08:47:43'),
(39208, 1019, 29827, NULL, '2021-08-09 00:00:00.000', 'Not Eligible', 'UBH Rejected due to Temp License, see attached for reference.', NULL, NULL, '2021-08-02 16:32:55', '2021-08-02 16:32:55'),
(39209, 1019, 29827, NULL, '2021-08-09 00:00:00.000', 'Initiated', 'Re- Initiated  Application with Permanent address.', NULL, NULL, '2021-08-02 16:55:54', '2021-08-02 16:55:54'),
(39210, 1019, 29827, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Received the following email from bhcredentialing@optum.com 8/4/2021     Cemetrice Muhammed  Email:  snbc@claimsmedinc.com  Email:  snbc@claimsmedinc.com    Dear Cemetrice Muhammed,    Optum received your request for network participation. Your application is now in process for credentialing.    Once a decision has been made as to your credentialing status, you will receive a notification to include a decision letter outlining your effective date with Optum.  You can track the status of your credentialing by going to providerexpress.com > Our Network > Initial Credentialing Status, and then follow instructions for provider type.    Please note that once your CAQH application and contract documents are submitted, you have the right to:  Review information submitted to support your credentialing application; Correct erroneous information; Be informed, upon request, of the status of your credentialing or recredentialing application. If you identify any incorrect information, please contact the Provider Services Line at 1-877-614-0484 within 10 business days.      Thank you,  Optum Credentialing Department    a0b2T0000084oJy|AMTLetter|Letters        United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California  © 2020 Optum, Inc. All Rights Reserved BH2922b_09/2020  ', NULL, NULL, '2021-08-04 11:52:03', '2021-08-04 11:52:03'),
(39211, 1019, 29827, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer continue with SNBCARE. ', NULL, NULL, '2021-10-25 10:59:04', '2021-10-25 10:59:04'),
(39212, 1019, 29828, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-12 07:55:58', '2021-05-12 07:55:58'),
(39213, 1019, 29828, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Waiting for Cemetrice State license.', NULL, NULL, '2021-05-12 08:02:59', '2021-05-12 08:02:59'),
(39214, 1019, 29828, NULL, '2021-06-29 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com  SUB: Enrollment Application || Cemetrice Muhammed || SNBCARE || Tufts Health  Please find the attached request to initiate the credentialing/contracting for our provider Cemetrice Muhammed. Do let me know if anything else is required. ', NULL, NULL, '2021-06-15 09:50:15', '2021-06-15 09:50:15'),
(39215, 1019, 29828, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Received the following email from Tufts_Health_Plan_Credentialing_Department@tufts-health.com  Hello,  Attached please find your Allied Health Provider Agreement with Tufts Associated Health Maintenance Organization, Inc., Total Health Plan, Inc.     Complete the signature page (signature, printed name, title, and date) and return to us so that we may countersign it.     If you make any changes to the contract document we will not be able to process your contract for you.     You may return the completed signature page via email to:  Tufts_Health_Plan_Credentialing_Department@tufts-health.com or fax it to 617-972-9591     Once we are in receipt of your completed contract, the credentialing process will begin.       Thank you    Tufts Health Plan', NULL, NULL, '2021-07-23 11:03:34', '2021-07-23 11:03:34'),
(39216, 1019, 29828, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com  Hello,  Attached is the signed contract as requested, please expedite the request for credentialing as well.   Regards, Alex', NULL, NULL, '2021-07-23 11:04:18', '2021-07-23 11:04:18'),
(39217, 1019, 29828, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer continue with SNBCARE. ', NULL, NULL, '2021-10-25 10:58:49', '2021-10-25 10:58:49'),
(39218, 1019, 29829, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-12 07:55:58', '2021-05-12 07:55:58'),
(39219, 1019, 29829, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Waiting for Cemetrice State license.', NULL, NULL, '2021-05-12 08:03:07', '2021-05-12 08:03:07'),
(39220, 1019, 29829, NULL, '2021-06-29 00:00:00.000', 'Initiated', 'Request Initiated thru Provider Portal, Attached is the SS for Ref', NULL, NULL, '2021-06-15 08:30:50', '2021-06-15 08:30:50'),
(39221, 1019, 29829, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer continue with SNBCARE. ', NULL, NULL, '2021-10-25 10:58:01', '2021-10-25 10:58:01'),
(39222, 1019, 29830, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-12 07:55:59', '2021-05-12 07:55:59'),
(39223, 1019, 29830, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Waiting for Cemetrice State license.', NULL, NULL, '2021-05-12 08:03:29', '2021-05-12 08:03:29'),
(39224, 1019, 29830, NULL, '2021-06-29 00:00:00.000', 'Initiated', 'Sent the following email to provider_data_request@tufts-health.com  SUB: Enrollment Application || Cemetrice Muhammed || SNBCARE || Tufts Health  Please find the attached request to initiate the credentialing/contracting for our provider Cemetrice Muhammed. Do let me know if anything else is required. ', NULL, NULL, '2021-06-15 09:53:32', '2021-06-15 09:53:32'),
(39225, 1019, 29830, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com  Hello ,  We are in receipt of your request regarding Enrollment Application || Cemetrice Muhammed || SNBCARE || Tufts Health Public Plans that was submitted on 2021-06-15 10:54:53 EDT.  Please reference ticket number PRO0140032 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team  Ref:MSG7084466', NULL, NULL, '2021-06-22 08:31:28', '2021-06-22 08:31:28'),
(39226, 1019, 29830, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer continue with SNBCARE. ', NULL, NULL, '2021-10-25 10:58:56', '2021-10-25 10:58:56'),
(39227, 1019, 29831, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-12 07:55:59', '2021-05-12 07:55:59'),
(39228, 1019, 29831, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Waiting for Cemetrice State license.', NULL, NULL, '2021-05-12 08:03:14', '2021-05-12 08:03:14'),
(39229, 1019, 29831, NULL, '2021-06-29 00:00:00.000', 'Initiated', 'CAQH Application Faxed to (866) 612-7790 for Cemetrice. Attached is the copy of the CAQH application for ref. ', NULL, NULL, '2021-06-14 16:21:54', '2021-06-14 16:21:54'),
(39230, 1019, 29831, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  Hello, Can you please let me know about the enrollment status for the following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Prisca Hefti NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan  NPI: 1699761965  Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Regards,  Alex', NULL, NULL, '2021-08-24 11:23:24', '2021-08-24 11:23:24'),
(39231, 1019, 29831, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer continue with SNBCARE. ', NULL, NULL, '2021-10-25 10:56:52', '2021-10-25 10:56:52'),
(39232, 1006, 29907, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:56', '2021-05-14 14:36:56'),
(39233, 3040, 29907, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-18 12:26:25', '2021-05-18 12:26:25'),
(39234, 3040, 29907, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:33:30', '2021-06-08 10:33:30'),
(39235, 3040, 29907, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:36:13', '2021-06-08 10:36:13'),
(39236, 3040, 29907, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige     ', NULL, NULL, '2021-06-08 14:27:14', '2021-06-08 14:27:14'),
(39237, 1006, 29909, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:56', '2021-05-14 14:36:56'),
(39238, 3040, 29909, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:37:09', '2021-05-20 09:37:09'),
(39239, 3040, 29909, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:53:08', '2021-06-09 10:53:08'),
(39240, 3040, 29909, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:24', '2021-07-20 09:44:24'),
(39241, 11056, 29909, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:44:48', '2021-08-05 13:44:48'),
(39242, 3040, 29909, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:22', '2021-09-03 14:38:22'),
(39243, 10057, 29909, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:43:12', '2021-10-18 11:43:12'),
(39244, 10057, 29909, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:39:41', '2021-11-23 17:39:41'),
(39245, 10057, 29909, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-06 13:36:11', '2021-12-06 13:36:11'),
(39246, 10057, 29909, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:05:28', '2021-12-13 13:05:28'),
(39247, 10057, 29909, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:30:51', '2021-12-20 13:30:51'),
(39248, 10057, 29909, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:48:25', '2021-12-27 12:48:25'),
(39249, 10057, 29909, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:09:56', '2021-12-30 14:09:56'),
(39250, 19067, 29909, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:38:25', '2022-01-10 09:38:25'),
(39251, 20067, 29909, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:28:57', '2022-01-19 12:28:57'),
(39252, 20067, 29909, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 05/03/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:54:43', '2022-01-19 17:54:43'),
(39253, 1006, 29910, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:56', '2021-05-14 14:36:56'),
(39254, 3040, 29910, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-19 14:36:07', '2021-05-19 14:36:07'),
(39255, 3040, 29910, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:09:28', '2021-06-08 12:09:28'),
(39256, 3040, 29910, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:32:12', '2021-06-08 12:32:12'),
(39257, 3040, 29910, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:43:17', '2021-06-20 16:43:17'),
(39258, 1006, 29911, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:56', '2021-05-14 14:36:56'),
(39259, 3040, 29911, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-17 12:54:17', '2021-05-17 12:54:17'),
(39260, 3040, 29911, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 18:00:46', '2021-06-07 18:00:46'),
(39261, 3040, 29911, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:47', '2021-06-24 11:21:47'),
(39262, 3040, 29911, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:15:00', '2021-07-13 13:15:00'),
(39263, 1006, 29912, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:56', '2021-05-14 14:36:56'),
(39264, 1006, 29912, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:54:25', '2021-06-01 13:54:25'),
(39265, 3040, 29912, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:31', '2021-07-22 10:06:31'),
(39266, 11056, 29912, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:26:44', '2021-08-04 15:26:44'),
(39267, 3040, 29912, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:28', '2021-08-17 10:58:28'),
(39268, 3040, 29912, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 11:04:30', '2021-08-17 11:04:30'),
(39269, 3040, 29912, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:24', '2021-08-17 13:14:24'),
(39270, 1006, 29913, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:56', '2021-05-14 14:36:56'),
(39271, 3040, 29913, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-20 09:16:50', '2021-05-20 09:16:50'),
(39272, 3040, 29913, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:37:07', '2021-06-09 12:37:07'),
(39273, 3040, 29913, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:14', '2021-07-20 10:27:14'),
(39274, 3040, 29913, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:32', '2021-07-26 12:02:32'),
(39275, 1006, 29920, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:57', '2021-05-14 14:36:57'),
(39276, 3040, 29920, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:20:09', '2021-05-18 12:20:09'),
(39277, 1006, 29921, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:57', '2021-05-14 14:36:57'),
(39278, 3040, 29921, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:21:17', '2021-05-18 10:21:17'),
(39279, 1006, 29922, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:57', '2021-05-14 14:36:57'),
(39280, 3040, 29922, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   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, '2021-05-20 08:54:46', '2021-05-20 08:54:46'),
(39281, 3040, 29922, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Thank you, I have sent this over to our Updates department to complete.  Best,  Austin Owens Provider Contracting Specialist', NULL, NULL, '2021-06-09 13:02:07', '2021-06-09 13:02:07'),
(39282, 3040, 29922, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject:  Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   Hope you are doing well. I wanted to know if there is any update regarding the enrollment that was requested in my previous email.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 13:03:03', '2021-06-09 13:03:03'),
(39283, 3040, 29922, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   I didn\'t receive any email from your department regarding the request that was sent out 05/20/2021. Can you please check and advise how to proceed with enrollment?  Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-28 13:42:10', '2021-06-28 13:42:10'),
(39284, 3040, 29922, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: updates@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-16 16:49:16', '2021-07-16 16:49:16');
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
(39285, 11056, 29922, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	austin.owens@primehealthservices.com  Sub : Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning!  Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 12 : Provider Name : John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!    I have called Prime Health services thrice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:07:25', '2021-08-05 11:07:25'),
(39286, 12062, 29922, NULL, '2021-09-25 00:00:00.000', 'In Process', 'Sent a follow up email to :austin.owens@primehealthservices.com  Subject: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Dear Owens,  Good Day!  May I have the updated status on below?  I would appreciate your earliest response for a subject query.  Have a nice weekend ! ', NULL, NULL, '2021-09-17 14:31:45', '2021-09-17 14:31:45'),
(39287, 12062, 29922, NULL, '2021-09-25 00:00:00.000', 'In Process', 'As per the below mail the provider is enrolled, but we are unable to verify from web directory therefore query has been shared with primary health services via email.See attached mail for a reference.  See attached file and below mail for a reference.  from:providerrelations@primehealthservices.com Subject:Re: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Please see updates highlighted in yellow, as all listed providers are enrolled under this group.   Thank you, Provider Relations   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215   Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067 Enrolled effective: 08/10/2020 Provider ID:11731313   Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Enrolled effective: 08/10/2020 Provider ID: 11548953   Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Enrolled effective: 08/10/2020 Provider ID: 11418820  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Enrolled effective: 08/10/2020 Provider ID:    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Enrolled effective: 08/10/2020 Provider ID: 12276289   Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Enrolled effective: 08/10/2020 Provider ID: 7163504   Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Enrolled effective: 08/10/2020 Provider ID: 11548952   Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Enrolled effective: 08/10/2020 Provider ID: 12504178   Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Enrolled effective: 08/10/2020 Provider ID: 12504179   Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 Enrolled effective: 08/10/2020 Provider ID: 12504180', NULL, NULL, '2021-09-17 17:01:08', '2021-09-17 17:01:08'),
(39288, 12062, 29922, NULL, '2021-09-28 00:00:00.000', 'Approved', 'The provider has now enrolled.  Attached screenshot for reference and copy of last email received ', NULL, NULL, '2021-09-20 15:58:18', '2021-09-20 15:58:18'),
(39289, 1006, 29923, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:57', '2021-05-14 14:36:57'),
(39290, 3040, 29923, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-18 12:26:28', '2021-05-18 12:26:28'),
(39291, 3040, 29923, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:33:24', '2021-06-08 10:33:24'),
(39292, 3040, 29923, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:36:08', '2021-06-08 10:36:08'),
(39293, 3040, 29923, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:27:27', '2021-06-08 14:27:27'),
(39294, 1006, 29925, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:57', '2021-05-14 14:36:57'),
(39295, 3040, 29925, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:36:08', '2021-05-20 09:36:08'),
(39296, 3040, 29925, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:53:13', '2021-06-09 10:53:13'),
(39297, 3040, 29925, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:25', '2021-07-20 09:44:25'),
(39298, 11056, 29925, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:44:40', '2021-08-05 13:44:40'),
(39299, 3040, 29925, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:37', '2021-09-03 14:38:37'),
(39300, 10057, 29925, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:43:06', '2021-10-18 11:43:06'),
(39301, 10057, 29925, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:39:35', '2021-11-23 17:39:35'),
(39302, 10057, 29925, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment:', NULL, NULL, '2021-12-06 13:32:59', '2021-12-06 13:32:59'),
(39303, 10057, 29925, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:05:21', '2021-12-13 13:05:21'),
(39304, 10057, 29925, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:30:45', '2021-12-20 13:30:45'),
(39305, 10057, 29925, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:48:19', '2021-12-27 12:48:19'),
(39306, 10057, 29925, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:09:50', '2021-12-30 14:09:50'),
(39307, 19067, 29925, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:38:40', '2022-01-10 09:38:40'),
(39308, 20067, 29925, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:28:51', '2022-01-19 12:28:51'),
(39309, 20067, 29925, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 06/24/2020 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:52:43', '2022-01-19 17:52:43'),
(39310, 1006, 29926, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:57', '2021-05-14 14:36:57'),
(39311, 3040, 29926, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-19 14:36:11', '2021-05-19 14:36:11'),
(39312, 3040, 29926, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:09:22', '2021-06-08 12:09:22'),
(39313, 3040, 29926, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:32:09', '2021-06-08 12:32:09'),
(39314, 3040, 29926, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:43:12', '2021-06-20 16:43:12'),
(39315, 1006, 29927, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:57', '2021-05-14 14:36:57'),
(39316, 3040, 29927, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-17 12:54:22', '2021-05-17 12:54:22'),
(39317, 3040, 29927, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 18:00:38', '2021-06-07 18:00:38'),
(39318, 3040, 29927, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:47', '2021-06-24 11:21:47'),
(39319, 3040, 29927, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:15:00', '2021-07-13 13:15:00'),
(39320, 1006, 29928, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:57', '2021-05-14 14:36:57'),
(39321, 1006, 29928, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:54:07', '2021-06-01 13:54:07'),
(39322, 3040, 29928, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:30', '2021-07-22 10:06:30'),
(39323, 11056, 29928, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:25:31', '2021-08-04 15:25:31'),
(39324, 3040, 29928, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:28', '2021-08-17 10:58:28'),
(39325, 3040, 29928, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:24', '2021-08-17 13:14:24'),
(39326, 1006, 29929, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:57', '2021-05-14 14:36:57'),
(39327, 3040, 29929, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-20 09:16:54', '2021-05-20 09:16:54'),
(39328, 3040, 29929, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:37:00', '2021-06-09 12:37:00'),
(39329, 3040, 29929, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:13', '2021-07-20 10:27:13'),
(39330, 3040, 29929, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:32', '2021-07-26 12:02:32'),
(39331, 1006, 29936, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:58', '2021-05-14 14:36:58'),
(39332, 3040, 29936, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:20:14', '2021-05-18 12:20:14'),
(39333, 1006, 29937, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:58', '2021-05-14 14:36:58'),
(39334, 3040, 29937, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:21:33', '2021-05-18 10:21:33'),
(39335, 1006, 29938, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:58', '2021-05-14 14:36:58'),
(39336, 3040, 29938, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   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, '2021-05-20 08:54:51', '2021-05-20 08:54:51'),
(39337, 3040, 29938, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Thank you, I have sent this over to our Updates department to complete.  Best,  Austin Owens Provider Contracting Specialist', NULL, NULL, '2021-06-09 13:02:01', '2021-06-09 13:02:01'),
(39338, 3040, 29938, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject:  Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   Hope you are doing well. I wanted to know if there is any update regarding the enrollment that was requested in my previous email.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 13:02:59', '2021-06-09 13:02:59'),
(39339, 3040, 29938, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   I didn\'t receive any email from your department regarding the request that was sent out 05/20/2021. Can you please check and advise how to proceed with enrollment?  Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-28 13:42:07', '2021-06-28 13:42:07'),
(39340, 3040, 29938, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: updates@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-16 16:49:15', '2021-07-16 16:49:15'),
(39341, 11056, 29938, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	austin.owens@primehealthservices.com  Sub : Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning!  Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 12 : Provider Name : John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!    I have called Prime Health services thrice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:07:16', '2021-08-05 11:07:16'),
(39342, 12062, 29938, NULL, '2021-09-25 00:00:00.000', 'In Process', 'Sent a follow up email to :austin.owens@primehealthservices.com  Subject: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Dear Owens,  Good Day!  May I have the updated status on below?  I would appreciate your earliest response for a subject query.  Have a nice weekend ! ', NULL, NULL, '2021-09-17 14:32:43', '2021-09-17 14:32:43'),
(39343, 12062, 29938, NULL, '2021-09-25 00:00:00.000', 'Approved', 'As per the below mail the provider is enrolled. See attached file and below mail for a reference.  from:providerrelations@primehealthservices.com Subject:Re: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Please see updates highlighted in yellow, as all listed providers are enrolled under this group.   Thank you, Provider Relations   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215   Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067 Enrolled effective: 08/10/2020 Provider ID:11731313   Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Enrolled effective: 08/10/2020 Provider ID: 11548953   Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Enrolled effective: 08/10/2020 Provider ID: 11418820  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Enrolled effective: 08/10/2020 Provider ID:    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Enrolled effective: 08/10/2020 Provider ID: 12276289   Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Enrolled effective: 08/10/2020 Provider ID: 7163504   Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Enrolled effective: 08/10/2020 Provider ID: 11548952   Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Enrolled effective: 08/10/2020 Provider ID: 12504178   Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Enrolled effective: 08/10/2020 Provider ID: 12504179   Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 Enrolled effective: 08/10/2020 Provider ID: 12504180', NULL, NULL, '2021-09-17 16:37:51', '2021-09-17 16:37:51'),
(39344, 1006, 29939, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:58', '2021-05-14 14:36:58'),
(39345, 3040, 29939, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-18 12:26:32', '2021-05-18 12:26:32'),
(39346, 3040, 29939, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:33:20', '2021-06-08 10:33:20'),
(39347, 3040, 29939, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:36:03', '2021-06-08 10:36:03'),
(39348, 3040, 29939, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:27:31', '2021-06-08 14:27:31'),
(39349, 1006, 29941, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:58', '2021-05-14 14:36:58'),
(39350, 3040, 29941, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:36:12', '2021-05-20 09:36:12'),
(39351, 3040, 29941, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:53:18', '2021-06-09 10:53:18'),
(39352, 3040, 29941, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:25', '2021-07-20 09:44:25'),
(39353, 11056, 29941, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:44:16', '2021-08-05 13:44:16'),
(39354, 3040, 29941, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:37', '2021-09-03 14:38:37'),
(39355, 10057, 29941, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:42:57', '2021-10-18 11:42:57'),
(39356, 10057, 29941, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:39:29', '2021-11-23 17:39:29'),
(39357, 10057, 29941, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment:', NULL, NULL, '2021-12-06 13:27:28', '2021-12-06 13:27:28'),
(39358, 10057, 29941, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:05:15', '2021-12-13 13:05:15'),
(39359, 10057, 29941, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:30:39', '2021-12-20 13:30:39'),
(39360, 10057, 29941, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:48:14', '2021-12-27 12:48:14'),
(39361, 10057, 29941, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:09:45', '2021-12-30 14:09:45');
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
(39362, 19067, 29941, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:38:49', '2022-01-10 09:38:49'),
(39363, 20067, 29941, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:28:45', '2022-01-19 12:28:45'),
(39364, 20067, 29941, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 12/01/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:51:05', '2022-01-19 17:51:05'),
(39365, 1006, 29942, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:58', '2021-05-14 14:36:58'),
(39366, 3040, 29942, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-19 14:36:15', '2021-05-19 14:36:15'),
(39367, 3040, 29942, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:09:16', '2021-06-08 12:09:16'),
(39368, 3040, 29942, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:32:06', '2021-06-08 12:32:06'),
(39369, 3040, 29942, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:43:07', '2021-06-20 16:43:07'),
(39370, 1006, 29943, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:58', '2021-05-14 14:36:58'),
(39371, 3040, 29943, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-17 12:54:26', '2021-05-17 12:54:26'),
(39372, 3040, 29943, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 18:00:32', '2021-06-07 18:00:32'),
(39373, 3040, 29943, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:46', '2021-06-24 11:21:46'),
(39374, 3040, 29943, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:15:00', '2021-07-13 13:15:00'),
(39375, 1006, 29944, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:58', '2021-05-14 14:36:58'),
(39376, 1006, 29944, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:53:32', '2021-06-01 13:53:32'),
(39377, 3040, 29944, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:29', '2021-07-22 10:06:29'),
(39378, 11056, 29944, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:25:45', '2021-08-04 15:25:45'),
(39379, 3040, 29944, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:27', '2021-08-17 10:58:27'),
(39380, 3040, 29944, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:24', '2021-08-17 13:14:24'),
(39381, 1006, 29945, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:58', '2021-05-14 14:36:58'),
(39382, 3040, 29945, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-20 09:16:58', '2021-05-20 09:16:58'),
(39383, 3040, 29945, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:36:54', '2021-06-09 12:36:54'),
(39384, 3040, 29945, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:13', '2021-07-20 10:27:13'),
(39385, 3040, 29945, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:31', '2021-07-26 12:02:31'),
(39386, 1006, 29952, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:59', '2021-05-14 14:36:59'),
(39387, 3040, 29952, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:20:18', '2021-05-18 12:20:18'),
(39388, 1006, 29953, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:59', '2021-05-14 14:36:59'),
(39389, 3040, 29953, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:21:54', '2021-05-18 10:21:54'),
(39390, 1006, 29954, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:59', '2021-05-14 14:36:59'),
(39391, 3040, 29954, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   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, '2021-05-20 08:54:56', '2021-05-20 08:54:56'),
(39392, 3040, 29954, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Thank you, I have sent this over to our Updates department to complete.  Best,  Austin Owens Provider Contracting Specialist', NULL, NULL, '2021-06-09 13:01:57', '2021-06-09 13:01:57'),
(39393, 3040, 29954, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject:  Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   Hope you are doing well. I wanted to know if there is any update regarding the enrollment that was requested in my previous email.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 13:02:55', '2021-06-09 13:02:55'),
(39394, 3040, 29954, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   I didn\'t receive any email from your department regarding the request that was sent out 05/20/2021. Can you please check and advise how to proceed with enrollment?  Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-28 13:42:06', '2021-06-28 13:42:06'),
(39395, 3040, 29954, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: updates@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-16 16:49:15', '2021-07-16 16:49:15'),
(39396, 11056, 29954, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	austin.owens@primehealthservices.com  Sub : Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning!  Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 12 : Provider Name : John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!    I have called Prime Health services thrice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:07:02', '2021-08-05 11:07:02'),
(39397, 12062, 29954, NULL, '2021-09-25 00:00:00.000', 'In Process', 'Sent a follow up email to :austin.owens@primehealthservices.com  Subject: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Dear Owens,  Good Day!  May I have the updated status on below?  I would appreciate your earliest response for a subject query.  Have a nice weekend ! ', NULL, NULL, '2021-09-17 14:29:53', '2021-09-17 14:29:53'),
(39398, 12062, 29954, NULL, '2021-09-25 00:00:00.000', 'Approved', 'As per the below mail the provider is enrolled. See attached file and below mail for a reference.  from:providerrelations@primehealthservices.com Subject:Re: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Please see updates highlighted in yellow, as all listed providers are enrolled under this group.   Thank you, Provider Relations   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215   Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067 Enrolled effective: 08/10/2020 Provider ID:11731313   Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Enrolled effective: 08/10/2020 Provider ID: 11548953   Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Enrolled effective: 08/10/2020 Provider ID: 11418820  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Enrolled effective: 08/10/2020 Provider ID:    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Enrolled effective: 08/10/2020 Provider ID: 12276289   Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Enrolled effective: 08/10/2020 Provider ID: 7163504   Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Enrolled effective: 08/10/2020 Provider ID: 11548952   Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Enrolled effective: 08/10/2020 Provider ID: 12504178   Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Enrolled effective: 08/10/2020 Provider ID: 12504179   Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 Enrolled effective: 08/10/2020 Provider ID: 12504180', NULL, NULL, '2021-09-17 16:35:18', '2021-09-17 16:35:18'),
(39399, 1006, 29955, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:59', '2021-05-14 14:36:59'),
(39400, 3040, 29955, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-18 12:26:36', '2021-05-18 12:26:36'),
(39401, 3040, 29955, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:33:15', '2021-06-08 10:33:15'),
(39402, 3040, 29955, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:35:59', '2021-06-08 10:35:59'),
(39403, 3040, 29955, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:27:35', '2021-06-08 14:27:35'),
(39404, 1006, 29957, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:59', '2021-05-14 14:36:59'),
(39405, 3040, 29957, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:36:16', '2021-05-20 09:36:16'),
(39406, 3040, 29957, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:53:23', '2021-06-09 10:53:23'),
(39407, 3040, 29957, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:26', '2021-07-20 09:44:26'),
(39408, 11056, 29957, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:43:34', '2021-08-05 13:43:34'),
(39409, 11056, 29957, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:44:06', '2021-08-05 13:44:06'),
(39410, 3040, 29957, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:36', '2021-09-03 14:38:36'),
(39411, 10057, 29957, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:42:49', '2021-10-18 11:42:49'),
(39412, 10057, 29957, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:39:23', '2021-11-23 17:39:23'),
(39413, 10057, 29957, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment:', NULL, NULL, '2021-12-06 13:18:07', '2021-12-06 13:18:07'),
(39414, 10057, 29957, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:05:08', '2021-12-13 13:05:08'),
(39415, 10057, 29957, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:30:33', '2021-12-20 13:30:33'),
(39416, 10057, 29957, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:48:08', '2021-12-27 12:48:08'),
(39417, 10057, 29957, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:09:40', '2021-12-30 14:09:40'),
(39418, 19067, 29957, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:38:54', '2022-01-10 09:38:54'),
(39419, 20067, 29957, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:28:39', '2022-01-19 12:28:39'),
(39420, 20067, 29957, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 09/30/2020 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:48:57', '2022-01-19 17:48:57'),
(39421, 1006, 29958, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:59', '2021-05-14 14:36:59'),
(39422, 3040, 29958, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-17 12:54:30', '2021-05-17 12:54:30'),
(39423, 3040, 29958, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 18:00:27', '2021-06-07 18:00:27'),
(39424, 3040, 29958, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:46', '2021-06-24 11:21:46'),
(39425, 3040, 29958, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:59', '2021-07-13 13:14:59'),
(39426, 1006, 29959, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:59', '2021-05-14 14:36:59'),
(39427, 1006, 29959, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:54:02', '2021-06-01 13:54:02'),
(39428, 3040, 29959, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:29', '2021-07-22 10:06:29'),
(39429, 11056, 29959, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:25:51', '2021-08-04 15:25:51'),
(39430, 3040, 29959, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:27', '2021-08-17 10:58:27'),
(39431, 3040, 29959, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:23', '2021-08-17 13:14:23'),
(39432, 1006, 29960, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:36:59', '2021-05-14 14:36:59'),
(39433, 3040, 29960, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-20 09:17:02', '2021-05-20 09:17:02'),
(39434, 3040, 29960, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:36:43', '2021-06-09 12:36:43'),
(39435, 3040, 29960, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:13', '2021-07-20 10:27:13'),
(39436, 3040, 29960, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:31', '2021-07-26 12:02:31'),
(39437, 1006, 29967, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:00', '2021-05-14 14:37:00'),
(39438, 3040, 29967, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:20:22', '2021-05-18 12:20:22'),
(39439, 1006, 29968, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:00', '2021-05-14 14:37:00'),
(39440, 3040, 29968, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:21:57', '2021-05-18 10:21:57'),
(39441, 1006, 29969, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:00', '2021-05-14 14:37:00'),
(39442, 3040, 29969, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   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, '2021-05-20 08:55:00', '2021-05-20 08:55:00');
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
(39443, 3040, 29969, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Thank you, I have sent this over to our Updates department to complete.  Best,  Austin Owens Provider Contracting Specialist', NULL, NULL, '2021-06-09 13:01:52', '2021-06-09 13:01:52'),
(39444, 3040, 29969, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject:  Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   Hope you are doing well. I wanted to know if there is any update regarding the enrollment that was requested in my previous email.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 13:02:51', '2021-06-09 13:02:51'),
(39445, 3040, 29969, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   I didn\'t receive any email from your department regarding the request that was sent out 05/20/2021. Can you please check and advise how to proceed with enrollment?  Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-28 13:42:04', '2021-06-28 13:42:04'),
(39446, 3040, 29969, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: updates@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-16 16:49:14', '2021-07-16 16:49:14'),
(39447, 11056, 29969, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	austin.owens@primehealthservices.com  Sub : Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning!  Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 12 : Provider Name : John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!    I have called Prime Health services thrice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:06:53', '2021-08-05 11:06:53'),
(39448, 12062, 29969, NULL, '2021-09-25 00:00:00.000', 'In Process', 'Sent a follow up email to :austin.owens@primehealthservices.com  Subject: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Dear Owens,  Good Day!  May I have the updated status on below?  I would appreciate your earliest response for a subject query.  Have a nice weekend ! ', NULL, NULL, '2021-09-17 14:29:07', '2021-09-17 14:29:07'),
(39449, 12062, 29969, NULL, '2021-09-25 00:00:00.000', 'Approved', 'As per the below mail the provider is enrolled. See attached file and below mail for a reference.  from:providerrelations@primehealthservices.com Subject:Re: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Please see updates highlighted in yellow, as all listed providers are enrolled under this group.   Thank you, Provider Relations   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215   Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067 Enrolled effective: 08/10/2020 Provider ID:11731313   Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Enrolled effective: 08/10/2020 Provider ID: 11548953   Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Enrolled effective: 08/10/2020 Provider ID: 11418820  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Enrolled effective: 08/10/2020 Provider ID:    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Enrolled effective: 08/10/2020 Provider ID: 12276289   Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Enrolled effective: 08/10/2020 Provider ID: 7163504   Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Enrolled effective: 08/10/2020 Provider ID: 11548952   Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Enrolled effective: 08/10/2020 Provider ID: 12504178   Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Enrolled effective: 08/10/2020 Provider ID: 12504179   Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 Enrolled effective: 08/10/2020 Provider ID: 12504180', NULL, NULL, '2021-09-17 16:34:32', '2021-09-17 16:34:32'),
(39450, 1006, 29970, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:00', '2021-05-14 14:37:00'),
(39451, 3040, 29970, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-18 12:26:40', '2021-05-18 12:26:40'),
(39452, 3040, 29970, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:33:09', '2021-06-08 10:33:09'),
(39453, 3040, 29970, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:35:55', '2021-06-08 10:35:55'),
(39454, 3040, 29970, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:27:38', '2021-06-08 14:27:38'),
(39455, 1006, 29972, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:00', '2021-05-14 14:37:00'),
(39456, 3040, 29972, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:36:22', '2021-05-20 09:36:22'),
(39457, 3040, 29972, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:53:28', '2021-06-09 10:53:28'),
(39458, 3040, 29972, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:26', '2021-07-20 09:44:26'),
(39459, 11056, 29972, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:43:22', '2021-08-05 13:43:22'),
(39460, 3040, 29972, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:36', '2021-09-03 14:38:36'),
(39461, 10057, 29972, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:42:43', '2021-10-18 11:42:43'),
(39462, 10057, 29972, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:39:18', '2021-11-23 17:39:18'),
(39463, 10057, 29972, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment:', NULL, NULL, '2021-12-06 13:10:53', '2021-12-06 13:10:53'),
(39464, 10057, 29972, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:04:57', '2021-12-13 13:04:57'),
(39465, 10057, 29972, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:30:27', '2021-12-20 13:30:27'),
(39466, 10057, 29972, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:48:02', '2021-12-27 12:48:02'),
(39467, 10057, 29972, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:09:34', '2021-12-30 14:09:34'),
(39468, 19067, 29972, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:39:01', '2022-01-10 09:39:01'),
(39469, 20067, 29972, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:28:30', '2022-01-19 12:28:30'),
(39470, 20067, 29972, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 12/08/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:46:41', '2022-01-19 17:46:41'),
(39471, 1006, 29973, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:00', '2021-05-14 14:37:00'),
(39472, 3040, 29973, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-17 12:54:35', '2021-05-17 12:54:35'),
(39473, 3040, 29973, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 18:00:22', '2021-06-07 18:00:22'),
(39474, 3040, 29973, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:45', '2021-06-24 11:21:45'),
(39475, 3040, 29973, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:59', '2021-07-13 13:14:59'),
(39476, 1006, 29974, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:00', '2021-05-14 14:37:00'),
(39477, 1006, 29974, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:53:54', '2021-06-01 13:53:54'),
(39478, 3040, 29974, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:28', '2021-07-22 10:06:28'),
(39479, 11056, 29974, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:26:08', '2021-08-04 15:26:08'),
(39480, 11056, 29974, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:26:08', '2021-08-04 15:26:08'),
(39481, 3040, 29974, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:26', '2021-08-17 10:58:26'),
(39482, 3040, 29974, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:22', '2021-08-17 13:14:22'),
(39483, 1006, 29975, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:00', '2021-05-14 14:37:00'),
(39484, 3040, 29975, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-20 09:17:06', '2021-05-20 09:17:06'),
(39485, 3040, 29975, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:36:40', '2021-06-09 12:36:40'),
(39486, 3040, 29975, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:12', '2021-07-20 10:27:12'),
(39487, 3040, 29975, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:30', '2021-07-26 12:02:30'),
(39488, 1006, 29982, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:01', '2021-05-14 14:37:01'),
(39489, 3040, 29982, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:20:26', '2021-05-18 12:20:26'),
(39490, 1006, 29983, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:01', '2021-05-14 14:37:01'),
(39491, 3040, 29983, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:22:00', '2021-05-18 10:22:00'),
(39492, 1006, 29984, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:01', '2021-05-14 14:37:01'),
(39493, 3040, 29984, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   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, '2021-05-20 08:55:05', '2021-05-20 08:55:05'),
(39494, 3040, 29984, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Thank you, I have sent this over to our Updates department to complete.  Best,  Austin Owens Provider Contracting Specialist', NULL, NULL, '2021-06-09 13:01:47', '2021-06-09 13:01:47'),
(39495, 3040, 29984, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject:  Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   Hope you are doing well. I wanted to know if there is any update regarding the enrollment that was requested in my previous email.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 13:02:48', '2021-06-09 13:02:48'),
(39496, 3040, 29984, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   I didn\'t receive any email from your department regarding the request that was sent out 05/20/2021. Can you please check and advise how to proceed with enrollment?  Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-28 13:42:02', '2021-06-28 13:42:02'),
(39497, 3040, 29984, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: updates@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-16 16:49:14', '2021-07-16 16:49:14'),
(39498, 11056, 29984, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	austin.owens@primehealthservices.com  Sub : Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning!  Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 12 : Provider Name : John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!    I have called Prime Health services thrice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:06:44', '2021-08-05 11:06:44'),
(39499, 12062, 29984, NULL, '2021-09-25 00:00:00.000', 'In Process', 'Sent a follow up email to :austin.owens@primehealthservices.com  Subject: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Dear Owens,  Good Day!  May I have the updated status on below?  I would appreciate your earliest response for a subject query.  Have a nice weekend !  ', NULL, NULL, '2021-09-17 14:27:03', '2021-09-17 14:27:03'),
(39500, 12062, 29984, NULL, '2021-09-25 00:00:00.000', 'Approved', 'As per the below mail the provider is enrolled. See attached file and below mail for a reference.  from:providerrelations@primehealthservices.com Subject:Re: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Please see updates highlighted in yellow, as all listed providers are enrolled under this group.   Thank you, Provider Relations   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215   Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067 Enrolled effective: 08/10/2020 Provider ID:11731313   Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Enrolled effective: 08/10/2020 Provider ID: 11548953   Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Enrolled effective: 08/10/2020 Provider ID: 11418820  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Enrolled effective: 08/10/2020 Provider ID:    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Enrolled effective: 08/10/2020 Provider ID: 12276289   Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Enrolled effective: 08/10/2020 Provider ID: 7163504   Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Enrolled effective: 08/10/2020 Provider ID: 11548952   Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Enrolled effective: 08/10/2020 Provider ID: 12504178   Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Enrolled effective: 08/10/2020 Provider ID: 12504179   Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 Enrolled effective: 08/10/2020 Provider ID: 12504180 ', NULL, NULL, '2021-09-17 16:33:36', '2021-09-17 16:33:36'),
(39501, 1006, 29985, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:01', '2021-05-14 14:37:01'),
(39502, 3040, 29985, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-18 12:26:44', '2021-05-18 12:26:44'),
(39503, 3040, 29985, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:32:59', '2021-06-08 10:32:59'),
(39504, 3040, 29985, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:35:49', '2021-06-08 10:35:49'),
(39505, 3040, 29985, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:27:42', '2021-06-08 14:27:42'),
(39506, 1006, 29987, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:01', '2021-05-14 14:37:01'),
(39507, 3040, 29987, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:36:27', '2021-05-20 09:36:27'),
(39508, 3040, 29987, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:53:32', '2021-06-09 10:53:32'),
(39509, 3040, 29987, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:27', '2021-07-20 09:44:27'),
(39510, 11056, 29987, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:43:09', '2021-08-05 13:43:09'),
(39511, 3040, 29987, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:36', '2021-09-03 14:38:36'),
(39512, 10057, 29987, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:42:34', '2021-10-18 11:42:34'),
(39513, 10057, 29987, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:39:11', '2021-11-23 17:39:11'),
(39514, 10057, 29987, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment:', NULL, NULL, '2021-12-06 13:04:52', '2021-12-06 13:04:52'),
(39515, 10057, 29987, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:04:51', '2021-12-13 13:04:51'),
(39516, 10057, 29987, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:30:22', '2021-12-20 13:30:22'),
(39517, 10057, 29987, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:47:57', '2021-12-27 12:47:57'),
(39518, 10057, 29987, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:09:29', '2021-12-30 14:09:29'),
(39519, 19067, 29987, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:39:09', '2022-01-10 09:39:09'),
(39520, 20067, 29987, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:28:22', '2022-01-19 12:28:22');
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
(39521, 20067, 29987, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 12/08/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:45:01', '2022-01-19 17:45:01'),
(39522, 1006, 29988, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:01', '2021-05-14 14:37:01'),
(39523, 3040, 29988, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-19 14:36:20', '2021-05-19 14:36:20'),
(39524, 3040, 29988, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:09:11', '2021-06-08 12:09:11'),
(39525, 3040, 29988, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:32:02', '2021-06-08 12:32:02'),
(39526, 3040, 29988, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:43:02', '2021-06-20 16:43:02'),
(39527, 1006, 29989, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:01', '2021-05-14 14:37:01'),
(39528, 3040, 29989, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-17 12:54:39', '2021-05-17 12:54:39'),
(39529, 3040, 29989, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 18:00:17', '2021-06-07 18:00:17'),
(39530, 3040, 29989, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:45', '2021-06-24 11:21:45'),
(39531, 3040, 29989, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:58', '2021-07-13 13:14:58'),
(39532, 1006, 29990, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:01', '2021-05-14 14:37:01'),
(39533, 1006, 29990, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:54:30', '2021-06-01 13:54:30'),
(39534, 3040, 29990, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:28', '2021-07-22 10:06:28'),
(39535, 11056, 29990, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:26:26', '2021-08-04 15:26:26'),
(39536, 3040, 29990, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:26', '2021-08-17 10:58:26'),
(39537, 3040, 29990, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:22', '2021-08-17 13:14:22'),
(39538, 1006, 29991, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:02', '2021-05-14 14:37:02'),
(39539, 3040, 29991, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-20 09:17:10', '2021-05-20 09:17:10'),
(39540, 3040, 29991, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:36:35', '2021-06-09 12:36:35'),
(39541, 3040, 29991, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:12', '2021-07-20 10:27:12'),
(39542, 3040, 29991, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:29', '2021-07-26 12:02:29'),
(39543, 1006, 29998, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:02', '2021-05-14 14:37:02'),
(39544, 3040, 29998, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:20:31', '2021-05-18 12:20:31'),
(39545, 1006, 29999, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:02', '2021-05-14 14:37:02'),
(39546, 3040, 29999, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:22:03', '2021-05-18 10:22:03'),
(39547, 1006, 30000, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:02', '2021-05-14 14:37:02'),
(39548, 3040, 30000, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-18 12:26:47', '2021-05-18 12:26:47'),
(39549, 3040, 30000, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:32:50', '2021-06-08 10:32:50'),
(39550, 3040, 30000, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:35:44', '2021-06-08 10:35:44'),
(39551, 3040, 30000, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:27:46', '2021-06-08 14:27:46'),
(39552, 1006, 30002, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:02', '2021-05-14 14:37:02'),
(39553, 3040, 30002, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:36:31', '2021-05-20 09:36:31'),
(39554, 3040, 30002, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:53:37', '2021-06-09 10:53:37'),
(39555, 3040, 30002, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:27', '2021-07-20 09:44:27'),
(39556, 11056, 30002, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:42:53', '2021-08-05 13:42:53'),
(39557, 3040, 30002, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:35', '2021-09-03 14:38:35'),
(39558, 10057, 30002, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:42:27', '2021-10-18 11:42:27'),
(39559, 10057, 30002, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:39:05', '2021-11-23 17:39:05'),
(39560, 10057, 30002, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment: ', NULL, NULL, '2021-12-06 11:54:33', '2021-12-06 11:54:33'),
(39561, 10057, 30002, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:04:45', '2021-12-13 13:04:45'),
(39562, 10057, 30002, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:30:17', '2021-12-20 13:30:17'),
(39563, 10057, 30002, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:47:51', '2021-12-27 12:47:51'),
(39564, 10057, 30002, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:09:23', '2021-12-30 14:09:23'),
(39565, 19067, 30002, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:39:16', '2022-01-10 09:39:16'),
(39566, 20067, 30002, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:28:16', '2022-01-19 12:28:16'),
(39567, 20067, 30002, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 07/09/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:43:27', '2022-01-19 17:43:27'),
(39568, 1006, 30003, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:02', '2021-05-14 14:37:02'),
(39569, 3040, 30003, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-19 14:36:24', '2021-05-19 14:36:24'),
(39570, 3040, 30003, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:09:06', '2021-06-08 12:09:06'),
(39571, 3040, 30003, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:31:58', '2021-06-08 12:31:58'),
(39572, 3040, 30003, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:42:57', '2021-06-20 16:42:57'),
(39573, 1006, 30004, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:02', '2021-05-14 14:37:02'),
(39574, 3040, 30004, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-17 12:54:43', '2021-05-17 12:54:43'),
(39575, 3040, 30004, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 18:00:12', '2021-06-07 18:00:12'),
(39576, 3040, 30004, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:44', '2021-06-24 11:21:44'),
(39577, 3040, 30004, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:58', '2021-07-13 13:14:58'),
(39578, 1006, 30005, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:03', '2021-05-14 14:37:03'),
(39579, 1006, 30005, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:54:34', '2021-06-01 13:54:34'),
(39580, 3040, 30005, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:27', '2021-07-22 10:06:27'),
(39581, 11056, 30005, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:29:09', '2021-08-04 15:29:09'),
(39582, 3040, 30005, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:26', '2021-08-17 10:58:26'),
(39583, 3040, 30005, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:21', '2021-08-17 13:14:21'),
(39584, 1006, 30006, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:03', '2021-05-14 14:37:03'),
(39585, 3040, 30006, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-20 09:17:14', '2021-05-20 09:17:14'),
(39586, 3040, 30006, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:36:30', '2021-06-09 12:36:30'),
(39587, 3040, 30006, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:11', '2021-07-20 10:27:11'),
(39588, 3040, 30006, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:29', '2021-07-26 12:02:29'),
(39589, 1006, 30013, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:03', '2021-05-14 14:37:03'),
(39590, 3040, 30013, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:20:35', '2021-05-18 12:20:35'),
(39591, 1006, 30014, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:03', '2021-05-14 14:37:03'),
(39592, 3040, 30014, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:22:07', '2021-05-18 10:22:07'),
(39593, 1006, 30015, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:03', '2021-05-14 14:37:03'),
(39594, 3040, 30015, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-18 12:26:51', '2021-05-18 12:26:51'),
(39595, 3040, 30015, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:32:45', '2021-06-08 10:32:45'),
(39596, 3040, 30015, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:35:39', '2021-06-08 10:35:39'),
(39597, 3040, 30015, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:27:50', '2021-06-08 14:27:50'),
(39598, 1006, 30017, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:03', '2021-05-14 14:37:03'),
(39599, 3040, 30017, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:36:37', '2021-05-20 09:36:37'),
(39600, 3040, 30017, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:53:40', '2021-06-09 10:53:40'),
(39601, 3040, 30017, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:28', '2021-07-20 09:44:28'),
(39602, 11056, 30017, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:42:39', '2021-08-05 13:42:39'),
(39603, 3040, 30017, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:35', '2021-09-03 14:38:35'),
(39604, 10057, 30017, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:42:20', '2021-10-18 11:42:20'),
(39605, 10057, 30017, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:39:00', '2021-11-23 17:39:00'),
(39606, 10057, 30017, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment:', NULL, NULL, '2021-12-06 11:44:15', '2021-12-06 11:44:15'),
(39607, 10057, 30017, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:04:39', '2021-12-13 13:04:39'),
(39608, 10057, 30017, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:30:11', '2021-12-20 13:30:11'),
(39609, 10057, 30017, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:47:45', '2021-12-27 12:47:45');
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
(39610, 10057, 30017, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:09:17', '2021-12-30 14:09:17'),
(39611, 19067, 30017, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:39:21', '2022-01-10 09:39:21'),
(39612, 20067, 30017, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:28:11', '2022-01-19 12:28:11'),
(39613, 20067, 30017, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 02/25/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:41:35', '2022-01-19 17:41:35'),
(39614, 1006, 30018, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:03', '2021-05-14 14:37:03'),
(39615, 3040, 30018, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-19 14:36:29', '2021-05-19 14:36:29'),
(39616, 3040, 30018, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:09:00', '2021-06-08 12:09:00'),
(39617, 3040, 30018, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:31:54', '2021-06-08 12:31:54'),
(39618, 3040, 30018, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:42:51', '2021-06-20 16:42:51'),
(39619, 1006, 30019, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:04', '2021-05-14 14:37:04'),
(39620, 3040, 30019, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-17 12:54:47', '2021-05-17 12:54:47'),
(39621, 3040, 30019, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 18:00:07', '2021-06-07 18:00:07'),
(39622, 3040, 30019, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:44', '2021-06-24 11:21:44'),
(39623, 3040, 30019, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:58', '2021-07-13 13:14:58'),
(39624, 1006, 30020, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:04', '2021-05-14 14:37:04'),
(39625, 1006, 30020, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:53:48', '2021-06-01 13:53:48'),
(39626, 3040, 30020, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:26', '2021-07-22 10:06:26'),
(39627, 11056, 30020, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:29:02', '2021-08-04 15:29:02'),
(39628, 3040, 30020, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:25', '2021-08-17 10:58:25'),
(39629, 3040, 30020, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:21', '2021-08-17 13:14:21'),
(39630, 1006, 30021, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:04', '2021-05-14 14:37:04'),
(39631, 3040, 30021, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-20 09:17:18', '2021-05-20 09:17:18'),
(39632, 3040, 30021, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:36:24', '2021-06-09 12:36:24'),
(39633, 3040, 30021, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:11', '2021-07-20 10:27:11'),
(39634, 3040, 30021, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:28', '2021-07-26 12:02:28'),
(39635, 1006, 30028, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:04', '2021-05-14 14:37:04'),
(39636, 3040, 30028, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:20:39', '2021-05-18 12:20:39'),
(39637, 1006, 30029, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:04', '2021-05-14 14:37:04'),
(39638, 3040, 30029, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:22:11', '2021-05-18 10:22:11'),
(39639, 1006, 30030, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:04', '2021-05-14 14:37:04'),
(39640, 3040, 30030, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   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, '2021-05-20 08:55:09', '2021-05-20 08:55:09'),
(39641, 3040, 30030, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Thank you, I have sent this over to our Updates department to complete.  Best,  Austin Owens Provider Contracting Specialist', NULL, NULL, '2021-06-09 13:01:42', '2021-06-09 13:01:42'),
(39642, 3040, 30030, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject:  Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   Hope you are doing well. I wanted to know if there is any update regarding the enrollment that was requested in my previous email.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 13:02:42', '2021-06-09 13:02:42'),
(39643, 3040, 30030, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   I didn\'t receive any email from your department regarding the request that was sent out 05/20/2021. Can you please check and advise how to proceed with enrollment?  Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-28 13:42:01', '2021-06-28 13:42:01'),
(39644, 3040, 30030, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: updates@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-16 16:49:13', '2021-07-16 16:49:13'),
(39645, 11056, 30030, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	austin.owens@primehealthservices.com  Sub : Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning!  Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 12 : Provider Name : John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!    I have called Prime Health services thrice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:06:32', '2021-08-05 11:06:32'),
(39646, 12062, 30030, NULL, '2021-09-25 00:00:00.000', 'In Process', 'Sent a follow up email to :austin.owens@primehealthservices.com  Subject: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Dear Owens,  Good Day!  May I have the updated status on below?  I would appreciate your earliest response for a subject query.  Have a nice weekend ! ', NULL, NULL, '2021-09-17 14:30:58', '2021-09-17 14:30:58'),
(39647, 12062, 30030, NULL, '2021-09-25 00:00:00.000', 'Approved', 'As per the below mail the provider is enrolled. See attached file and below mail for a reference.  from:providerrelations@primehealthservices.com Subject:Re: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Please see updates highlighted in yellow, as all listed providers are enrolled under this group.   Thank you, Provider Relations   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215   Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067 Enrolled effective: 08/10/2020 Provider ID:11731313   Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Enrolled effective: 08/10/2020 Provider ID: 11548953   Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Enrolled effective: 08/10/2020 Provider ID: 11418820  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Enrolled effective: 08/10/2020 Provider ID:    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Enrolled effective: 08/10/2020 Provider ID: 12276289   Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Enrolled effective: 08/10/2020 Provider ID: 7163504   Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Enrolled effective: 08/10/2020 Provider ID: 11548952   Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Enrolled effective: 08/10/2020 Provider ID: 12504178   Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Enrolled effective: 08/10/2020 Provider ID: 12504179   Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 Enrolled effective: 08/10/2020 Provider ID: 12504180', NULL, NULL, '2021-09-17 16:36:59', '2021-09-17 16:36:59'),
(39648, 1006, 30031, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:04', '2021-05-14 14:37:04'),
(39649, 3040, 30031, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-18 12:26:55', '2021-05-18 12:26:55'),
(39650, 3040, 30031, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:32:38', '2021-06-08 10:32:38'),
(39651, 3040, 30031, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:35:34', '2021-06-08 10:35:34'),
(39652, 3040, 30031, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:27:55', '2021-06-08 14:27:55'),
(39653, 1006, 30033, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:05', '2021-05-14 14:37:05'),
(39654, 3040, 30033, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:36:40', '2021-05-20 09:36:40'),
(39655, 3040, 30033, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:53:44', '2021-06-09 10:53:44'),
(39656, 3040, 30033, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:28', '2021-07-20 09:44:28'),
(39657, 11056, 30033, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:42:24', '2021-08-05 13:42:24'),
(39658, 3040, 30033, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:34', '2021-09-03 14:38:34'),
(39659, 10057, 30033, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:42:13', '2021-10-18 11:42:13'),
(39660, 10057, 30033, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:38:54', '2021-11-23 17:38:54'),
(39661, 10057, 30033, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment:', NULL, NULL, '2021-12-14 14:04:05', '2021-12-14 14:04:05'),
(39662, 10057, 30033, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:30:05', '2021-12-20 13:30:05'),
(39663, 10057, 30033, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:47:39', '2021-12-27 12:47:39'),
(39664, 10057, 30033, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:09:09', '2021-12-30 14:09:09'),
(39665, 19067, 30033, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:39:26', '2022-01-10 09:39:26'),
(39666, 20067, 30033, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:28:05', '2022-01-19 12:28:05'),
(39667, 20067, 30033, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 12/01/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:39:37', '2022-01-19 17:39:37'),
(39668, 1006, 30034, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:05', '2021-05-14 14:37:05'),
(39669, 3040, 30034, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-19 14:36:33', '2021-05-19 14:36:33'),
(39670, 3040, 30034, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:08:54', '2021-06-08 12:08:54'),
(39671, 3040, 30034, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:31:51', '2021-06-08 12:31:51'),
(39672, 3040, 30034, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:42:46', '2021-06-20 16:42:46'),
(39673, 1006, 30035, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:05', '2021-05-14 14:37:05'),
(39674, 3040, 30035, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-17 12:54:51', '2021-05-17 12:54:51'),
(39675, 3040, 30035, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 18:00:01', '2021-06-07 18:00:01'),
(39676, 3040, 30035, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:43', '2021-06-24 11:21:43'),
(39677, 3040, 30035, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:57', '2021-07-13 13:14:57'),
(39678, 1006, 30036, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:05', '2021-05-14 14:37:05'),
(39679, 1006, 30036, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:54:38', '2021-06-01 13:54:38'),
(39680, 3040, 30036, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:26', '2021-07-22 10:06:26'),
(39681, 11056, 30036, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:28:50', '2021-08-04 15:28:50'),
(39682, 3040, 30036, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:25', '2021-08-17 10:58:25'),
(39683, 3040, 30036, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:22', '2021-08-17 13:14:22'),
(39684, 1006, 30037, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:05', '2021-05-14 14:37:05'),
(39685, 3040, 30037, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-20 09:17:22', '2021-05-20 09:17:22'),
(39686, 3040, 30037, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:36:20', '2021-06-09 12:36:20'),
(39687, 3040, 30037, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:10', '2021-07-20 10:27:10'),
(39688, 3040, 30037, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:28', '2021-07-26 12:02:28'),
(39689, 1006, 30044, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:05', '2021-05-14 14:37:05'),
(39690, 3040, 30044, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:20:44', '2021-05-18 12:20:44'),
(39691, 1006, 30045, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:06', '2021-05-14 14:37:06');
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
(39692, 3040, 30045, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:22:15', '2021-05-18 10:22:15'),
(39693, 1006, 30046, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:06', '2021-05-14 14:37:06'),
(39694, 3040, 30046, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-18 12:27:01', '2021-05-18 12:27:01'),
(39695, 3040, 30046, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:32:33', '2021-06-08 10:32:33'),
(39696, 3040, 30046, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:35:29', '2021-06-08 10:35:29'),
(39697, 3040, 30046, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:27:59', '2021-06-08 14:27:59'),
(39698, 1006, 30048, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:06', '2021-05-14 14:37:06'),
(39699, 3040, 30048, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:36:44', '2021-05-20 09:36:44'),
(39700, 3040, 30048, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:53:49', '2021-06-09 10:53:49'),
(39701, 3040, 30048, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:29', '2021-07-20 09:44:29'),
(39702, 11056, 30048, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:42:10', '2021-08-05 13:42:10'),
(39703, 3040, 30048, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:34', '2021-09-03 14:38:34'),
(39704, 10057, 30048, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:42:05', '2021-10-18 11:42:05'),
(39705, 10057, 30048, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:38:49', '2021-11-23 17:38:49'),
(39706, 10057, 30048, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-06 13:36:16', '2021-12-06 13:36:16'),
(39707, 10057, 30048, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:04:32', '2021-12-13 13:04:32'),
(39708, 10057, 30048, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:29:59', '2021-12-20 13:29:59'),
(39709, 10057, 30048, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:47:33', '2021-12-27 12:47:33'),
(39710, 10057, 30048, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:08:59', '2021-12-30 14:08:59'),
(39711, 19067, 30048, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:39:32', '2022-01-10 09:39:32'),
(39712, 20067, 30048, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:27:59', '2022-01-19 12:27:59'),
(39713, 20067, 30048, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 05/03/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:36:30', '2022-01-19 17:36:30'),
(39714, 1006, 30049, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:06', '2021-05-14 14:37:06'),
(39715, 3040, 30049, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-19 14:36:37', '2021-05-19 14:36:37'),
(39716, 3040, 30049, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:08:49', '2021-06-08 12:08:49'),
(39717, 3040, 30049, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:31:37', '2021-06-08 12:31:37'),
(39718, 3040, 30049, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:42:40', '2021-06-20 16:42:40'),
(39719, 1006, 30050, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:06', '2021-05-14 14:37:06'),
(39720, 3040, 30050, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-17 12:54:59', '2021-05-17 12:54:59'),
(39721, 3040, 30050, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 17:59:53', '2021-06-07 17:59:53'),
(39722, 3040, 30050, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:42', '2021-06-24 11:21:42'),
(39723, 3040, 30050, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:57', '2021-07-13 13:14:57'),
(39724, 1006, 30051, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:06', '2021-05-14 14:37:06'),
(39725, 1006, 30051, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:54:20', '2021-06-01 13:54:20'),
(39726, 3040, 30051, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:25', '2021-07-22 10:06:25'),
(39727, 11056, 30051, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:28:04', '2021-08-04 15:28:04'),
(39728, 3040, 30051, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:24', '2021-08-17 10:58:24'),
(39729, 3040, 30051, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:21', '2021-08-17 13:14:21'),
(39730, 1006, 30052, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:06', '2021-05-14 14:37:06'),
(39731, 3040, 30052, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-20 09:17:25', '2021-05-20 09:17:25'),
(39732, 3040, 30052, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:36:15', '2021-06-09 12:36:15'),
(39733, 3040, 30052, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:10', '2021-07-20 10:27:10'),
(39734, 3040, 30052, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:27', '2021-07-26 12:02:27'),
(39735, 1006, 30059, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:07', '2021-05-14 14:37:07'),
(39736, 3040, 30059, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:20:48', '2021-05-18 12:20:48'),
(39737, 1006, 30060, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:07', '2021-05-14 14:37:07'),
(39738, 3040, 30060, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:22:19', '2021-05-18 10:22:19'),
(39739, 1006, 30061, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:07', '2021-05-14 14:37:07'),
(39740, 3040, 30061, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-18 12:27:05', '2021-05-18 12:27:05'),
(39741, 3040, 30061, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:32:28', '2021-06-08 10:32:28'),
(39742, 3040, 30061, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:35:24', '2021-06-08 10:35:24'),
(39743, 3040, 30061, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:28:04', '2021-06-08 14:28:04'),
(39744, 1006, 30063, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:07', '2021-05-14 14:37:07'),
(39745, 3040, 30063, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:36:48', '2021-05-20 09:36:48'),
(39746, 3040, 30063, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:53:57', '2021-06-09 10:53:57'),
(39747, 3040, 30063, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:29', '2021-07-20 09:44:29'),
(39748, 11056, 30063, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:41:57', '2021-08-05 13:41:57'),
(39749, 3040, 30063, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:33', '2021-09-03 14:38:33'),
(39750, 10057, 30063, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:41:59', '2021-10-18 11:41:59'),
(39751, 10057, 30063, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:38:43', '2021-11-23 17:38:43'),
(39752, 10057, 30063, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment:', NULL, NULL, '2021-12-06 11:34:46', '2021-12-06 11:34:46'),
(39753, 10057, 30063, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:04:25', '2021-12-13 13:04:25'),
(39754, 10057, 30063, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:29:54', '2021-12-20 13:29:54'),
(39755, 10057, 30063, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:47:27', '2021-12-27 12:47:27'),
(39756, 10057, 30063, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:08:50', '2021-12-30 14:08:50'),
(39757, 19067, 30063, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:39:37', '2022-01-10 09:39:37'),
(39758, 20067, 30063, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:27:52', '2022-01-19 12:27:52'),
(39759, 20067, 30063, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 12/08/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:33:10', '2022-01-19 17:33:10'),
(39760, 1006, 30064, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:07', '2021-05-14 14:37:07'),
(39761, 3040, 30064, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-19 14:36:41', '2021-05-19 14:36:41'),
(39762, 3040, 30064, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:08:43', '2021-06-08 12:08:43'),
(39763, 3040, 30064, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:31:46', '2021-06-08 12:31:46'),
(39764, 3040, 30064, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:42:35', '2021-06-20 16:42:35'),
(39765, 1006, 30065, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:07', '2021-05-14 14:37:07'),
(39766, 3040, 30065, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-17 12:55:02', '2021-05-17 12:55:02'),
(39767, 3040, 30065, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 17:59:48', '2021-06-07 17:59:48'),
(39768, 3040, 30065, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:42', '2021-06-24 11:21:42'),
(39769, 3040, 30065, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:56', '2021-07-13 13:14:56'),
(39770, 1006, 30066, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:07', '2021-05-14 14:37:07'),
(39771, 1006, 30066, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:54:11', '2021-06-01 13:54:11'),
(39772, 3040, 30066, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:24', '2021-07-22 10:06:24'),
(39773, 11056, 30066, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:27:51', '2021-08-04 15:27:51'),
(39774, 3040, 30066, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.  Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you  Thank you ', NULL, NULL, '2021-08-17 10:58:24', '2021-08-17 10:58:24'),
(39775, 3040, 30066, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:20', '2021-08-17 13:14:20'),
(39776, 1006, 30067, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:07', '2021-05-14 14:37:07');
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
(39777, 3040, 30067, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-20 09:17:29', '2021-05-20 09:17:29'),
(39778, 3040, 30067, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:36:11', '2021-06-09 12:36:11'),
(39779, 3040, 30067, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:09', '2021-07-20 10:27:09'),
(39780, 3040, 30067, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:27', '2021-07-26 12:02:27'),
(39781, 1006, 30074, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:08', '2021-05-14 14:37:08'),
(39782, 3040, 30074, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:20:52', '2021-05-18 12:20:52'),
(39783, 1006, 30075, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:08', '2021-05-14 14:37:08'),
(39784, 3040, 30075, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:22:22', '2021-05-18 10:22:22'),
(39785, 1006, 30076, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:08', '2021-05-14 14:37:08'),
(39786, 3040, 30076, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-18 12:27:09', '2021-05-18 12:27:09'),
(39787, 3040, 30076, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:32:22', '2021-06-08 10:32:22'),
(39788, 3040, 30076, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:35:19', '2021-06-08 10:35:19'),
(39789, 3040, 30076, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:28:08', '2021-06-08 14:28:08'),
(39790, 1006, 30078, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:08', '2021-05-14 14:37:08'),
(39791, 3040, 30078, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:36:52', '2021-05-20 09:36:52'),
(39792, 3040, 30078, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:54:01', '2021-06-09 10:54:01'),
(39793, 3040, 30078, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:30', '2021-07-20 09:44:30'),
(39794, 11056, 30078, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:41:47', '2021-08-05 13:41:47'),
(39795, 3040, 30078, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:33', '2021-09-03 14:38:33'),
(39796, 10057, 30078, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:41:52', '2021-10-18 11:41:52'),
(39797, 10057, 30078, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:38:38', '2021-11-23 17:38:38'),
(39798, 10057, 30078, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment:', NULL, NULL, '2021-12-06 11:27:08', '2021-12-06 11:27:08'),
(39799, 10057, 30078, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:04:19', '2021-12-13 13:04:19'),
(39800, 10057, 30078, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:29:48', '2021-12-20 13:29:48'),
(39801, 10057, 30078, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:47:22', '2021-12-27 12:47:22'),
(39802, 10057, 30078, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:08:44', '2021-12-30 14:08:44'),
(39803, 19067, 30078, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:39:42', '2022-01-10 09:39:42'),
(39804, 20067, 30078, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:27:47', '2022-01-19 12:27:47'),
(39805, 20067, 30078, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 12/01/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:31:15', '2022-01-19 17:31:15'),
(39806, 1006, 30079, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:08', '2021-05-14 14:37:08'),
(39807, 3040, 30079, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-19 14:36:45', '2021-05-19 14:36:45'),
(39808, 3040, 30079, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:08:37', '2021-06-08 12:08:37'),
(39809, 3040, 30079, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:31:29', '2021-06-08 12:31:29'),
(39810, 3040, 30079, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:42:29', '2021-06-20 16:42:29'),
(39811, 1006, 30080, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:09', '2021-05-14 14:37:09'),
(39812, 3040, 30080, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-17 12:55:06', '2021-05-17 12:55:06'),
(39813, 3040, 30080, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 17:59:45', '2021-06-07 17:59:45'),
(39814, 3040, 30080, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:41', '2021-06-24 11:21:41'),
(39815, 3040, 30080, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:56', '2021-07-13 13:14:56'),
(39816, 1006, 30081, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:09', '2021-05-14 14:37:09'),
(39817, 1006, 30081, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:54:43', '2021-06-01 13:54:43'),
(39818, 3040, 30081, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:24', '2021-07-22 10:06:24'),
(39819, 11056, 30081, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:27:44', '2021-08-04 15:27:44'),
(39820, 3040, 30081, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:23', '2021-08-17 10:58:23'),
(39821, 3040, 30081, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:19', '2021-08-17 13:14:19'),
(39822, 1006, 30082, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:09', '2021-05-14 14:37:09'),
(39823, 3040, 30082, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-20 09:17:33', '2021-05-20 09:17:33'),
(39824, 3040, 30082, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:36:07', '2021-06-09 12:36:07'),
(39825, 3040, 30082, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:09', '2021-07-20 10:27:09'),
(39826, 3040, 30082, NULL, '2021-08-02 00:00:00.000', 'Approved', '', NULL, NULL, '2021-07-26 12:02:26', '2021-07-26 12:02:26'),
(39827, 1006, 30089, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:09', '2021-05-14 14:37:09'),
(39828, 3040, 30089, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:20:56', '2021-05-18 12:20:56'),
(39829, 1006, 30090, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:09', '2021-05-14 14:37:09'),
(39830, 3040, 30090, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:22:25', '2021-05-18 10:22:25'),
(39831, 1006, 30091, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:09', '2021-05-14 14:37:09'),
(39832, 3040, 30091, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   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, '2021-05-20 08:55:13', '2021-05-20 08:55:13'),
(39833, 3040, 30091, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Thank you, I have sent this over to our Updates department to complete.  Best,  Austin Owens Provider Contracting Specialist', NULL, NULL, '2021-06-09 13:01:38', '2021-06-09 13:01:38'),
(39834, 3040, 30091, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject:  Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   Hope you are doing well. I wanted to know if there is any update regarding the enrollment that was requested in my previous email.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 13:02:38', '2021-06-09 13:02:38'),
(39835, 3040, 30091, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   I didn\'t receive any email from your department regarding the request that was sent out 05/20/2021. Can you please check and advise how to proceed with enrollment?  Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-28 13:41:59', '2021-06-28 13:41:59'),
(39836, 3040, 30091, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: updates@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-16 16:49:13', '2021-07-16 16:49:13'),
(39837, 11056, 30091, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	austin.owens@primehealthservices.com  Sub : Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning!  Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 12 : Provider Name : John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!    I have called Prime Health services thrice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:06:22', '2021-08-05 11:06:22'),
(39838, 12062, 30091, NULL, '2021-09-25 00:00:00.000', 'In Process', 'Sent a follow up email to :austin.owens@primehealthservices.com  Subject: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Dear Owens,  Good Day!  May I have the updated status on below?  I would appreciate your earliest response for a subject query.  Have a nice weekend ! ', NULL, NULL, '2021-09-17 14:33:40', '2021-09-17 14:33:40'),
(39839, 12062, 30091, NULL, '2021-09-25 00:00:00.000', 'Approved', 'As per the below mail the provider is enrolled. See attached file and below mail for a reference.  from:providerrelations@primehealthservices.com Subject:Re: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Please see updates highlighted in yellow, as all listed providers are enrolled under this group.   Thank you, Provider Relations   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215   Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067 Enrolled effective: 08/10/2020 Provider ID:11731313   Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Enrolled effective: 08/10/2020 Provider ID: 11548953   Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Enrolled effective: 08/10/2020 Provider ID: 11418820  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Enrolled effective: 08/10/2020 Provider ID:    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Enrolled effective: 08/10/2020 Provider ID: 12276289   Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Enrolled effective: 08/10/2020 Provider ID: 7163504   Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Enrolled effective: 08/10/2020 Provider ID: 11548952   Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Enrolled effective: 08/10/2020 Provider ID: 12504178   Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Enrolled effective: 08/10/2020 Provider ID: 12504179   Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 Enrolled effective: 08/10/2020 Provider ID: 12504180', NULL, NULL, '2021-09-17 16:38:30', '2021-09-17 16:38:30'),
(39840, 1006, 30092, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:10', '2021-05-14 14:37:10'),
(39841, 3040, 30092, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  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, '2021-05-18 12:27:13', '2021-05-18 12:27:13'),
(39842, 3040, 30092, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:32:16', '2021-06-08 10:32:16'),
(39843, 3040, 30092, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:35:13', '2021-06-08 10:35:13'),
(39844, 3040, 30092, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:28:11', '2021-06-08 14:28:11'),
(39845, 1006, 30094, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:10', '2021-05-14 14:37:10'),
(39846, 3040, 30094, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:36:57', '2021-05-20 09:36:57'),
(39847, 3040, 30094, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:54:06', '2021-06-09 10:54:06'),
(39848, 3040, 30094, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:30', '2021-07-20 09:44:30'),
(39849, 11056, 30094, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:41:35', '2021-08-05 13:41:35'),
(39850, 3040, 30094, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:32', '2021-09-03 14:38:32'),
(39851, 10057, 30094, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:41:46', '2021-10-18 11:41:46'),
(39852, 10057, 30094, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:38:32', '2021-11-23 17:38:32'),
(39853, 10057, 30094, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment:', NULL, NULL, '2021-12-06 10:59:48', '2021-12-06 10:59:48'),
(39854, 10057, 30094, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:04:13', '2021-12-13 13:04:13'),
(39855, 10057, 30094, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:29:43', '2021-12-20 13:29:43'),
(39856, 10057, 30094, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:47:15', '2021-12-27 12:47:15'),
(39857, 10057, 30094, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:08:35', '2021-12-30 14:08:35'),
(39858, 19067, 30094, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:39:47', '2022-01-10 09:39:47'),
(39859, 20067, 30094, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:27:41', '2022-01-19 12:27:41');
