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
(25854, 11056, 22582, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:12:22', '2021-09-21 16:12:22'),
(25855, 11056, 22582, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:54:25', '2021-10-01 12:54:25'),
(25856, 11056, 22582, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:55:36', '2021-10-18 15:55:36'),
(25857, 11056, 22582, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:05:39', '2021-10-26 12:05:39'),
(25858, 11056, 22582, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:29:32', '2021-11-11 14:29:32'),
(25859, 11056, 22582, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:30:14', '2021-11-11 14:30:14'),
(25860, 11056, 22582, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:40:56', '2021-12-02 16:40:56'),
(25861, 11056, 22582, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:11:26', '2021-12-16 14:11:26'),
(25862, 11056, 22582, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective date  Rose P Trevino Pa  Kingsville - 6/1/2017 Calallen - 6/1/2017 Staples - 6/1/2017   Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 15:10:12', '2021-12-21 15:10:12'),
(25863, 3046, 22583, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:53:29', '2021-03-16 16:53:29'),
(25864, 3040, 22583, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Additional Location || Statcare Minor Emergency Clinic || Providers || UMR ||  Greetings,  Hope you are doing well. I wanted to add the providers in the UHC for our group Statcare Minor Emergency Clinic under the below locations.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 3: Provider Name: Capupus, Mari Katrina  Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415       Provider 4: Provider Name: Gonzalez, Mary C  Provider NPI# 1952713083 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415          Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415                Provider 6: Provider Name: Rabagos, Katherine  Provider NPI#  1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413     Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 7: Provider Name: Svatek, Maegan  Provider NPI#  1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-08 08:56:30', '2021-04-08 08:56:30'),
(25865, 1006, 22583, NULL, '2021-05-18 00:00:00.000', 'Approved', 'The provider has been added to the location, approval and location confirmation are attached for reference. ', NULL, NULL, '2021-05-11 15:55:31', '2021-05-11 15:55:31'),
(25866, 3046, 22584, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:53:31', '2021-03-16 16:53:31'),
(25867, 3040, 22584, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Additional Location || Statcare Minor Emergency Clinic || Providers || UMR ||  Greetings,  Hope you are doing well. I wanted to add the providers in the UHC for our group Statcare Minor Emergency Clinic under the below locations.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 3: Provider Name: Capupus, Mari Katrina  Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415       Provider 4: Provider Name: Gonzalez, Mary C  Provider NPI# 1952713083 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415          Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415                Provider 6: Provider Name: Rabagos, Katherine  Provider NPI#  1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413     Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 7: Provider Name: Svatek, Maegan  Provider NPI#  1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-08 08:57:41', '2021-04-08 08:57:41'),
(25868, 1006, 22584, NULL, '2021-05-18 00:00:00.000', 'Approved', 'The provider has been added to the location, approval and location confirmation are attached.', NULL, NULL, '2021-05-11 16:07:59', '2021-05-11 16:07:59'),
(25869, 3046, 22585, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:53:33', '2021-03-16 16:53:33'),
(25870, 3040, 22585, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Additional Location || Statcare Minor Emergency Clinic || Providers || UMR ||  Greetings,  Hope you are doing well. I wanted to add the providers in the UHC for our group Statcare Minor Emergency Clinic under the below locations.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 3: Provider Name: Capupus, Mari Katrina  Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415       Provider 4: Provider Name: Gonzalez, Mary C  Provider NPI# 1952713083 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415          Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415                Provider 6: Provider Name: Rabagos, Katherine  Provider NPI#  1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413     Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 7: Provider Name: Svatek, Maegan  Provider NPI#  1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-08 09:04:33', '2021-04-08 09:04:33'),
(25871, 1006, 22585, NULL, '2021-05-18 00:00:00.000', 'Approved', 'The provider has been added to the location, approval and location confirmation are attached. ', NULL, NULL, '2021-05-11 16:09:06', '2021-05-11 16:09:06'),
(25872, 3046, 22586, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:53:35', '2021-03-16 16:53:35'),
(25873, 3040, 22586, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Request for Roster || Statcare Minor Emergency Clinic || Group & Providers || UHC ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-08 09:12:09', '2021-04-08 09:12:09'),
(25874, 3040, 22586, NULL, '2021-04-16 00:00:00.000', 'Approved', 'Provider participating with UHC.', NULL, NULL, '2021-04-09 16:04:51', '2021-04-09 16:04:51'),
(25875, 3046, 22587, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:53:35', '2021-03-16 16:53:35'),
(25876, 3040, 22587, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Additional Location || Statcare Minor Emergency Clinic || Providers || UMR ||  Greetings,  Hope you are doing well. I wanted to add the providers in the UHC for our group Statcare Minor Emergency Clinic under the below locations.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 3: Provider Name: Capupus, Mari Katrina  Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415       Provider 4: Provider Name: Gonzalez, Mary C  Provider NPI# 1952713083 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415          Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415                Provider 6: Provider Name: Rabagos, Katherine  Provider NPI#  1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413     Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 7: Provider Name: Svatek, Maegan  Provider NPI#  1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-08 09:18:55', '2021-04-08 09:18:55'),
(25877, 1006, 22587, NULL, '2021-05-18 00:00:00.000', 'Approved', 'The provider has been added to the location, approval and location confirmation are attached. ', NULL, NULL, '2021-05-11 16:11:39', '2021-05-11 16:11:39'),
(25878, 3046, 22588, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:53:37', '2021-03-16 16:53:37'),
(25879, 3040, 22588, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Additional Location || Statcare Minor Emergency Clinic || Providers || UMR ||  Greetings,  Hope you are doing well. I wanted to add the providers in the UHC for our group Statcare Minor Emergency Clinic under the below locations.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 3: Provider Name: Capupus, Mari Katrina  Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415       Provider 4: Provider Name: Gonzalez, Mary C  Provider NPI# 1952713083 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415          Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415                Provider 6: Provider Name: Rabagos, Katherine  Provider NPI#  1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413     Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 7: Provider Name: Svatek, Maegan  Provider NPI#  1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-08 09:28:15', '2021-04-08 09:28:15'),
(25880, 1006, 22588, NULL, '2021-05-18 00:00:00.000', 'Approved', 'The location has been added, approval and location confirmation are attached for reference.  ', NULL, NULL, '2021-05-11 13:56:46', '2021-05-11 13:56:46'),
(25881, 1006, 22588, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'We received the following email from donotreplyemail@aperturecvo.com:  Sub; Important Credentialing Information Requested: MASON, TRACI SMITH - 8C3PT  \"Aperture Credentialing, LLC, a national credentials verification organization, has been contracted to handle primary source verification of your credentials.  Documentation needed to complete your credentialing application is missing, incomplete, or expired.  In order to continue the credentialing process with the Health Plan(s) requesting information, you will need to provide the requested information within three (3) business days from the date of this notice so that the processing of your application can be completed.  Health Plan(s) Requesting Information: United HealthCare of Houston  Credentials Request for: MASON, TRACI SMITH  Attention: Traci Mason Credentialing Contact  Information Requested: Please provide who admits on your behalf, or the name of the covering colleague, or hospitalist group name?  How to Respond: Fax:  Click on the Aperture Supporting Documentation website link below to download your custom fax coversheet and fax number to transmit information requested via fax. Online:  Click on the Aperture Supporting Documentation website link below to download specific forms, attach documentation, or provide a quick response for information requested.  NOTE: This email was sent from a notification-only email address that cannot accept incoming email.  Please do not reply to this message. The website link is custom to the provider and health plan specific to the Credentialing Information Request contained in this email.  Please do not submit other providers not listed in this email using this link. Please disregard this notice if you have already submitted your application or information requested. If you are using CAQH to upload supporting documentation, please allow up to two (2) business days for CAQH processing.  Once the documents are processed by CAQH, Aperture will be able to download that information. Aperture Supporting Documentation website: https://outreach.aperturecvo.com/445a83f7-ea0e-4a82-b59c-1b46e53d50b0\"  Replied with request information as Rolando Perez is her supervising physican. ', NULL, NULL, '2021-08-30 14:58:36', '2021-08-30 14:58:36'),
(25882, 11056, 22588, NULL, '2021-09-28 00:00:00.000', 'Revalidation', 'Email sent to : networkhelp@uhc.com  Sub : Status Update of recredentialing - Traci Mason - UHC  Good evening!  Hope all is well with you. Please provide me with the recredentialing status for the below mentioned provider under the facility TIN. And also confirm if all of the locations are listed below that provider or not?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details:  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-21 17:12:07', '2021-09-21 17:12:07'),
(25883, 11056, 22588, NULL, '2021-10-01 00:00:00.000', 'Revalidation', 'Secure Message from david.c.cliff@optum.com', NULL, NULL, '2021-09-24 13:53:32', '2021-09-24 13:53:32'),
(25884, 11056, 22588, NULL, '2021-10-19 00:00:00.000', 'Revalidation', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from david.c.cliff@optum.com  Good Afternoon,  The provider is currently in a recredentialing process that is due 11/2021 (the CAQH application has been accessed and the recredentialing will complete before the end of 11/2021).  The only service locations loaded for this provider are  3817 S PADRE ISLAND DR CORPUS CHRISTI, TX 78415-2913 and 4042 RIVER HILL DR CORPUS CHRISTI, TX 78410-5606   David Cliff UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-10-12 10:59:47', '2021-10-12 10:59:47'),
(25885, 11056, 22588, NULL, '2021-10-25 00:00:00.000', 'Revalidation', 'Email sent to : networkhelp@uhc.com  Sub : Secure Message from david.c.cliff@optum.com  Good afternoon!  Hope this email finds you well. What about the other 2 mentioned below 1. Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 2. Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413', NULL, NULL, '2021-10-18 12:54:30', '2021-10-18 12:54:30'),
(25886, 11056, 22588, NULL, '2021-11-01 00:00:00.000', 'Revalidation', 'Email received from : networkhelp@uhc.com  Sub : RE: Secure Message from david.c.cliff@optum.com  The 500 E CAESAR  KINGSVILLE , TX 78363 and 6646 S. Staples St. # 122 Corpus Christi , TX 78413 are currently not loaded as service locations for this provider.  A request to add these locations would need to be submitted to our demographics group for processing   Request has been submitted', NULL, NULL, '2021-10-25 13:13:38', '2021-10-25 13:13:38'),
(25887, 11056, 22588, NULL, '2021-11-18 00:00:00.000', 'Revalidation', 'Email sent to: hpdemo@uhc.com,  networkhelp@uhc.com  Sub : Status Update of recredentialing - Traci Mason - UHC - Statcare Minor Emergency Clinic   Good afternoon!  Hope you are having a great day. Has the re-credentialing been completed of the provider, Traci Mason? Have all the below mention locations been listed under the provider?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Traci Mason	1497127831  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-11 13:58:50', '2021-11-11 13:58:50'),
(25888, 11056, 22588, NULL, '2021-11-23 00:00:00.000', 'Revalidated', 'Email received from: networkhelp@uhc.com  Sub : Secure Message from cameron_l_pickett@uhc.com  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry. I have included the product roster showing the demographic information, lines of business, and effective dates for the providers requested.      Additionally, if you are wanting the specific lines of business that the providers are linked to this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). Please see the attached handout for more information.    If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).    Please let us know if we can assist further.       Sincerely,       *--SecureDelivery--*    All locations are added. Please see the roster.', NULL, NULL, '2021-11-16 14:39:36', '2021-11-16 14:39:36'),
(25889, 3046, 22589, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:53:38', '2021-03-16 16:53:38'),
(25890, 3040, 22589, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Additional Location || Statcare Minor Emergency Clinic || Providers || UMR ||  Greetings,  Hope you are doing well. I wanted to add the providers in the UHC for our group Statcare Minor Emergency Clinic under the below locations.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 3: Provider Name: Capupus, Mari Katrina  Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415       Provider 4: Provider Name: Gonzalez, Mary C  Provider NPI# 1952713083 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415          Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415                Provider 6: Provider Name: Rabagos, Katherine  Provider NPI#  1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413     Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 7: Provider Name: Svatek, Maegan  Provider NPI#  1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-08 09:38:15', '2021-04-08 09:38:15'),
(25891, 9057, 22589, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to networkhelp@uhc.com Sub: Enrollment & Additional Location Status request - RHC United HealthCare  Hello, We submitted a request for the enrollment for the following providers under the mentioned group, please let me know what the status is:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415      Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415          Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415                Provider 6: Provider Name: Rabagos, Katherine Provider NPI#  1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413     Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 7: Provider Name: Svatek, Maegan Provider NPI#  1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Kindly get back to us soon as possible.  Thank you ', NULL, NULL, '2021-05-25 14:37:32', '2021-05-25 14:37:32'),
(25892, 1006, 22589, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent another f/u email @ NMRT networkhelp@uhc.com as there\'s no other way to reach them:  Sub: Location Query - RHC - UHC  \"Hello, I hope you\'re doing well, I wanted to verify if the following providers under our group had the mentioned practice locations listed under them as of yet? The information is as follows: Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name: Rabagos, Katherine Provider NPI#  1134415631  Provider Name: Svatek, Maegan Provider NPI#  1639670250  Please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-11 17:00:15', '2021-06-11 17:00:15'),
(25893, 3040, 22589, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Location Query - RHC - UHC  Greetings,  I hope you\'re doing well, I wanted to verify if the following providers under our group had the mentioned practice locations listed under them as of yet? The information is as follows:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name: Rabagos, Katherine Provider NPI#  1134415631  Provider Name: Svatek, Maegan Provider NPI#  1639670250  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-30 16:40:53', '2021-06-30 16:40:53'),
(25894, 1006, 22589, NULL, '2021-07-19 00:00:00.000', 'Approved', 'The location has been updated, location confirmation is attached for reference.   Eff: 12/22/2019', NULL, NULL, '2021-07-12 16:52:27', '2021-07-12 16:52:27'),
(25895, 3046, 22590, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:53:40', '2021-03-16 16:53:40'),
(25896, 3040, 22590, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Request for Roster || Statcare Minor Emergency Clinic || Group & Providers || UHC ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 09:44:20', '2021-04-08 09:44:20'),
(25897, 3040, 22590, NULL, '2021-04-16 00:00:00.000', 'Approved', 'Provider Participating with UHC.', NULL, NULL, '2021-04-09 16:31:44', '2021-04-09 16:31:44'),
(25898, 3046, 22591, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:53:41', '2021-03-16 16:53:41'),
(25899, 3040, 22591, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Additional Location || Statcare Minor Emergency Clinic || Providers || UMR ||  Greetings,  Hope you are doing well. I wanted to add the providers in the UHC for our group Statcare Minor Emergency Clinic under the below locations.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 3: Provider Name: Capupus, Mari Katrina  Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415       Provider 4: Provider Name: Gonzalez, Mary C  Provider NPI# 1952713083 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415          Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415                Provider 6: Provider Name: Rabagos, Katherine  Provider NPI#  1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413     Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 7: Provider Name: Svatek, Maegan  Provider NPI#  1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-08 09:46:35', '2021-04-08 09:46:35'),
(25900, 9057, 22591, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to networkhelp@uhc.com Sub: Enrollment & Additional Location Status request - RHC United HealthCare  Hello, We submitted a request for the enrollment for the following providers under the mentioned group, please let me know what the status is:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415      Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415          Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415                Provider 6: Provider Name: Rabagos, Katherine Provider NPI#  1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413     Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 7: Provider Name: Svatek, Maegan Provider NPI#  1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Kindly get back to us soon as possible.  Thank you ', NULL, NULL, '2021-05-25 14:37:48', '2021-05-25 14:37:48'),
(25901, 1006, 22591, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent another f/u email @ NMRT networkhelp@uhc.com as there\'s no other way to reach them:  Sub: Location Query - RHC - UHC  \"Hello, I hope you\'re doing well, I wanted to verify if the following providers under our group had the mentioned practice locations listed under them as of yet? The information is as follows: Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name: Rabagos, Katherine Provider NPI#  1134415631  Provider Name: Svatek, Maegan Provider NPI#  1639670250  Please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-11 17:00:10', '2021-06-11 17:00:10'),
(25902, 3040, 22591, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Location Query - RHC - UHC  Greetings,  I hope you\'re doing well, I wanted to verify if the following providers under our group had the mentioned practice locations listed under them as of yet? The information is as follows:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name: Rabagos, Katherine Provider NPI#  1134415631  Provider Name: Svatek, Maegan Provider NPI#  1639670250  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-30 16:40:49', '2021-06-30 16:40:49'),
(25903, 1006, 22591, NULL, '2021-07-19 00:00:00.000', 'Approved', 'The location has been updated, location confirmation is attached for reference.   Eff: 12/22/2018 ', NULL, NULL, '2021-07-12 16:54:29', '2021-07-12 16:54:29'),
(25904, 3046, 22592, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 16:53:44', '2021-03-16 16:53:44'),
(25905, 3040, 22592, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Request for Roster || Statcare Minor Emergency Clinic || Group & Providers || UHC ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 08:52:58', '2021-04-08 08:52:58'),
(25906, 1006, 22592, NULL, '2021-05-11 00:00:00.000', 'Approved', 'The group has been added to the mentioned address, approval and location confirmation is attached for reference. Eff: 12/22/2018', NULL, NULL, '2021-05-11 10:06:31', '2021-05-11 10:06:31'),
(25907, 3046, 22604, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 12:41:09', '2021-03-17 12:41:09'),
(25908, 3046, 22604, NULL, '2021-03-26 00:00:00.000', 'Initiated', 'Your request to join the network has been received. You can expect to hear from us in the next 45days. If it has been more than 60 days and you haven\'t heard from us regarding next steps, you can call 1-800-353-1232 for assistance. Please reference code \"MEDICAL\"', NULL, NULL, '2021-03-19 15:58:46', '2021-03-19 15:58:46'),
(25909, 1006, 22604, NULL, '2021-04-21 00:00:00.000', 'Approved', 'The provider has been enrolled with Medicare. Eff: 03/01/2021 Medicare ID# 1N3947', NULL, NULL, '2021-04-14 07:26:42', '2021-04-14 07:26:42'),
(25910, 1006, 22604, NULL, NULL, 'Revalidation', 'The request still shows up as in-process, need to allow more time. Request can take upto 45~60 business days.   Tracking# PVB1269985', NULL, NULL, '2021-04-14 09:34:09', '2021-04-14 09:34:09'),
(25911, 1006, 22604, NULL, '2021-06-16 00:00:00.000', 'Revalidation', 'Application is in the credentialing process, this was received by the credentialing team on 04/28. Need to allow more time for processing.  Tracking# PVB1269985 Ref# 6023625762', NULL, NULL, '2021-06-09 09:00:32', '2021-06-09 09:00:32'),
(25912, 1006, 22604, NULL, '2021-07-06 00:00:00.000', 'Revalidation', 'The request is still in process, need to allow more time for processing.  Ticket# NAF437742 Ref# 6027623500', NULL, NULL, '2021-06-29 10:33:44', '2021-06-29 10:33:44'),
(25913, 1006, 22604, NULL, '2021-07-30 00:00:00.000', 'Revalidation', 'The request is still in-process, as per the representative it will take 30 business days to complete.   Ref# 6032082538', NULL, NULL, '2021-07-23 13:11:04', '2021-07-23 13:11:04'),
(25914, 1006, 22604, NULL, '2021-08-17 00:00:00.000', 'Revalidated', '\"Linkage for an individual is not a requirement as we are holding a facility setup contract Effective 10/15/2015 and we can bill using the facility\'s NPI. ', NULL, NULL, '2021-08-10 13:25:45', '2021-08-10 13:25:45'),
(25915, 3046, 22605, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 12:44:01', '2021-03-17 12:44:01'),
(25916, 1006, 22605, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The ancillary contract is already in place, no need to individually add providers.   Eff: 02/15/2018', NULL, NULL, '2021-04-20 08:40:51', '2021-04-20 08:40:51'),
(25917, 3046, 22606, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 12:44:24', '2021-03-17 12:44:24'),
(25918, 1006, 22606, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Submitted provider onboarding form to BCBS for enrollment. Attached for reference. ', NULL, NULL, '2021-04-14 12:21:44', '2021-04-14 12:21:44'),
(25919, 9057, 22606, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: Provider_Relations_Houston@bcbstx.com Sub: Request for Enrollment Status - BAQC - Blue Cross Blue Shield  Hello,  We submitted an enrollment form for the below mentioned provider under the following group.   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418 Provider Name: Melissa Ramsden NPI# 1194376228   Kindly update me with the current status regarding the above mentioned request.  Thank you', NULL, NULL, '2021-05-27 13:12:09', '2021-05-27 13:12:09'),
(25920, 1006, 22606, NULL, '2021-06-23 00:00:00.000', 'Approved', 'We received the group roster and the provider is showing as enrolled: Provider ID# H08PE47201 Effective Date: 05/13/2021  The roster is attached for reference. ', NULL, NULL, '2021-06-16 11:01:36', '2021-06-16 11:01:36'),
(25921, 3046, 22607, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 12:47:39', '2021-03-17 12:47:39'),
(25922, 1006, 22607, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Spoke to Cigna, as per the representative provider is already enrolled with Cigna and we need to send in a link request. Submitted email @ intake_pdm@cigna.com with W9:  Sub: Provider Link Request - Melissa Ramsden   \"Hello, We wish to link the following credentialed provider with our group, the information is as follows: Provider Name: Melissa Ramsden NPI# 1194376228 Group Name: Bay Area Quick Care LLCTIN# 27-1702009  Please let me know if anything else is required to complete this request. Thank you. \"', NULL, NULL, '2021-04-14 13:21:46', '2021-04-14 13:21:46');
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
(25923, 1006, 22607, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Received a call from Cigna provider representative Donna, she was asking for the provider\'s COI. Sent her an email with the COI attached @ donna.hand@cigna.com:  Sub: Malpractice - Melissa Ramsden - BAQC  \"Hello Donna,   I\'ve updated Melissa\'s CAQH and it should be attested by Monday, but here\'s the updated COI for Melissa just in case you can use this to proceed with the request.   Please let me know if there\'s anything else that you may need.  Thank you!\"', NULL, NULL, '2021-04-16 07:33:41', '2021-04-16 07:33:41'),
(25924, 1006, 22607, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Need to allow 20 calendar days for the request to be processed completely.   Ref# Cherrelle 04/27/2021 ', NULL, NULL, '2021-04-27 13:53:07', '2021-04-27 13:53:07'),
(25925, 9057, 22607, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: intake_pdm@cigna.com, donna.hand@cigna.com Sub: Credentialed provider link status request- BAQC - Cigna  Hello, We asked to link the following credentialed provider with our group, the information is as follows:   Provider Name: Melissa Ramsden NPI# 1194376228  Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Kindly update us with the current status regarding the above mentioned request.  Thank you ', NULL, NULL, '2021-05-27 09:12:48', '2021-05-27 09:12:48'),
(25926, 9057, 22607, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We Sent an email to: intake_pdm@cigna.com Sub: Enrollment Request Status - BAQC - Cigna  Hello, We asked to link the following credentialed providers under the following group, the information is as follows:   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418    Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Kindly update us with the current status regarding the above mentioned request.as soon as possible.  Thank you', NULL, NULL, '2021-05-31 12:03:11', '2021-05-31 12:03:11'),
(25927, 1006, 22607, NULL, '2021-06-24 00:00:00.000', 'Approved', 'The provider is individually enrolled with Cigna under our group and also under the ancillary contract. Both confirmations are attached for reference.   Provider Name / Group Name    CPF  Provider ID   Completed:  Yes / No. Effective / Termination Date Ramsden, Melissa                               8121614                    Contracted                 3/15/2021  Cigna has an ancillary contract,  Provider ID# 8174536 Eff: 10/10/2018 Ref# Paul D 06/17/2021', NULL, NULL, '2021-06-17 12:25:51', '2021-06-17 12:25:51'),
(25928, 3046, 22608, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 12:55:19', '2021-03-17 12:55:19'),
(25929, 1006, 22608, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'The group enrollment is currently in process, check group task for further clarification. ', NULL, NULL, '2021-05-04 10:46:37', '2021-05-04 10:46:37'),
(25930, 3040, 22608, NULL, '2021-06-17 00:00:00.000', 'On Hold', 'The group enrollment is currently in process, check group task for further clarification.  ', NULL, NULL, '2021-06-10 10:58:25', '2021-06-10 10:58:25'),
(25931, 1006, 22608, NULL, '2021-06-23 00:00:00.000', 'Approved', 'Received following approval confirmation email from @ Offord, Tommishia S. tommishia.offord@christushealth.org:  Sub: Request for enrollment status - BAQC - CHRISTUS HEALTH PLAN  \"Good morning,  Bay Area Quick Care PLLC is credentialed as a facility and would not require the providers to be credentialed individually. All billing will be under the ancillary agreement. Please reach out to your Network Contractor for an executed contract (Michal Simms). I have attached the Credentialing Approval Welcome Letter that was sent on May 12, 2021 to email address “baqc@claimsmedinc.com”. As stated in the email history, the network effective date will be 7/1/2021. Please let us know if you need anything else. Have a blessed day!  Thank you,  Tommishia Offord, CPCS Credentialing Supervisor CHRISTUS Health (o) 469.282.3158 (f) 210.766.9254\"  The welcome letter is attached for reference in the main group task as this is a facility contract.  ', NULL, NULL, '2021-06-16 11:51:30', '2021-06-16 11:51:30'),
(25932, 3046, 22609, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 12:57:22', '2021-03-17 12:57:22'),
(25933, 1006, 22609, NULL, '2021-04-27 00:00:00.000', 'On Hold', 'Pending Medicaid Enrollment.', NULL, NULL, '2021-04-20 12:19:34', '2021-04-20 12:19:34'),
(25934, 9057, 22609, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', '\"Hold off on Driscoll for now.  The reason is because there’s a doctor on their Board named Dr Buck, and he hates NPs.  A friend got credentialed with them and he wrote her a letter demanding a copy of her collaborating agreement with a physician - he told her that if she didn’t give it to him within three days, he was going to report both her and the doctor to the Board.  After they credentialed her, she told them to forget it, knowing that Dr Buck would cause trouble.  Unfortunately, Dr Buck lives in CC and causes trouble for NPs, especially if they own their own clinic. ', NULL, NULL, '2021-05-31 16:16:15', '2021-05-31 16:16:15'),
(25935, 3046, 22610, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 12:57:53', '2021-03-17 12:57:53'),
(25936, 1006, 22610, NULL, '2021-04-27 00:00:00.000', 'Initiated', 'Sent an email query @ mmedina@ghn-mci.com & Susdeys@ghn-mci.com for enrollment status and how to proceed:   Sub: Enrollment Query - Bay Area Quick Care - Galaxy Health  \"Hello,   I hope you\'re doing well, I wanted to verify the enrollment status for the following group and providers:   Group Name: Bay Area Quick Care LLC NPI# 1437481421  Provider Name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  If the above-mentioned providers are enrolled please send over their welcome letters and if they require enrollment please let me know what the process is.   Thank you.\"', NULL, NULL, '2021-04-20 13:11:39', '2021-04-20 13:11:39'),
(25937, 1006, 22610, NULL, '2021-04-30 00:00:00.000', 'In Process', 'We received the following reply from Susdey Sud Susdeys@ghn-mci.com:  Sub: Enrollment Query - Bay Area Quick Care - Galaxy Health  \"Hello,  Cynthia Malowitz effective date is 01/26/18 and William Francis effective date is 08/31/20.  The attachment is application for you to complete for Melissa Ramsden and Kynda Orsak. Should you have any questions, please do not hesitate to call us.  Sincerely,  Susdey Sud Director, Network Operations Office Phone: (800) 975-3322 Office Fax: (817) 887-3355\"', NULL, NULL, '2021-04-23 09:48:40', '2021-04-23 09:48:40'),
(25938, 1006, 22610, NULL, '2021-04-30 00:00:00.000', 'In Process', 'The form is filled out and we are currently waiting on the provider\'s updated resume copy. ', NULL, NULL, '2021-04-23 12:01:07', '2021-04-23 12:01:07'),
(25939, 1006, 22610, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Form has been sent, as resume has been received.', NULL, NULL, '2021-04-23 12:11:37', '2021-04-23 12:11:37'),
(25940, 1006, 22610, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following reply from Malanie Medina mmedina@ghn-mci.com:  Sub: Enrollment Query - Bay Area Quick Care - Galaxy Health  \"Hi Brad,  Are you wanting a copy of the group contract Bay Area Quick care, that’s how the providers are contracted. Thanks  Malanie Medina Network Support Coordinator Galaxy Health Network Ph: 817-633-5822 or 800-975-3322 Fx: 817-633-5729  HIPAA Compliance Disclosure:  This email message and its attachments may contain confidential information that is legally privileged.  This information is intended only for the use of the intended recipient of this email message.  The authorized recipient of this information is prohibited from disclosing this information to any other party and is required to destroy the information after its stated need has been fulfilled unless otherwise required by state law. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken with regard to the contents of these documents is strictly prohibited.  If you have received this email message in error, please notify the sender immediately to arrange for return of these documents.\"', NULL, NULL, '2021-04-27 08:36:31', '2021-04-27 08:36:31'),
(25941, 3040, 22610, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Received the following reply from Malanie Medina mmedina@ghn-mci.com:  Sub: Enrollment Query - Bay Area Quick Care - Galaxy Health  Hi Brad,  Can you please send a letter from the facility requesting a copy of the contract. thanks ', NULL, NULL, '2021-06-10 10:38:40', '2021-06-10 10:38:40'),
(25942, 11056, 22610, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Sent email to LeeAnn to send email to mmedina@ghn-mci.com for group contract. Letter is attached for reference.', NULL, NULL, '2021-06-21 13:22:36', '2021-06-21 13:22:36'),
(25943, 1006, 22610, NULL, '2021-07-14 00:00:00.000', 'In Process', 'We received the following reply from kavalos@ghn-mci.com:  Sub: Fw:  \"Good morning;  Please send a letter signed by the person who sing the agreement.  Thank you if you have any questions please contact me directly. At 800-975-3322 ext 1601  Karen A   Karen Avalos Network Support Coordinator Galaxy Health Network Ph: 817-633-5822 or 800-975-3322 ext 1601 Fx: 817-633-5729\"  Asked LeeAnn to get the request signed by Cynthia and to forward it to me for further use. ', NULL, NULL, '2021-07-07 16:13:24', '2021-07-07 16:13:24'),
(25944, 1006, 22610, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Signed copy of the request received, sent following email @ Karen Avalos kavalos@ghn-mci.com:  Sub: RE: Group Contract Request - Bay Area Quick Care  \"Good morning Karen,   You requested a copy of this letter with the correct signature, please find it attached. Please send over the group contract as soon as you\'re able.   Thank you. \"', NULL, NULL, '2021-07-13 09:59:44', '2021-07-13 09:59:44'),
(25945, 1006, 22610, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Executed contract is attached for reference.   Eff: 01/26/2018', NULL, NULL, '2021-07-16 16:54:42', '2021-07-16 16:54:42'),
(25946, 3046, 22611, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 12:58:13', '2021-03-17 12:58:13'),
(25947, 1006, 22611, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Submitted enrollment request via HealthSmart online portal, attached for reference: \"Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.\"', NULL, NULL, '2021-04-14 13:33:52', '2021-04-14 13:33:52'),
(25948, 1006, 22611, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received an email from HealthSmart asking for CAQH Form, filled out and sent:   Sub:  RE: HealthSmart.com - Join Our Network - Individual Provider - Ramsden   \"Hello,   Please find the attached filled-out application, do let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-04-14 15:08:36', '2021-04-14 15:08:36'),
(25949, 1006, 22611, NULL, '2021-04-28 00:00:00.000', 'In Process', 'We received the following update from MDI PR Support mdiprsupport@healthsmart.com:  Sub: RE: HealthSmart.com - Join Our Network - Individual Provider - Ramsden  \"Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  * Ramsden, Melissa L APN.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com (Inventory Log ID : 78616)  Thanks HealthSmart Provider Relation\"', NULL, NULL, '2021-04-21 07:45:17', '2021-04-21 07:45:17'),
(25950, 9057, 22611, NULL, '2021-06-03 00:00:00.000', 'In Process', 'we sent an email to pr.south@healthsmart.com Sub:Request for enrollment status - BAQC - Health Smart  Hello, we submitted an enrollment form for the below mentioned provider under the following group.   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider Name: Melissa Ramsden NPI# 1194376228   Kindly update me with the current status regarding the above mentioned request.  Thank you ', NULL, NULL, '2021-05-27 10:21:37', '2021-05-27 10:21:37'),
(25951, 9057, 22611, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We sent an email to  pr.south@healthsmart.com Request for enrollment status - BAQC - Health Smart  Hello, we submitted enrollment forms for the below mentioned provider under the following group.   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228   Kindly update me with the current status regarding the above mentioned request.as soon as possible.  Thank you', NULL, NULL, '2021-05-31 13:07:31', '2021-05-31 13:07:31'),
(25952, 1006, 22611, NULL, '2021-06-24 00:00:00.000', 'Approved', 'Received following approval confirmation from pr.south@healthsmart.com:  Sub: Request for enrollment status - BAQC - Health Smart  \"Hi,  01- Please see the following Providers with effective dates.  Provider Name                  Effective Date   Melissa Ramsden, NP          06/01/2021 \"  Approval confirmation is attached for reference. ', NULL, NULL, '2021-06-17 15:51:27', '2021-06-17 15:51:27'),
(25953, 3046, 22612, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 12:58:54', '2021-03-17 12:58:54'),
(25954, 1006, 22612, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent following email @ S TX Network Mgmt stxnm@humana.com with provider roster to add Melissa:    Sub: Provider Enrollment Request - Melissa Ramsden - BAQC    \"Hello,   I hope you\'re doing well, please find the attached roster of the provider that we wish to add to our group. Please let me know if anything else is required and if so what the next steps are?  Thank you.\"', NULL, NULL, '2021-04-14 14:13:57', '2021-04-14 14:13:57'),
(25955, 1006, 22612, NULL, '2021-04-22 00:00:00.000', 'In Process', 'We received the following email from S TX Network Mgmt stxnm@humana.com:  Sub: Provider Enrollment Request - Melissa Ramsden - BAQC  \"Thank you for your e-mail.  We have successfully received your message and will respond as soon as possible.    DEMOGRAPHIC REQUESTS  Please allow 45-60 days for the completion of demographic requests.  You will receive an email notification once your request has been completed.   You may check your demographic information at any time through Humana’s online directory:  https://www.humana.com/finder/medical?pageId=e59a074a04e741fbb164fc08ce8222fe.  OTHER KEY RESOURCES  For all other requests including claims inquiries, contract copies, fee schedules, etc., please contact Humana Provider Relations at 1-800-626-2741. Additional information may be accessed on our website at  https://www.humana.com/provider/medical-resources  Thank you Network Operations Coordinator /Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 T 800-626-2741 F 855.461.6048 stxnm@humana.com\"', NULL, NULL, '2021-04-15 07:28:54', '2021-04-15 07:28:54'),
(25956, 9057, 22612, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to stxnm@humana.com Sub: Request for enrollment status  - BAQC - Humana  Hello, we submitted an enrollment form for the below mentioned provider under the following group.   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider Name: Melissa Ramsden NPI# 1194376228   Kindly update me with the current status regarding the above mentioned request.  Thank you', NULL, NULL, '2021-05-27 10:42:50', '2021-05-27 10:42:50'),
(25957, 9057, 22612, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We sent an email to stxnm@humana.com Sub: Request for enrollment status  - BAQC - Humana  Hello, We asked to link the following credentialed providers under the following group, the information is as follows:   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228   Kindly update me with the current status regarding the above mentioned request.as soon as possible.  Thank you', NULL, NULL, '2021-05-31 13:09:32', '2021-05-31 13:09:32'),
(25958, 1006, 22612, NULL, '2021-06-24 00:00:00.000', 'In Process', 'As per my discussion with Humana, the request is still showing as in-process and we need to allow more time for processing.   Ref# 2000188531709', NULL, NULL, '2021-06-17 16:39:49', '2021-06-17 16:39:49'),
(25959, 1006, 22612, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Sent f/u email @ S TX Network Mgmt stxnm@humana.com:  Sub: Enrollment Status - BAQC - Humana  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned provider under our group:  Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider Name: Ramsden, Melissa NPI# 1194376228  Please get back to me as soon as possible as this request has been in process since April.  Thank you.\"', NULL, NULL, '2021-07-07 12:59:02', '2021-07-07 12:59:02'),
(25960, 1006, 22612, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ S TX Network Mgmt stxnm@humana.com:  Sub: Enrollment Status - BAQC - Humana  \"Hello,   I wanted to get an update regarding the enrollment status for the following provider under our group:  Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider Name: Ramsden, Melissa NPI# 1194376228  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-23 15:46:58', '2021-07-23 15:46:58'),
(25961, 1006, 22612, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Sent another f/u email as we were unable to get in touch with them on call @ S TX Network Mgmt stxnm@humana.com:  Sub: Enrollment Status - Humana - BAQC  \"Hello,  We are still waiting on an update regarding the enrollment status for the following group and providers:  Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider Name: Ramsden, Melissa NPI# 1194376228  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-10 16:29:52', '2021-08-10 16:29:52'),
(25962, 1006, 22612, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Received the following update from stxnm@humana.com:  Sub: Enrollment Status - Humana - BAQC  \"Your request was received and is in the queue to be worked.  Please allow more time for completion of your requests.   You will receive an email notification once your request has been completed.   Thank you  Network Operations Coordinator – Provider Contracting South Texas Network Management Humana 8119 Datapoint  Dr. 6th floor / San Antonio, TX 78229 T 1.502.301.2506 F 855.461.6048 stxnm@humana.com\"', NULL, NULL, '2021-08-11 09:31:36', '2021-08-11 09:31:36'),
(25963, 11056, 22612, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : stxnm@humana.com  Sub : Enrollment Status - Humana - BAQC  Good morning!  Hope all is well. Could you provide us the time frame for completion of the request? And please provide us with the latest updates soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-20 12:14:59', '2021-08-20 12:14:59'),
(25964, 11056, 22612, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email received from : KMoten4@humana.com  Sub : Secured: RE: Welcome letter Request - HUMANA - BAY QUICK AREA CARE PLLC  Good Afternoon,     We do not have access to the Welcome Letters. Those come from WPS, our claims processing company. You can call 1-800-444-5445 if you need additional information.        Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana  T 502-318-5250  F 210-239-0401  kmoten4@humana.com  HumanaMilitary.com ', NULL, NULL, '2021-08-30 10:35:37', '2021-08-30 10:35:37'),
(25965, 11056, 22612, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email sent to : Katherine Moten KMoten4@humana.com, MDuffee@humana.com, HumanaHoustonPD HumanaHoustonPD@humana.com  Sub : Enrollment Status - Humana - BAQC  Good morning!  Hope this email finds you well. Please provide me with the latest updates of the enrollment status regarding the below mentioned provider under the Facility Tax ID and location soon.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148  Provider Name	NPI Melissa Ramsden	1194376228   If you need any documents or information or have any questions or concerns don\'t hesitate in reaching out to me.   Thank you Have a blessed day!', NULL, NULL, '2021-09-24 09:51:20', '2021-09-24 09:51:20'),
(25966, 11056, 22612, NULL, '2021-10-20 00:00:00.000', 'Approved', 'Email received from : RArchez@humana.com  Sub : Participation status of Ramsden Melissa _Interaction 2000204924695  Hi Ahmed,  Good day!  Here are the participation status of provider Ramsden Melissa (PID: 3135441) under the TIN 271702009. The provider is In network, participating with Medicare PPO, Medicare Private Fee for Service, ChoiceCare Medicare PPO, Humana PPO  and ChoiceCare PPO  all effective date 03/15/2021  Kind Regards,  Ryan R. Archez Network Specialist| Provider Relations Humana HGS Manila  T 800 626 2741 F 920 569 3589 RArchez@humana.com    Confirmed on the call to Rep : Ryan A  Status : Provider is in network participating with Humana  Eff date : 03/15/2021  Plans : Medicare PPO Medicare PRIVATE C Medicare choice care PPO Humana PPO Choice care PPO   Ref code : 2000204924695', NULL, NULL, '2021-10-13 15:03:46', '2021-10-13 15:03:46'),
(25967, 3046, 22613, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 12:59:26', '2021-03-17 12:59:26'),
(25968, 1006, 22613, NULL, '2021-05-11 00:00:00.000', 'Approved', 'The group is contracted with MCO and listed as an Urgent Care Facility. Effective 09/16/2020. Provider ID#1304027. Executed contract is attached on group task for reference. ', NULL, NULL, '2021-05-04 10:40:10', '2021-05-04 10:40:10'),
(25969, 3046, 22614, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 13:00:22', '2021-03-17 13:00:22'),
(25970, 1006, 22614, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Enrollment request submitted via TMHP:  Enrollment Application Status   Application Status PEP Ticket Number     Submitted		 17715736 ', NULL, NULL, '2021-04-14 09:54:59', '2021-04-14 09:54:59'),
(25971, 1006, 22614, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider has been enrolled with Medicaid, the approval letter is attached for reference.   Eff Date: 03/01/2021 TPI# 4036923-02', NULL, NULL, '2021-04-20 13:21:35', '2021-04-20 13:21:35'),
(25972, 1006, 22614, NULL, '2021-09-09 00:00:00.000', 'Revalidation', 'Requested disenrollment from Medicaid with 09/01/2021 effective date. ', NULL, NULL, '2021-09-02 10:26:12', '2021-09-02 10:26:12'),
(25973, 11056, 22614, NULL, '2021-10-04 00:00:00.000', 'Revalidation', 'Disenrolled =  Closed  Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status		 18058678	PIMS Enrollment Information		9/16/2021	Provider Information Change (PIC) Form	Closed', NULL, NULL, '2021-09-27 15:55:43', '2021-09-27 15:55:43'),
(25974, 11056, 22614, NULL, '2021-12-08 00:00:00.000', 'Revalidated', 'Disenrolled  Portal Ticket #Ascending	Application Name	NPI	Status Update Date	Transction Type	Status   15122518	Cynthia Malowitz	1336173244	6/22/2018	Enrollment - First Time Applicant	Closed', NULL, NULL, '2021-12-01 12:23:39', '2021-12-01 12:23:39'),
(25975, 3046, 22615, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 13:01:10', '2021-03-17 13:01:10'),
(25976, 9057, 22615, NULL, '2021-06-08 00:00:00.000', 'Approved', 'This Provider has already been approved  Effective Date: 05/01/2020 TPI #414490901  Proof is attached', NULL, NULL, '2021-05-31 15:06:57', '2021-05-31 15:06:57'),
(25977, 1006, 22615, NULL, '2021-09-09 00:00:00.000', 'Revalidation', 'Requested disenrollment from Medicaid with 09/01/2021 effective date. ', NULL, NULL, '2021-09-02 10:26:07', '2021-09-02 10:26:07'),
(25978, 11056, 22615, NULL, '2021-10-04 00:00:00.000', 'Revalidation', 'Disenrolled  Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	  18058681	PIMS Enrollment Informati		9/15/2021	Provider Information Change (PIC) Form	Closed', NULL, NULL, '2021-09-27 15:57:11', '2021-09-27 15:57:11'),
(25979, 3046, 22616, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 13:04:27', '2021-03-17 13:04:27'),
(25980, 3046, 22616, NULL, '2021-03-24 00:00:00.000', 'Initiated', 'Medicare Enrollment initiated   Enrollment Tracking Information Applicant Name: MELISSA RAMSDEN  Tracking ID: T031720210002621  Reassignment Tracking ID: T031720210002622  Submitted Date: WED - MARCH 17 2021 03:22:30 PM EST  Submitted By: melissa ramsden  Contact Email(s): MELISSARAMSDENLNCC@GMAIL.COM KATY.MORGAN@WOUNDCENTRICS.COM HJ@CLAIMSMEDINC.COM Reason(s) for submission: A Medicare Part B practitioner is currently enrolled in the Medicare program.  The practitioner is adding, deleting, or changing general Medicare enrollment information.', NULL, NULL, '2021-03-17 14:30:39', '2021-03-17 14:30:39'),
(25981, 1006, 22616, NULL, '2021-04-21 00:00:00.000', 'Approved', 'The provider has been enrolled with Medicare. Eff: 03/01/2021 Medicare ID# 1N3947', NULL, NULL, '2021-04-14 07:28:34', '2021-04-14 07:28:34'),
(25982, 3046, 22617, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 13:04:55', '2021-03-17 13:04:55'),
(25983, 1006, 22617, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Submitted request to get Medicare RR PTAN. Attached for reference.', NULL, NULL, '2021-04-14 14:18:07', '2021-04-14 14:18:07'),
(25984, 1006, 22617, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	MELISSA L RAMSDEN NP PROVIDER PTAN	Q00056547 PROVIDER NPI	1194376228 EFFECTIVE DATE	03/01/2021 END DATE	 GROUP NAME	BAY AREA QUICK CARE PLLC GROUP PTAN	DV9128 BUSINESS STATE	TX EFFECTIVE DATE	04/01/2010 END DATE	  ', NULL, NULL, '2021-04-20 10:13:51', '2021-04-20 10:13:51'),
(25985, 3046, 22619, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 13:07:05', '2021-03-17 13:07:05'),
(25986, 1006, 22619, NULL, '2021-04-27 00:00:00.000', 'On Hold', 'On Hold', NULL, NULL, '2021-04-20 12:20:56', '2021-04-20 12:20:56'),
(25987, 9057, 22619, NULL, '2021-06-08 00:00:00.000', 'Initiated', 'We sent an email to: Juliana.Mata@molinahealthcare.com  Sub: Requisition for Enrollment - BAQC - Molina Health Care  Hello, Hope you are doing well, We wish to enroll our below mentioned providers, under the following group. Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Provider Name: Francis, William: NPI# 1457994436  If you need any more details, please let me know.  Thank you', NULL, NULL, '2021-06-01 10:40:09', '2021-06-01 10:40:09'),
(25988, 11056, 22619, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Enrollment Request has been submitted. Waiting for the contract. Email and Contract has been attached in the group.', NULL, NULL, '2021-06-21 11:01:24', '2021-06-21 11:01:24'),
(25989, 1006, 22619, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Sent f/u email @ \"Mata, Juliana\" Juliana.Mata@molinahealthcare.com & MHTContractrequest MHTContractrequest@molinahealthcare.com:  Sub: Enrollment Status - BAQC - Molina  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers, we already have a group contract with Molina and I wanted to know what is required to enroll the mentioned providers if they aren\'t already enrolled their information is as follows:  Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Provider Name: Francis, William: NPI# 1457994436  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-07 16:38:49', '2021-07-07 16:38:49'),
(25990, 1006, 22619, NULL, '2021-07-30 00:00:00.000', 'Approved', 'Approval email received from @ Mata, Juliana Juliana.Mata@molinahealthcare.com:  Sub: Enrollment Status - BAQC - Molina  \"Good morning,  Happy Friday!!  Hope you are doing well.  per information on our system, facility Bay Area Quick Care is loaded into network billing system with effective date 9/1/2020, Molina does not contract individual providers to urgent care, Molina contracts facility itself.  Thank you  Juliana Mata | Associate Specialist Provider Contracts Molina Healthcare Of Texas Molina Healthcare Of Texas, Inc Juliana.Mata@Molinahealthcare.com 1660 Westridge Circle N. Irving, TX 75038 \'(888) 562-5442 ext 200249\"', NULL, NULL, '2021-07-23 15:53:46', '2021-07-23 15:53:46'),
(25991, 3046, 22620, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 13:07:32', '2021-03-17 13:07:32'),
(25992, 1006, 22620, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Submitted enrollment request online, attached for reference: \"Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 0414211DG\"', NULL, NULL, '2021-04-14 14:46:06', '2021-04-14 14:46:06'),
(25993, 1006, 22620, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Received the following email from Multiplan @ pif@multiplan.com:  Sub: Multiplan Request for Information for Melissa Ramsden MSN - State: TX - SEID: 2141723926  \"Dear Provider:  We would like to invite you to participate in MultiPlan\'s provider networks.  When you choose to join MultiPlan, the nation\'s oldest and largest independent provider network, you select an organization that delivers patient volume from a diverse base of healthcare payers, offers administrative ease, and helps you evolve with the market through a wide range of network-based solutions.  We have included a sample fee schedule for your review. You can access our Provider Handbook located under Helpful Resources in the Providers section at: www.multiplan.com  If you are interested in signing a MultiPlan Agreement and Provider Application, please REPLY to this email and COMPLETE or correct your information by typing into the form below.  ONLY use this email for the provider you nominated. If you need to nominate additional providers then please submit your provider nomination request by clicking the following link: Nominate Provider  MultiPlan has implemented an electronic signature process; you will receive electronic documents for signature via DocuSign. To expedite the contracting process, please follow the instructions included in the DocuSign email. If you would like additional information about MultiPlan or the services we offer, please visit our website at:www.multiplan.com  Sincerely, Gloria Esplana Director, Network Contract Support\"  Information was filled out and sent back to Multiplan.', NULL, NULL, '2021-04-19 07:56:24', '2021-04-19 07:56:24'),
(25994, 9057, 22620, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to pif@multiplan.com Sub: Request for enrollment status -Tracking# 0414211DG - BAQC - Multiplan  Hello, we submitted an enrollment form for the below mentioned provider under the following group.   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider Name: Melissa Ramsden NPI# 1194376228   Kindly update me with the current status regarding the above mentioned request.  Thank you ', NULL, NULL, '2021-05-27 10:42:53', '2021-05-27 10:42:53'),
(25995, 9057, 22620, NULL, '2021-06-08 00:00:00.000', 'In Process', 'We sent an email to: registrar@multiplan.com Sub: Request for Enrollment Status - BAQC - Multiplan  Hello, I want to get the current status of the below mentioned group & providers  Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Kindly respond to us as soon as possible.  Thank you ', NULL, NULL, '2021-05-31 16:48:06', '2021-05-31 16:48:06'),
(25996, 1006, 22620, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Opened a service case through Multiplan\'s provider portal @ Service Case #7644056:   \"Hello,  Please get back to me regarding the enrollment status for the below mentioned provider and do let me know what is required to enroll our group as well.  Thank you!\"', NULL, NULL, '2021-06-17 16:52:27', '2021-06-17 16:52:27'),
(25997, 1006, 22620, NULL, '2021-07-14 00:00:00.000', 'In Process', 'As per my discussion with Multiplan, BAQC is going through enrollment as an ancillary facility which is incorrect.   Sent following email to pif@multiplan.com:  Sub: Multiplan Request for Information for Bay Area Quick Care PLLC - State: TX - SEID: 214290783  \"Hello,   I wanted to set up Bay Area Quick Care as a group, the nomination request was sent for a group contract. Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-07-07 12:46:34', '2021-07-07 12:46:34'),
(25998, 1006, 22620, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Received following reply from @ Juarez, Mariana Mariana.Juarez@multiplan.com:  Sub: Bay Area Quick Care PLLC - State: TX - SEID: 214290783  \"Hi Brad,  Does Bay Area Quick Care have urgent care accreditations? The NPI taxonomy indicates this is an urgent care center and your website indicates Bay Area Quick Care is an urgent care center.  Mariana Juarez Provider Contracting Representative mariana.juarez@multiplan.com  MultiPlan 25550 Commercentre Drive, Suite 200 Lake Forest, CA 92630 ph: 949-672-1561 fx: 630-245-2462\"  Replied with:  \"Hello Mariana,  Bay area quick care does not have any urgentcare accreditations. Please let me know how we can proceed. Thank you.\"  ', NULL, NULL, '2021-07-23 16:26:38', '2021-07-23 16:26:38'),
(25999, 1006, 22620, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received the group contract from mark.sokel@multiplan.com:  Sub: Multiplan Agreement For Signature  \"Mark Sokel mark.sokel@multiplan.com Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan’s provider networks.  An agreement for electronic signature is enclosed and includes instructions on how to sign electronically.    Credentialing documents will be sent to you in a separate communication. You will be notified of your effective date upon acceptance into the network(s).  If you have questions regarding this letter, please contact our Service Operations Department at 800-950-7040 from 8:30 a.m. to 5:30 p.m. ET. Among other things, Service Operations can answer your credentialing questions, correct erroneous information submitted in your credentialing application, or report the status of your credentialing application. If you would like additional information about MultiPlan or the services we offer, please visit our website at www.multiplan.com.  Sincerely,  Gloria Esplana Director, Network Contract Support\"  Signed and sent back. ', NULL, NULL, '2021-08-03 16:17:35', '2021-08-03 16:17:35'),
(26000, 1006, 22620, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Received the following update from Mark.Sokel@multiplan.com:  Sub: Bay Area Quick Care PLLC - possible Multiplan network participation contracting - received completed Roster & W9 - submitting contract packet for Approval for processing  \"Hello Brad,  This is to confirm for you that I received your completed Roster and W9.  I had previously received your signed Multiplan network participation contract for Bay Area Quick Care PLLC.  At this point I have your Provider signed Group contract, your completed Roster and a copy of your W9.  I believe I have a complete contract packet.  Today I will be submitting your Multiplan contract packet to our QA Folks for review/Approval for processing.  If they kick it back to me for any reason, I will immediately contact you to work out whatever the issue might be.  (But I am hoping it will sail through QA).  As long as there are no issues with the contract packet, as soon as the contract is executed, a copy of the countersigned contract will be automatically emailed back to your office.  The contract has a 9/15 effective date on the Group contract.  Mark J. Sokel Provider Contracting Representative mark.sokel@multiplan.com MultiPlan  25550 Commercentre Drive, Suite 200 Lake Forest, CA 92630 ph: 949-639-3832 fx: 630-245-2491 Interoffice: *23 3832\"', NULL, NULL, '2021-08-04 12:38:11', '2021-08-04 12:38:11'),
(26001, 1006, 22620, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Executed contract was received and is attached in main group task for reference. ', NULL, NULL, '2021-08-10 09:47:01', '2021-08-10 09:47:01'),
(26002, 11056, 22620, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : mark.sokel@multiplan.com  &  Mariana.Juarez@multiplan.com   registrar@multiplan.com  Sub : Notification regarding your nomination for - Bay Area Quick Care PLLC - Seid: 214290783  Good morning!  Hope this email finds you well. Please provide me with the latest enrollment updates of the below mentioned provider.  The CAQH application of the provider is authorised to multiplan.  Provider Details: Provider Name: Ramsden, Melissa Provider NPI# : 1194376228 CAQH I.D : 14570014   If you need documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-20 10:14:16', '2021-08-20 10:14:16'),
(26003, 11056, 22620, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Email received from : Mark.Sokel@multiplan.com  Sub : Notification regarding your nomination for - Bay Area Quick Care PLLC - Seid: 214290783  Hello Ahmed,     Multiplan’s Service Operations at 800-950-7040 can give update status on credentialing and data changes.     I checked our system and do see Melissa Ramsden attached to TIN 271702009 and the group contract with Bay Area Quick Care.  However – do confirm this with Multiplan’s Service Operations at 800-950-7040.  (as I set up group contracts and am not too much involved with Credentialing)        Mark J. Sokel  Provider Contracting Representative  mark.sokel@multiplan.com     MultiPlan  25550 Commercentre Drive, Suite 200  Lake Forest, CA 92630  ph: 949-639-3832  fx: 630-245-2491  Interoffice: *23 3832', NULL, NULL, '2021-08-30 14:43:48', '2021-08-30 14:43:48'),
(26004, 11056, 22620, NULL, '2021-09-30 00:00:00.000', 'Approved', 'Rep. : Jenifer W  Status :  Participating under Tax ID and Practice too. The address is also listed below the provider. Approved from their side.  They will be going to provide welcome letter within one or 2 weeks.  Eff date : 09/15/2021  Ref code : 7751560   Provider is also available on directory of multiplan.  Please see the attachment. ', NULL, NULL, '2021-09-23 14:54:11', '2021-09-23 14:54:11'),
(26005, 11056, 22620, NULL, '2021-10-01 00:00:00.000', 'Approved', 'Correction  Eff date is : 08/12/2021 ', NULL, NULL, '2021-09-24 08:59:57', '2021-09-24 08:59:57'),
(26006, 3046, 22621, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 13:10:47', '2021-03-17 13:10:47'),
(26007, 1006, 22621, NULL, '2021-05-19 00:00:00.000', 'Initiated', 'Enrollment request was submitted online via Superior\'s enrollment portal, attached a copy of the form for reference: \"Thank You for Your Interest in Becoming a Part of Superior HealthPlan’s Growing Network! Important to Note:  Please ensure you’ve completed the IRS W-9 Form (PDF) and submit it to SHP.NetworkDevelopment@SuperiorHealthPlan.com. Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs. Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation. If additional information is required to process your request, a Superior representative will contact you.\"', NULL, NULL, '2021-05-03 14:09:05', '2021-05-03 14:09:05'),
(26008, 1006, 22621, NULL, '2021-05-17 00:00:00.000', 'In Process', 'We received the following email from Superior Healthplan @ SHP Network Development NPR Contracting SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com:  Sub: Important request from Superior HealthPlan  \"Hello Provider,  We received a request for TIN 27-1702009 to receive a new contract from Superior Health Plan.   In order to process your request:  Ø  Can you provide me the name of the group/ facility or if (provider) practices alone? Ø  Please respond with a copy of your W9. Ø  Does the provider want to participate with all of our products (Medicaid, Chip, Medicare, and Ambetter)? Ø  Please provide a good call back number.  Without a response, we are unable to move forward.   Jeannie Lopez Superior Health Plan | Network Operations\"  Replied to them with requested information. ', NULL, NULL, '2021-05-10 12:17:06', '2021-05-10 12:17:06'),
(26009, 1006, 22621, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Important request from Superior HealthPlan Hello,   Please find the requested information below:  Group Name: Bay Area Quick Care PLLC Yes, we wish to participate in all products. Call back# 713-893-6214 W9 is attached for your reference, please let me know if anything else is required and what the expected timeframe is for this to be completed?  Thank you. ', NULL, NULL, '2021-06-10 12:32:54', '2021-06-10 12:32:54'),
(26010, 1006, 22621, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent f/u email @ SHP Network Development NPR Contracting SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com:  Sub: Enrollment Status - BAQC - Superior Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following group and providers:   Group Name: Bay Area Quick Care PLLC NPI# 1437481421 TIN# 27-1702009  Provider Name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: Francis William NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  Please get back to me as soon as possible. Thank you.\"', NULL, NULL, '2021-06-11 11:48:23', '2021-06-11 11:48:23'),
(26011, 1006, 22621, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Left voicemail @ (877) 687-1196 asking for enrollment updates as we\'re not getting any updates through the email.  ', NULL, NULL, '2021-06-15 12:03:56', '2021-06-15 12:03:56'),
(26012, 1006, 22621, NULL, '2021-06-23 00:00:00.000', 'In Process', 'We received the following reply from Credentialing Credentialing@superiorhealthplan.com:  Sub: 1437481421  \"Good Morning,  We received a voice message from you and I am happy to assist you. I understand that you would like to check the status for NPI: 1437481421.  I do not currently show information for this provider. The process to inquire about a new contract/adding provider or service to your existing contract begins by completing a Network Participation Inquiry through our website.   http://www.superiorhealthplan.com/for-providers/join-our-network/  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"  Submitted ancillary enrollment request, attached in main group task for reference. ', NULL, NULL, '2021-06-16 16:38:50', '2021-06-16 16:38:50'),
(26013, 1006, 22621, NULL, '2021-07-09 00:00:00.000', 'In Process', 'We rcvd the following reply from SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"We received your signed contract. However, we have not received your Credentialing Application packet. Attached is the email that was sent. Please complete the forms & return along with a copy of your current W9 so that we can start the process.  Thank you, Leslie Gilchrist Intake Coordinator Contract Management\"  Replied with:  \"Hello Leslie,  Please find the requested documents attached, do let me know if anything else is required.  Thank you. \"  The ancillary contracting request is attached in the main group task for reference. ', NULL, NULL, '2021-07-02 11:00:01', '2021-07-02 11:00:01'),
(26014, 1006, 22621, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,   I wanted to get an update regarding the enrollment status for our provider. Please get back to me as soon as possible.  Thank you.\" ', NULL, NULL, '2021-07-23 16:33:27', '2021-07-23 16:33:27'),
(26015, 1006, 22621, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,  We received your completed application on July 2, 2021 Your projected effective date is August 1, 2021. Currently, it is in the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Sincerely,  Lucy Escobar Lead Contracts Coordinatoor, Contract Management Email-Block-6 Superior HealthPlan       7990 IH10 West San Antonio, TX 78230 Lucy.escobar@superiorhealthplan.com | SuperiorHealthPlan.com\"  ', NULL, NULL, '2021-08-02 15:59:30', '2021-08-02 15:59:30'),
(26016, 1006, 22621, NULL, '2021-08-17 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,  We received your completed application on July 2, 2021 Your projected effective date is August 1, 2021. Currently, it is in the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Sincerely,  Lucy Escobar Lead Contracts Coordinatoor, Contract Management\"  Need to allow more time for it to process and complete. ', NULL, NULL, '2021-08-10 12:57:44', '2021-08-10 12:57:44'),
(26017, 11056, 22621, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Hello,   I appreciate the update, I just wanted to confirm what the status for the ancillary contract is as well?  Thank you. ', NULL, NULL, '2021-08-20 10:21:43', '2021-08-20 10:21:43'),
(26018, 11056, 22621, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope this email finds you well. Whenever the application is uploaded and the provider\'s enrollment is completed, please inform us. Please keep us updated with the process. Please let us know the latest status for the ancillary contract too.  If you need any document or information feel free to reach out to me. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-30 10:20:46', '2021-08-30 10:20:46'),
(26019, 11056, 22621, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope you are doing well. We are still waiting to get the latest updates regarding the enrollment status of the below mentioned providers and practice as soon as possible. We haven\'t received the welcome packet yet.   Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148  Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	  1336173244 Melissa Ramsden	1194376228    If you have any questions or concerns please let me know. Eagerly,waiting to get the response from you.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-24 09:12:40', '2021-09-24 09:12:40');
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
(26020, 11056, 22621, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : Jeannie.Lopez@superiorhealthplan.com  Sub : Superior HealthPlan Participating Provider Agreement - BAY AREA QUICK CARE (534990) has been Signed and Filed    Attached is the final agreement for your reference. You can also open it online to review its activity history.', NULL, NULL, '2021-09-28 13:32:49', '2021-09-28 13:32:49'),
(26021, 11056, 22621, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email received from : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Hello  We received your completed application for Melissa Ramsden on 7/2/21. Your effective date is 8/1/21  and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-10-11 09:53:29', '2021-10-11 09:53:29'),
(26022, 11056, 22621, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Please assist me with the query at your earliest convenience. Does the Superior Health plan come under Medicare or Medicaid?', NULL, NULL, '2021-10-18 09:05:19', '2021-10-18 09:05:19'),
(26023, 11056, 22621, NULL, '2021-11-02 00:00:00.000', 'Approved', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Contacting and credentialing have been completed of the provider, Melissa Ramsden The effective date is: 8/1/21   Please see the attachment.', NULL, NULL, '2021-10-26 09:40:45', '2021-10-26 09:40:45'),
(26024, 3046, 22622, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 13:11:20', '2021-03-17 13:11:20'),
(26025, 1006, 22622, NULL, '2021-04-27 00:00:00.000', 'On Hold', 'Pending Medicaid Enrollment.', NULL, NULL, '2021-04-20 12:19:56', '2021-04-20 12:19:56'),
(26026, 9057, 22622, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Received following email from: mydavis@texaschildrens.org RE: Need status-BAQC Good Afternoon,   LOI’s are reviewed at the end of the following month they are submitted. I did take a look at what was submitted and noticed  the physical address listed on the LOI is in Corpus Christi which is outside of our current service area. Texas Children’s Health Plan is not licensed for CHIP and STAR in Nueces County. I provided a map of the current service area for reference.  Please let me know if you have any questions.', NULL, NULL, '2021-06-01 08:31:46', '2021-06-01 08:31:46'),
(26027, 3046, 22623, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 13:12:02', '2021-03-17 13:12:02'),
(26028, 9057, 22623, NULL, '2021-06-04 00:00:00.000', 'Initiated', 'We sent email to KMoten4@humana.com Sub: Certification and Enrollment Status - BAQC - Tricare  Hello Ketherine, Hope you are doing well, Kindly verify if the below mentioned providers are certified or not, if they are certified then we wish to enroll them under the following group.  Group Details Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Melissa Ramsden NPI# 1194376228  Also we want to know the credentialing status of the below mentioned providers under the above mentioned group.  Provider Details Provider Name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Waiting for your kind response  Thank you  ', NULL, NULL, '2021-05-28 13:45:55', '2021-05-28 13:45:55'),
(26029, 9057, 22623, NULL, '2021-06-05 00:00:00.000', 'In Process', '', NULL, NULL, '2021-05-28 14:06:23', '2021-05-28 14:06:23'),
(26030, 1006, 22623, NULL, '2021-06-23 00:00:00.000', 'In Process', 'We received the following reply from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Certification and Enrollment Status - BAQC - Tricare  \"Provider Name: Melissa Ramsden – please provide a credentialing application with the following documents: CV, DEA, Malpractice Insurance, License.  Provider Name: Cynthia Malowitz -  cred eff: 11/25/2019  Provider Name: Kynda Orsak – submitted for credentialing, please allow 90 days.  Provider Name: William Francis – cred eff: 2/2/2021\"  Sent reply to Katherine:  \"Hello Katherine,   I appreciate the update, can you please send us the credentialing form that you need for Melissa?   Thank you!\"', NULL, NULL, '2021-06-16 14:36:33', '2021-06-16 14:36:33'),
(26031, 1006, 22623, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com:  Sub: Enrollment Status - BAQC - Tricare  \"Hello Katherine,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers under the mentioned group:   Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Melissa Ramsden NPI# 1194376228  Provider Name: Kynda Orsak NPI# 1528553724  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-07-07 12:20:52', '2021-07-07 12:20:52'),
(26032, 1006, 22623, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment Status - BAQC - Tricare  \"Good Morning,  Please see updates below:  Provider Name: Melissa Ramsden – please provide a credentialing application with all documents. NPI# 1194376228  Provider Name: Kynda Orsak – provider is showing affiliated to the group. NPI# 1528553724  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Replied: \"Hello Katherine,  I appreciate the update, can you please let me know what the effective date is for Kynda Orsak and the group itself? Also, please send us the credentialing application so I can send it to you.   Thank you.\"', NULL, NULL, '2021-07-27 16:38:34', '2021-07-27 16:38:34'),
(26033, 1006, 22623, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Replied with the information Katherine Moten KMoten4@humana.com:  Sub; Re: Secured: RE: Secured: RE: Enrollment Status - BAQC - Tricare  \"Hello Katherine,   I appreciate the update, please find the attached credentialing form for the provider. Do let me know if anything else is required to proceed.  Thanks again!\"', NULL, NULL, '2021-08-04 14:01:33', '2021-08-04 14:01:33'),
(26034, 1006, 22623, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Received updated:  \"The application has been submitted for processing. Please allow 90 days to process.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"', NULL, NULL, '2021-08-04 15:50:55', '2021-08-04 15:50:55'),
(26035, 11056, 22623, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : kmoten4@humana.com  Sub : Welcome letter Request - HUMANA - BAY QUICK AREA CARE PLLC   Good morning!  Hope all is well. Could you please provide the welcome or approval letter for the provider Kynda Orsak?  Provider Name: Kynda Orsak NPI# 1528553724 License# AP137831  Thank you! Have a great day!', NULL, NULL, '2021-08-20 13:06:02', '2021-08-20 13:06:02'),
(26036, 11056, 22623, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email received from : KMoten4@humana.com  Sub : Secured: RE: Welcome letter Request - HUMANA - BAY QUICK AREA CARE PLLC  Good Afternoon,     We do not have access to the Welcome Letters. Those come from WPS, our claims processing company. You can call 1-800-444-5445 if you need additional information.        Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana  T 502-318-5250  F 210-239-0401  kmoten4@humana.com  HumanaMilitary.com   ', NULL, NULL, '2021-08-30 10:34:27', '2021-08-30 10:34:27'),
(26037, 11056, 22623, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : MDuffee@humana.com  Sub : Secured: RE: Enrollment Status - Humana - BAQC  Good afternoon,  I am unable to assist with Corpus Christi physicians , you need to contact provider services or the market directly.  Thank you.     Trying to reach new representatives who can respond on time.', NULL, NULL, '2021-09-27 08:30:52', '2021-09-27 08:30:52'),
(26038, 11056, 22623, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Rep : Keisha A  Emailed at : Jtrenz@humana.com for the updates  Contact no. : 502-318-5398  ref code : 14050947', NULL, NULL, '2021-10-11 12:07:14', '2021-10-11 12:07:14'),
(26039, 11056, 22623, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email received from:  jtrenz@humana.com  Sub : RE: Secured: RE: Welcome letter Request - HUMANA - BAY QUICK AREA CARE PLLC  Good morning.      NP Ramsden is certified, and her credentialing is pending verification of her taxonomy.     I have submitted a copy of the NPPES NPI registry information and am waiting on an update.     Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-18 10:03:36', '2021-10-18 10:03:36'),
(26040, 11056, 22623, NULL, '2021-11-02 00:00:00.000', 'Not Eligible', 'Please mark there task to Not Eligible so we can avoid errors and save time, also if you get any approval for them they will counted  Please see the attachment too.', NULL, NULL, '2021-10-26 10:37:40', '2021-10-26 10:37:40'),
(26041, 3046, 22624, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 13:13:47', '2021-03-17 13:13:47'),
(26042, 1006, 22624, NULL, '2021-05-11 00:00:00.000', 'Approved', 'The group is already enrolled with Triwest effective as of 8/22/2019.   Welcome letter is attached in group task for reference.  ', NULL, NULL, '2021-05-04 10:25:23', '2021-05-04 10:25:23'),
(26043, 3046, 22625, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 13:14:59', '2021-03-17 13:14:59'),
(26044, 9057, 22625, NULL, '2021-06-04 00:00:00.000', 'In Process', 'We sent an email to networkhelp@uhc.com Sub: New Provider Enrollment Request - BAQC - United Health Care  Hello, Hope you are doing well, we want to enroll the following provider under the following group.   Provider Detail Provider Name: Melissa Ramsden NPI# 1194376228  Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Kindly let me know what documents are required for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-27 14:10:08', '2021-05-27 14:10:08'),
(26045, 9057, 22625, NULL, '2021-06-04 00:00:00.000', 'Initiated', '', NULL, NULL, '2021-05-27 14:10:56', '2021-05-27 14:10:56'),
(26046, 9057, 22625, NULL, '2021-06-04 00:00:00.000', 'In Process', 'We received an email from networkhelp@uhc.com They asked  us to fill the Medical group roster and we have submitted it. Form is attached for ref. email sent to hpdemo@uhc.com', NULL, NULL, '2021-05-28 13:50:50', '2021-05-28 13:50:50'),
(26047, 1006, 22625, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Sent f/u email @ NMRT networkhelp@uhc.com:  Sub:  Enrollment Status - BAQC - UHC  \"Hello,  I wanted to get an update regarding the enrollment status for the following group and providers:  Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name:  Orsak, Kynda NPI: 1528553724 Provider Name: Malowitz, Cynthia NPI: 1336173244  Provider Name: Ramsden, Melissa NPI: 1194376228  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-16 14:49:25', '2021-06-16 14:49:25'),
(26048, 1006, 22625, NULL, '2021-06-25 00:00:00.000', 'In Process', 'We received the following reply from NMRT networkhelp@uhc.com:  Sub: Secure Message from japarker@uhc.com  \"Greetings,  Thank you for contacting the Network Management Resource Team. The provider has been linked to the TIN below. I’ve included the product roster showing the demographic information, lines of business, and effective dates.   Reviewing the provider MELISSA L RAMSDEN  record, it shows credentialing was completed/approved and the provider effective date is 07/27/2021.   Unfortunately, since the contracts were just loaded, it’s not available to send out as a report. Feel free to check back in 2 weeks. We’ll be happy to send it over or you can check under My Practice Profile by following the instructions in the attachment.  Did you know that you can get a product listing at any time from our website? Please see the attached handout for more information. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).    Please let us know if we can assist further.  Sincerely,  Janice P Associate Network Contractor Provider Operations Network Management Resource Team (NMRT)\"', NULL, NULL, '2021-06-18 14:14:56', '2021-06-18 14:14:56'),
(26049, 1006, 22625, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Sent f/u email as the provider is not showing up on the UHC provider directory as of yet email sent @ NMRT networkhelp@uhc.com:   Sub: Enrollment Status - BAQC - UHC  \"Hello,   I wanted to verify if the following provider had been enrolled under our group as of yet or not, their information is as follows:  Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider Name: Ramsden, Melissa NPI# 1194376228  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-07 13:55:20', '2021-07-07 13:55:20'),
(26050, 1006, 22625, NULL, '2021-07-15 00:00:00.000', 'Approved', 'We received the following approval confirmation from Allen, Andrea A andrea_allen@uhc.com:  Sub: Secure Message from andrea_allen@uhc.com  \"Hello  Thank you for contacting the Network Management Resource Team.  RAMSDEN, MELISSA L  - 7259370 has recently been linked to Tax ID 271702009 Effective 7/27/2021  Because it has a future effective date, please allow more time for the product roster that captures demographics, effective date’s and participating products to generate.    Please access My Practice Profile links below.  • Link Self-Service Tools: https://www.uhcprovider.com/en/resource-library/link-provider-self-service.html • Technical Support Email: ProviderTechSupport@uhc.com • Technical Support Phone: 866-842-3278, option 1  Thank you, Andrea Allen Network Management Resource Team (NMRT)  Our United Culture. The way forward. ■ Integrity ■ Compassion ■ Relationships ■ Innovation ■ Performance\"', NULL, NULL, '2021-07-08 13:54:25', '2021-07-08 13:54:25'),
(26051, 1006, 22626, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:50:36', '2021-03-17 15:50:36'),
(26052, 1006, 22626, NULL, '2021-05-27 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in main group task.  ', NULL, NULL, '2021-05-20 09:05:14', '2021-05-20 09:05:14'),
(26053, 1006, 22627, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:50:44', '2021-03-17 15:50:44'),
(26054, 1006, 22627, NULL, '2021-05-27 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in main group task.   Facility new effective date: 03/01/2021 Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint Ref# 6019877016', NULL, NULL, '2021-05-20 09:35:08', '2021-05-20 09:35:08'),
(26055, 1006, 22628, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:50:50', '2021-03-17 15:50:50'),
(26056, 1006, 22628, NULL, '2021-05-27 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in main group task.   Facility new effective date: 03/01/2021 Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint Ref# 6019877016', NULL, NULL, '2021-05-20 09:35:42', '2021-05-20 09:35:42'),
(26057, 1006, 22629, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:51:05', '2021-03-17 15:51:05'),
(26058, 1006, 22629, NULL, '2021-05-27 00:00:00.000', 'Approved', 'The group has an Ancillary contract. No need to add any providers individually, the contract is attached for reference in main group task.   Facility new effective date: 03/01/2021 Locations listed: 779 NUCC, 16272 IVUC, 9504 Longpoint Ref# 6019877016', NULL, NULL, '2021-05-20 09:35:23', '2021-05-20 09:35:23'),
(26059, 1006, 22630, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:52:45', '2021-03-17 15:52:45'),
(26060, 3040, 22630, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:36:48', '2021-06-02 15:36:48'),
(26061, 3040, 22630, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:04:52', '2021-06-21 17:04:52'),
(26062, 3040, 22630, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: RE: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Please see the attached contract showing your contracted for both.     Have a great weekend', NULL, NULL, '2021-07-12 11:23:07', '2021-07-12 11:23:07'),
(26063, 1006, 22631, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:52:49', '2021-03-17 15:52:49'),
(26064, 3040, 22631, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Ambetter. Please see attachment. ', NULL, NULL, '2021-05-21 08:21:30', '2021-05-21 08:21:30'),
(26065, 1006, 22632, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:52:50', '2021-03-17 15:52:50'),
(26066, 3040, 22632, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Ambetter. Please see attachment. ', NULL, NULL, '2021-05-21 08:24:14', '2021-05-21 08:24:14'),
(26067, 1006, 22633, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:52:51', '2021-03-17 15:52:51'),
(26068, 3040, 22633, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:36:00', '2021-06-02 15:36:00'),
(26069, 3040, 22633, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,  Thank you so much for the roster that was really helpful. I wanted to add the additional locations under the below mentioned providers in Ambetter for our group. Can you please advise the process?  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 3:   Provider Name: Jose, Julie Provider NPI# 1447883061 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 4:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 16:57:32', '2021-06-21 16:57:32'),
(26070, 3040, 22633, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter || ref# 45297  Hello Brittney,   Please find attached the demographic information form for the below mentioned providers for adding the locations in Ambetter in our group.   Provider 1:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 4:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-08 16:24:26', '2021-07-08 16:24:26'),
(26071, 3040, 22633, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: AM.Houston@superiorhealthplan.com  Subject: RE: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter || ref# 45297  Adil  I hope all is well. I am not sure what you are looking at but I just ran the report and looked in our systems and the providers locations were updated and the ticket is completed. Please see attached report as there is nothing further required on our end.  Have a great rest of the day!  Best Regards,  Brittney Kendle Provider Account Manager Region 7 (Harris & Jefferson SDA)', NULL, NULL, '2021-07-28 13:38:55', '2021-07-28 13:38:55'),
(26072, 3040, 22633, NULL, '2021-08-06 00:00:00.000', 'Approved', 'Provider is participating with Ambetter. Please see attachment.', NULL, NULL, '2021-07-30 13:17:13', '2021-07-30 13:17:13'),
(26073, 1006, 22634, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:52:53', '2021-03-17 15:52:53'),
(26074, 3040, 22634, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:36:05', '2021-06-02 15:36:05'),
(26075, 3040, 22634, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:03:51', '2021-06-21 17:03:51'),
(26076, 11056, 22634, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#47964  Good Morning Ahmed     I hope you are doing well. I wanted to advise that account management does not handle application requests. When you are submitting applications in which you have attached on each email you would submit them to our Network Development Team at SHP.NetworkDevelopment@superiorhealthplan.com     Also when the providers are in credentialing status we do not submit the requests to update the locations as that department is already working on the request based on what you submitted on the application.     With that being said your request is not required as these providers are already in credentialing status and the same information you listed on these applications is what is already on the original applications that were received. I provided a screenshot below.     Please keep in mind our credentialing process could take up to 90-120 days to complete. Although 3 providers have an anticipated effective date they still have to go through the cred process until everything is completed. The locations will be added in this process and everything will not be finalized until it says complete in our system.     You are more than welcome to follow-up in another month for cred status or complete status. And again all location requests for new providers are submitted on the application to our Network Development Team and does not come to us.     Have a great rest of the day!     Best Regards,     Brittney Kendle  Provider Account Manager  Region 7 (Harris & Jefferson SDA)  4888 Loop Central Drive  Houston, TX 77081  1-800-656-4817; Press 1 for English or 2 for Spanish and select Option #3 Provider Relations  Fax: 1-866-683-5630  AM.Houston@superiorhealthplan.com | SuperiorHealthPlan.com', NULL, NULL, '2021-07-09 14:30:41', '2021-07-09 14:30:41'),
(26077, 3040, 22634, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Greetings,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Thomas, Cini  Provider NPI# 1134777238    Provider 2:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini  Provider NPI# 1841755956    Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 5:   Provider Name: Rauf., Abdur  Provider NPI# 1497726202   Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-07-28 14:10:12', '2021-07-28 14:10:12'),
(26078, 11056, 22634, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:28:10', '2021-08-13 16:28:10'),
(26079, 3040, 22634, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Provider is participating with Ambetter. For more details please see attachment. ', NULL, NULL, '2021-08-27 16:39:13', '2021-08-27 16:39:13'),
(26080, 1006, 22635, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:52:57', '2021-03-17 15:52:57'),
(26081, 3040, 22635, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:36:08', '2021-06-02 15:36:08'),
(26082, 3040, 22635, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,  Thank you so much for the roster that was really helpful. I wanted to add the additional locations under the below mentioned providers in Ambetter for our group. Can you please advise the process?  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 3:   Provider Name: Jose, Julie Provider NPI# 1447883061 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 4:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 16:57:09', '2021-06-21 16:57:09'),
(26083, 3040, 22635, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Palmira Ambetter representative and she said the provider is in-network with the effective date 06/01/2021. For more details please see attachment.  Ref: I58685955', NULL, NULL, '2021-07-14 10:54:04', '2021-07-14 10:54:04'),
(26084, 1006, 22636, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:52:57', '2021-03-17 15:52:57'),
(26085, 3040, 22636, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Ambetter. Please see attachment. ', NULL, NULL, '2021-05-21 09:25:18', '2021-05-21 09:25:18'),
(26086, 1006, 22637, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:52:58', '2021-03-17 15:52:58'),
(26087, 3040, 22637, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:36:14', '2021-06-02 15:36:14'),
(26088, 3040, 22637, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:03:47', '2021-06-21 17:03:47'),
(26089, 3040, 22637, NULL, '2021-07-19 00:00:00.000', 'Not Eligible', 'Provider is no longer working in NUCC, IVUC, LPMC & CUCC.', NULL, NULL, '2021-07-12 11:04:43', '2021-07-12 11:04:43'),
(26090, 1006, 22638, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:52:58', '2021-03-17 15:52:58'),
(26091, 3040, 22638, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Ambetter. Please see attachment. ', NULL, NULL, '2021-05-21 10:09:55', '2021-05-21 10:09:55'),
(26092, 1006, 22639, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:53:00', '2021-03-17 15:53:00'),
(26093, 3040, 22639, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Ambetter. Please see attachment. ', NULL, NULL, '2021-05-21 10:27:43', '2021-05-21 10:27:43'),
(26094, 1006, 22640, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:53:03', '2021-03-17 15:53:03'),
(26095, 3040, 22640, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Ambetter. Please see attachment. ', NULL, NULL, '2021-05-21 10:48:00', '2021-05-21 10:48:00'),
(26096, 1006, 22641, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:53:03', '2021-03-17 15:53:03'),
(26097, 3040, 22641, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:36:21', '2021-06-02 15:36:21');
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
(26098, 3040, 22641, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:03:55', '2021-06-21 17:03:55'),
(26099, 11056, 22641, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email sent to : SHP.NetworkDevelopment@superiorhealthplan.com  Sub : Enrollment Forms Submission || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,  Hope you are doing well. Here are the enrollment forms filled out which you have provided for the below mentioned groups for Superior Health Plan .  Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Providers:  Provider 1:   Provider Name: Piccione JR, James  Provider NPI# : 1356321509    Provider 2:   Provider Name : PAUL, SIGI  Provider NPI# : 1033623616    If you need further information feel free to reach out to me.     Thank you!  Have a great day!', NULL, NULL, '2021-07-09 14:23:34', '2021-07-09 14:23:34'),
(26100, 3040, 22641, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Greetings,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Thomas, Cini  Provider NPI# 1134777238    Provider 2:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini  Provider NPI# 1841755956    Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 5:   Provider Name: Rauf., Abdur  Provider NPI# 1497726202   Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-07-28 14:10:15', '2021-07-28 14:10:15'),
(26101, 11056, 22641, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:28:03', '2021-08-13 16:28:03'),
(26102, 3040, 22641, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Hello,  I wanted to know the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616    Provider 3: Provider Name: Joseph, Molly Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-08-27 16:43:25', '2021-08-27 16:43:25'),
(26103, 10057, 22641, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status Query - CUCC - Tricare  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in Ambetter.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Piccione JR, James M	1356321509 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Your earliest response will be highly appreciated. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 15:25:12', '2021-10-11 15:25:12'),
(26104, 10057, 22641, NULL, '2021-11-25 00:00:00.000', 'Approved', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good afternoon Steve  My apologies for the delay in response Hope you had a great weekend Here is the information you requested for the following Providers under TID# 270796429  Please see attachments:', NULL, NULL, '2021-11-18 11:03:45', '2021-11-18 11:03:45'),
(26105, 1006, 22642, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:53:05', '2021-03-17 15:53:05'),
(26106, 3040, 22642, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:36:26', '2021-06-02 15:36:26'),
(26107, 3040, 22642, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:03:45', '2021-06-21 17:03:45'),
(26108, 11056, 22642, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email sent to : SHP.NetworkDevelopment@superiorhealthplan.com  Sub : Enrollment Forms Submission || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,  Hope you are doing well. Here are the enrollment forms filled out which you have provided for the below mentioned groups for Superior Health Plan .  Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Providers:  Provider 1:   Provider Name: Piccione JR, James  Provider NPI# : 1356321509    Provider 2:   Provider Name : PAUL, SIGI  Provider NPI# : 1033623616    If you need further information feel free to reach out to me.     Thank you!  Have a great day!', NULL, NULL, '2021-07-09 14:18:17', '2021-07-09 14:18:17'),
(26109, 3040, 22642, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Greetings,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Thomas, Cini  Provider NPI# 1134777238    Provider 2:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini  Provider NPI# 1841755956    Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 5:   Provider Name: Rauf., Abdur  Provider NPI# 1497726202   Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-07-28 14:10:13', '2021-07-28 14:10:13'),
(26110, 11056, 22642, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:27:56', '2021-08-13 16:27:56'),
(26111, 3040, 22642, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Hello,  I wanted to know the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616    Provider 3: Provider Name: Joseph, Molly Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-08-27 16:43:23', '2021-08-27 16:43:23'),
(26112, 10057, 22642, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status Query - CUCC - Tricare  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in Ambetter.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Piccione JR, James M	1356321509 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Your earliest response will be highly appreciated. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 15:25:01', '2021-10-11 15:25:01'),
(26113, 10057, 22642, NULL, '2021-11-18 00:00:00.000', 'Approved', 'Email Received From : ECMExecutionTeam@superiorhealthplan.com  Sub : JAMES PICCIONE JR WELCOME LETTER  JAMES PICCIONE JR NORMANDY URGENT CARE CENTER PA rehman@claimsmedinc.com  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:    10/01/2021                                      ', NULL, NULL, '2021-11-11 14:02:43', '2021-11-11 14:02:43'),
(26114, 1006, 22643, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:53:07', '2021-03-17 15:53:07'),
(26115, 3040, 22643, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:36:31', '2021-06-02 15:36:31'),
(26116, 3040, 22643, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:03:58', '2021-06-21 17:03:58'),
(26117, 11056, 22643, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#47964  Good Morning Ahmed     I hope you are doing well. I wanted to advise that account management does not handle application requests. When you are submitting applications in which you have attached on each email you would submit them to our Network Development Team at SHP.NetworkDevelopment@superiorhealthplan.com     Also when the providers are in credentialing status we do not submit the requests to update the locations as that department is already working on the request based on what you submitted on the application.     With that being said your request is not required as these providers are already in credentialing status and the same information you listed on these applications is what is already on the original applications that were received. I provided a screenshot below.     Please keep in mind our credentialing process could take up to 90-120 days to complete. Although 3 providers have an anticipated effective date they still have to go through the cred process until everything is completed. The locations will be added in this process and everything will not be finalized until it says complete in our system.     You are more than welcome to follow-up in another month for cred status or complete status. And again all location requests for new providers are submitted on the application to our Network Development Team and does not come to us.     Have a great rest of the day!     Best Regards,     Brittney Kendle  Provider Account Manager  Region 7 (Harris & Jefferson SDA)  4888 Loop Central Drive  Houston, TX 77081  1-800-656-4817; Press 1 for English or 2 for Spanish and select Option #3 Provider Relations  Fax: 1-866-683-5630  AM.Houston@superiorhealthplan.com | SuperiorHealthPlan.com', NULL, NULL, '2021-07-09 14:39:13', '2021-07-09 14:39:13'),
(26118, 3040, 22643, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Greetings,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Thomas, Cini  Provider NPI# 1134777238    Provider 2:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini  Provider NPI# 1841755956    Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 5:   Provider Name: Rauf., Abdur  Provider NPI# 1497726202   Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-07-28 14:10:10', '2021-07-28 14:10:10'),
(26119, 11056, 22643, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:27:49', '2021-08-13 16:27:49'),
(26120, 11056, 22643, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:27:50', '2021-08-13 16:27:50'),
(26121, 3040, 22643, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Provider is participating with Ambetter. Please see attachment. ', NULL, NULL, '2021-08-27 16:34:35', '2021-08-27 16:34:35'),
(26122, 1006, 22644, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:53:09', '2021-03-17 15:53:09'),
(26123, 3040, 22644, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:36:36', '2021-06-02 15:36:36'),
(26124, 3040, 22644, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:04:00', '2021-06-21 17:04:00'),
(26125, 11056, 22644, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#47964  Good Morning Ahmed     I hope you are doing well. I wanted to advise that account management does not handle application requests. When you are submitting applications in which you have attached on each email you would submit them to our Network Development Team at SHP.NetworkDevelopment@superiorhealthplan.com     Also when the providers are in credentialing status we do not submit the requests to update the locations as that department is already working on the request based on what you submitted on the application.     With that being said your request is not required as these providers are already in credentialing status and the same information you listed on these applications is what is already on the original applications that were received. I provided a screenshot below.     Please keep in mind our credentialing process could take up to 90-120 days to complete. Although 3 providers have an anticipated effective date they still have to go through the cred process until everything is completed. The locations will be added in this process and everything will not be finalized until it says complete in our system.     You are more than welcome to follow-up in another month for cred status or complete status. And again all location requests for new providers are submitted on the application to our Network Development Team and does not come to us.     Have a great rest of the day!     Best Regards,     Brittney Kendle  Provider Account Manager  Region 7 (Harris & Jefferson SDA)  4888 Loop Central Drive  Houston, TX 77081  1-800-656-4817; Press 1 for English or 2 for Spanish and select Option #3 Provider Relations  Fax: 1-866-683-5630  AM.Houston@superiorhealthplan.com | SuperiorHealthPlan.com', NULL, NULL, '2021-07-09 14:28:15', '2021-07-09 14:28:15'),
(26126, 3040, 22644, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Greetings,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Thomas, Cini  Provider NPI# 1134777238    Provider 2:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini  Provider NPI# 1841755956    Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 5:   Provider Name: Rauf., Abdur  Provider NPI# 1497726202   Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-07-28 14:10:09', '2021-07-28 14:10:09'),
(26127, 11056, 22644, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:27:44', '2021-08-13 16:27:44'),
(26128, 3040, 22644, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Provider is participating with Ambetter. Please see attachment.', NULL, NULL, '2021-08-27 16:31:39', '2021-08-27 16:31:39'),
(26129, 1006, 22645, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:55:33', '2021-03-17 15:55:33'),
(26130, 1006, 22645, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:07:03', '2021-05-31 15:07:03'),
(26131, 11056, 22645, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 11:01:43', '2021-06-17 11:01:43'),
(26132, 3040, 22645, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:42', '2021-07-06 09:58:42'),
(26133, 3040, 22645, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:28', '2021-07-26 15:24:28'),
(26134, 11056, 22645, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:13:22', '2021-08-13 14:13:22');
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
(26135, 3040, 22645, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:02', '2021-08-25 15:00:02'),
(26136, 3040, 22645, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:43', '2021-09-09 13:07:43'),
(26137, 10057, 22645, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI 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 15:16:09', '2021-10-18 15:16:09'),
(26138, 10057, 22645, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:00:47', '2021-11-11 13:00:47'),
(26139, 10057, 22645, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:48:28', '2021-11-30 10:48:28'),
(26140, 10057, 22645, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:04:32', '2021-12-06 16:04:32'),
(26141, 10057, 22645, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:48:24', '2021-12-13 10:48:24'),
(26142, 10057, 22645, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:54:37', '2021-12-20 13:54:37'),
(26143, 10057, 22645, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latina.small@anthem.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning Latina,  We have send the LOI and group roster to credentialing dept, but no one from that department is responding back to us, its been more than 45 calender days we have send them the LOI and can you please get back to me with an update.  Regards, Alex Credentialing Manager', NULL, NULL, '2021-12-27 09:54:45', '2021-12-27 09:54:45'),
(26144, 10057, 22645, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : latina.small@Amerigroup.com & txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning,  You can respond directly to the credentialing  email for assistance with credentialing concerns. I have included them on the email as well.  Thank You in Advance,  Latina Small Provider Experience Consultant Amerigroup, Inc.', NULL, NULL, '2021-12-30 09:22:09', '2021-12-30 09:22:09'),
(26145, 19067, 22645, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:05:46', '2022-01-04 16:05:46'),
(26146, 20067, 22645, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:37:04', '2022-01-14 10:37:04'),
(26147, 20067, 22645, NULL, '2022-01-31 00:00:00.000', 'Approved', 'Kindly see the attachment of Directory  Effective Date: 11/11/2021', NULL, NULL, '2022-01-24 13:06:35', '2022-01-24 13:06:35'),
(26148, 1006, 22646, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:55:34', '2021-03-17 15:55:34'),
(26149, 1006, 22646, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:07:08', '2021-05-31 15:07:08'),
(26150, 11056, 22646, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 11:01:02', '2021-06-17 11:01:02'),
(26151, 3040, 22646, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:41', '2021-07-06 09:58:41'),
(26152, 3040, 22646, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:27', '2021-07-26 15:24:27'),
(26153, 11056, 22646, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:13:28', '2021-08-13 14:13:28'),
(26154, 3040, 22646, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:02', '2021-08-25 15:00:02'),
(26155, 3040, 22646, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:42', '2021-09-09 13:07:42'),
(26156, 10057, 22646, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI 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 15:16:02', '2021-10-18 15:16:02'),
(26157, 10057, 22646, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:00:42', '2021-11-11 13:00:42'),
(26158, 10057, 22646, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:48:22', '2021-11-30 10:48:22'),
(26159, 10057, 22646, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:04:24', '2021-12-06 16:04:24'),
(26160, 10057, 22646, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:48:13', '2021-12-13 10:48:13'),
(26161, 10057, 22646, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:54:28', '2021-12-20 13:54:28'),
(26162, 10057, 22646, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latina.small@anthem.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning Latina,  We have send the LOI and group roster to credentialing dept, but no one from that department is responding back to us, its been more than 45 calender days we have send them the LOI and can you please get back to me with an update.  Regards, Alex Credentialing Manager', NULL, NULL, '2021-12-27 09:54:38', '2021-12-27 09:54:38'),
(26163, 10057, 22646, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : latina.small@Amerigroup.com & txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning,  You can respond directly to the credentialing  email for assistance with credentialing concerns. I have included them on the email as well.  Thank You in Advance,  Latina Small Provider Experience Consultant Amerigroup, Inc.', NULL, NULL, '2021-12-30 09:22:03', '2021-12-30 09:22:03'),
(26164, 19067, 22646, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:05:28', '2022-01-04 16:05:28'),
(26165, 20067, 22646, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:37:39', '2022-01-14 10:37:39'),
(26166, 20067, 22646, NULL, '2022-01-31 00:00:00.000', 'Approved', 'Kindly see the attachment of Directory  Effective Date: 11/11/2021', NULL, NULL, '2022-01-24 13:03:10', '2022-01-24 13:03:10'),
(26167, 1006, 22647, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:55:57', '2021-03-17 15:55:57'),
(26168, 1006, 22647, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:07:12', '2021-05-31 15:07:12'),
(26169, 11056, 22647, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 11:00:34', '2021-06-17 11:00:34'),
(26170, 3040, 22647, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:40', '2021-07-06 09:58:40');
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
(26171, 3040, 22647, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:27', '2021-07-26 15:24:27'),
(26172, 11056, 22647, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:13:34', '2021-08-13 14:13:34'),
(26173, 3040, 22647, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:02', '2021-08-25 15:00:02'),
(26174, 3040, 22647, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:41', '2021-09-09 13:07:41'),
(26175, 10057, 22647, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI 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 15:15:55', '2021-10-18 15:15:55'),
(26176, 10057, 22647, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:00:36', '2021-11-11 13:00:36'),
(26177, 10057, 22647, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:48:16', '2021-11-30 10:48:16'),
(26178, 10057, 22647, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:04:13', '2021-12-06 16:04:13'),
(26179, 10057, 22647, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:48:05', '2021-12-13 10:48:05'),
(26180, 10057, 22647, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:54:21', '2021-12-20 13:54:21'),
(26181, 10057, 22647, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latina.small@anthem.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning Latina,  We have send the LOI and group roster to credentialing dept, but no one from that department is responding back to us, its been more than 45 calender days we have send them the LOI and can you please get back to me with an update.  Regards, Alex Credentialing Manager', NULL, NULL, '2021-12-27 09:54:33', '2021-12-27 09:54:33'),
(26182, 10057, 22647, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : latina.small@Amerigroup.com & txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning,  You can respond directly to the credentialing  email for assistance with credentialing concerns. I have included them on the email as well.  Thank You in Advance,  Latina Small Provider Experience Consultant Amerigroup, Inc.', NULL, NULL, '2021-12-30 09:21:51', '2021-12-30 09:21:51'),
(26183, 10057, 22647, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : latina.small@Amerigroup.com & txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning,  You can respond directly to the credentialing  email for assistance with credentialing concerns. I have included them on the email as well.  Thank You in Advance,  Latina Small Provider Experience Consultant Amerigroup, Inc.', NULL, NULL, '2021-12-30 09:21:57', '2021-12-30 09:21:57'),
(26184, 19067, 22647, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:04:35', '2022-01-04 16:04:35'),
(26185, 20067, 22647, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:37:57', '2022-01-14 10:37:57'),
(26186, 20067, 22647, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-24 17:11:21', '2022-01-24 17:11:21'),
(26187, 20067, 22647, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  I added a column with my notes     Group Name  Normandy Urgent Care Center     Tax ID  27-0796429     Group NPI  1407171077     Provider Name  NPI  Location  AGP Notes  Jeny John  1073019493  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190140  Jeny John  1073019493  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Molly Joseph  1396380077  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Molly Joseph  1396380077  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Cini Thomas  1134777238  779 Normandy St STE 114, Houston, TX 77015-3441  Not par at this location, include phone and Fax  Cini Thomas  1134777238  16272 Imperial Valley DR STE K, Houston, TX 77060  -                                        Eff date 11/22/2021 P# 10869221  Ani Stephen  1588959118  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 12/20/2021.  P# 12190275  Ani Stephen  1588959118  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Abdur Rauf  1497726202  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 01641188  Abdur Rauf  1497726202  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 01641188  James Piccione JR  1356321509  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  James Piccione JR  1356321509  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Odette Kourouma  1134525868  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190157  Odette Kourouma  1134525868  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Vibitha Joseph  1952931560  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12221497  Vibitha Joseph  1952931560  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12221497  Julie Jose  1447883061  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 09807037  Julie Jose  1447883061  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 09807037  Jaya Jacob  1194336149  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12205914  Jaya Jacob  1194336149  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12205914  Jeemol George  1497219067  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 05/29/2020 (Amerivantage only) – 09805666   - not par at the Imperial Valley location, include the phone and fax  Limy Fernandus  1972005189  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190801  Limy Fernandus  1972005189  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Brittany Brown  1275163537  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 11/11/2021.  P# 09808410 (not par at the Imperial Valley location, include the phone and fax)  Jeena Abraham  1467901587  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 10286831  Jeena Abraham  1467901587  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Mini Chennemkara  1841755956  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190610  Mini Chennemkara  1841755956  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax', NULL, NULL, '2022-01-24 17:17:01', '2022-01-24 17:17:01'),
(26188, 20067, 22647, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-02-02 14:43:05', '2022-02-02 14:43:05'),
(26189, 20067, 22647, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Afternoon!  Hope you are doing well. Attached are the LOI for the Non-Par Providers. Can you please tell me how I can add a location under the remaining providers?  Thank you,', NULL, NULL, '2022-03-01 13:39:07', '2022-03-01 13:39:07'),
(26190, 20067, 22647, NULL, '2022-03-17 00:00:00.000', 'Approved', 'Received the welcome letter  See the attachment.', NULL, NULL, '2022-03-10 09:55:54', '2022-03-10 09:55:54'),
(26191, 1006, 22648, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:55:58', '2021-03-17 15:55:58'),
(26192, 1006, 22648, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:07:16', '2021-05-31 15:07:16'),
(26193, 11056, 22648, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 11:00:10', '2021-06-17 11:00:10'),
(26194, 3040, 22648, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:40', '2021-07-06 09:58:40'),
(26195, 3040, 22648, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:26', '2021-07-26 15:24:26'),
(26196, 11056, 22648, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:14:29', '2021-08-13 14:14:29'),
(26197, 3040, 22648, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:01', '2021-08-25 15:00:01'),
(26198, 3040, 22648, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:41', '2021-09-09 13:07:41'),
(26199, 10057, 22648, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI 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 15:15:48', '2021-10-18 15:15:48'),
(26200, 10057, 22648, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:00:29', '2021-11-11 13:00:29'),
(26201, 10057, 22648, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:48:10', '2021-11-30 10:48:10'),
(26202, 10057, 22648, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:04:03', '2021-12-06 16:04:03'),
(26203, 10057, 22648, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:47:54', '2021-12-13 10:47:54'),
(26204, 10057, 22648, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:54:13', '2021-12-20 13:54:13'),
(26205, 10057, 22648, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latina.small@anthem.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning Latina,  We have send the LOI and group roster to credentialing dept, but no one from that department is responding back to us, its been more than 45 calender days we have send them the LOI and can you please get back to me with an update.  Regards, Alex Credentialing Manager', NULL, NULL, '2021-12-27 09:54:27', '2021-12-27 09:54:27');
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
(26206, 10057, 22648, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : latina.small@Amerigroup.com & txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning,  You can respond directly to the credentialing  email for assistance with credentialing concerns. I have included them on the email as well.  Thank You in Advance,  Latina Small Provider Experience Consultant Amerigroup, Inc.', NULL, NULL, '2021-12-30 09:21:42', '2021-12-30 09:21:42'),
(26207, 19067, 22648, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:04:21', '2022-01-04 16:04:21'),
(26208, 20067, 22648, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:38:17', '2022-01-14 10:38:17'),
(26209, 20067, 22648, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-24 17:11:16', '2022-01-24 17:11:16'),
(26210, 20067, 22648, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  I added a column with my notes     Group Name  Normandy Urgent Care Center     Tax ID  27-0796429     Group NPI  1407171077     Provider Name  NPI  Location  AGP Notes  Jeny John  1073019493  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190140  Jeny John  1073019493  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Molly Joseph  1396380077  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Molly Joseph  1396380077  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Cini Thomas  1134777238  779 Normandy St STE 114, Houston, TX 77015-3441  Not par at this location, include phone and Fax  Cini Thomas  1134777238  16272 Imperial Valley DR STE K, Houston, TX 77060  -                                        Eff date 11/22/2021 P# 10869221  Ani Stephen  1588959118  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 12/20/2021.  P# 12190275  Ani Stephen  1588959118  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Abdur Rauf  1497726202  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 01641188  Abdur Rauf  1497726202  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 01641188  James Piccione JR  1356321509  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  James Piccione JR  1356321509  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Odette Kourouma  1134525868  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190157  Odette Kourouma  1134525868  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Vibitha Joseph  1952931560  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12221497  Vibitha Joseph  1952931560  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12221497  Julie Jose  1447883061  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 09807037  Julie Jose  1447883061  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 09807037  Jaya Jacob  1194336149  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12205914  Jaya Jacob  1194336149  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12205914  Jeemol George  1497219067  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 05/29/2020 (Amerivantage only) – 09805666   - not par at the Imperial Valley location, include the phone and fax  Limy Fernandus  1972005189  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190801  Limy Fernandus  1972005189  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Brittany Brown  1275163537  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 11/11/2021.  P# 09808410 (not par at the Imperial Valley location, include the phone and fax)  Jeena Abraham  1467901587  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 10286831  Jeena Abraham  1467901587  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Mini Chennemkara  1841755956  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190610  Mini Chennemkara  1841755956  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax', NULL, NULL, '2022-01-24 17:16:55', '2022-01-24 17:16:55'),
(26211, 20067, 22648, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-02-02 14:42:59', '2022-02-02 14:42:59'),
(26212, 20067, 22648, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Afternoon!  Hope you are doing well. Attached are the LOI for the Non-Par Providers. Can you please tell me how I can add a location under the remaining providers?  Thank you,', NULL, NULL, '2022-03-01 13:39:00', '2022-03-01 13:39:00'),
(26213, 20067, 22648, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: txcredentialing@amerigroup.com  Sub: FW: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Does this provider wish to be in the directory?  If so, please resend the lOI', NULL, NULL, '2022-03-18 16:59:07', '2022-03-18 16:59:07'),
(26214, 22077, 22648, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com  Subject: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hi,  Any update on the mentioned request?  Looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 14:01:11', '2022-04-14 14:01:11'),
(26215, 1006, 22649, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:56:00', '2021-03-17 15:56:00'),
(26216, 1006, 22649, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:07:20', '2021-05-31 15:07:20'),
(26217, 11056, 22649, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 10:59:39', '2021-06-17 10:59:39'),
(26218, 3040, 22649, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:39', '2021-07-06 09:58:39'),
(26219, 3040, 22649, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:25', '2021-07-26 15:24:25'),
(26220, 11056, 22649, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:14:18', '2021-08-13 14:14:18'),
(26221, 3040, 22649, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:01', '2021-08-25 15:00:01'),
(26222, 3040, 22649, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:40', '2021-09-09 13:07:40'),
(26223, 10057, 22649, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI 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 15:15:41', '2021-10-18 15:15:41'),
(26224, 10057, 22649, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:00:23', '2021-11-11 13:00:23'),
(26225, 10057, 22649, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:48:04', '2021-11-30 10:48:04'),
(26226, 10057, 22649, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:03:55', '2021-12-06 16:03:55'),
(26227, 10057, 22649, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:47:47', '2021-12-13 10:47:47'),
(26228, 10057, 22649, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:54:03', '2021-12-20 13:54:03'),
(26229, 10057, 22649, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latina.small@anthem.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning Latina,  We have send the LOI and group roster to credentialing dept, but no one from that department is responding back to us, its been more than 45 calender days we have send them the LOI and can you please get back to me with an update.  Regards, Alex Credentialing Manager', NULL, NULL, '2021-12-27 09:54:21', '2021-12-27 09:54:21'),
(26230, 10057, 22649, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : latina.small@Amerigroup.com & txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning,  You can respond directly to the credentialing  email for assistance with credentialing concerns. I have included them on the email as well.  Thank You in Advance,  Latina Small Provider Experience Consultant Amerigroup, Inc.', NULL, NULL, '2021-12-30 09:21:37', '2021-12-30 09:21:37'),
(26231, 19067, 22649, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:03:38', '2022-01-04 16:03:38'),
(26232, 20067, 22649, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:38:35', '2022-01-14 10:38:35'),
(26233, 20067, 22649, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-24 17:11:08', '2022-01-24 17:11:08'),
(26234, 20067, 22649, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  I added a column with my notes     Group Name  Normandy Urgent Care Center     Tax ID  27-0796429     Group NPI  1407171077     Provider Name  NPI  Location  AGP Notes  Jeny John  1073019493  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190140  Jeny John  1073019493  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Molly Joseph  1396380077  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Molly Joseph  1396380077  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Cini Thomas  1134777238  779 Normandy St STE 114, Houston, TX 77015-3441  Not par at this location, include phone and Fax  Cini Thomas  1134777238  16272 Imperial Valley DR STE K, Houston, TX 77060  -                                        Eff date 11/22/2021 P# 10869221  Ani Stephen  1588959118  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 12/20/2021.  P# 12190275  Ani Stephen  1588959118  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Abdur Rauf  1497726202  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 01641188  Abdur Rauf  1497726202  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 01641188  James Piccione JR  1356321509  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  James Piccione JR  1356321509  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Odette Kourouma  1134525868  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190157  Odette Kourouma  1134525868  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Vibitha Joseph  1952931560  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12221497  Vibitha Joseph  1952931560  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12221497  Julie Jose  1447883061  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 09807037  Julie Jose  1447883061  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 09807037  Jaya Jacob  1194336149  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12205914  Jaya Jacob  1194336149  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12205914  Jeemol George  1497219067  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 05/29/2020 (Amerivantage only) – 09805666   - not par at the Imperial Valley location, include the phone and fax  Limy Fernandus  1972005189  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190801  Limy Fernandus  1972005189  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Brittany Brown  1275163537  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 11/11/2021.  P# 09808410 (not par at the Imperial Valley location, include the phone and fax)  Jeena Abraham  1467901587  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 10286831  Jeena Abraham  1467901587  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Mini Chennemkara  1841755956  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190610  Mini Chennemkara  1841755956  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax', NULL, NULL, '2022-01-24 17:16:50', '2022-01-24 17:16:50'),
(26235, 20067, 22649, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-02-02 14:42:50', '2022-02-02 14:42:50'),
(26236, 20067, 22649, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Afternoon!  Hope you are doing well. Attached are the LOI for the Non-Par Providers. Can you please tell me how I can add a location under the remaining providers?  Thank you,', NULL, NULL, '2022-03-01 13:38:53', '2022-03-01 13:38:53'),
(26237, 20067, 22649, NULL, '2022-03-17 00:00:00.000', 'Approved', 'Received the welcome letter  Effective Date: 02/21/2022 ', NULL, NULL, '2022-03-10 09:51:09', '2022-03-10 09:51:09'),
(26238, 20067, 22649, NULL, '2022-03-17 00:00:00.000', 'Approved', 'Received the welcome letter   See the Attachment', NULL, NULL, '2022-03-10 09:54:46', '2022-03-10 09:54:46'),
(26239, 1006, 22650, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:56:01', '2021-03-17 15:56:01'),
(26240, 1006, 22650, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:07:25', '2021-05-31 15:07:25'),
(26241, 11056, 22650, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 10:58:49', '2021-06-17 10:58:49'),
(26242, 11056, 22650, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 10:58:49', '2021-06-17 10:58:49');
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
(26243, 3040, 22650, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:39', '2021-07-06 09:58:39'),
(26244, 3040, 22650, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:24', '2021-07-26 15:24:24'),
(26245, 11056, 22650, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:14:07', '2021-08-13 14:14:07'),
(26246, 3040, 22650, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:00', '2021-08-25 15:00:00'),
(26247, 3040, 22650, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:39', '2021-09-09 13:07:39'),
(26248, 10057, 22650, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI 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 15:15:34', '2021-10-18 15:15:34'),
(26249, 10057, 22650, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:00:14', '2021-11-11 13:00:14'),
(26250, 10057, 22650, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:47:58', '2021-11-30 10:47:58'),
(26251, 10057, 22650, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:03:46', '2021-12-06 16:03:46'),
(26252, 10057, 22650, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:47:39', '2021-12-13 10:47:39'),
(26253, 10057, 22650, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:53:55', '2021-12-20 13:53:55'),
(26254, 10057, 22650, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latina.small@anthem.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning Latina,  We have send the LOI and group roster to credentialing dept, but no one from that department is responding back to us, its been more than 45 calender days we have send them the LOI and can you please get back to me with an update.  Regards, Alex Credentialing Manager', NULL, NULL, '2021-12-27 09:54:16', '2021-12-27 09:54:16'),
(26255, 10057, 22650, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : latina.small@Amerigroup.com & txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning,  You can respond directly to the credentialing  email for assistance with credentialing concerns. I have included them on the email as well.  Thank You in Advance,  Latina Small Provider Experience Consultant Amerigroup, Inc.', NULL, NULL, '2021-12-30 09:21:30', '2021-12-30 09:21:30'),
(26256, 19067, 22650, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:06:16', '2022-01-04 16:06:16'),
(26257, 20067, 22650, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:38:54', '2022-01-14 10:38:54'),
(26258, 20067, 22650, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-24 17:10:46', '2022-01-24 17:10:46'),
(26259, 20067, 22650, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  I added a column with my notes     Group Name  Normandy Urgent Care Center     Tax ID  27-0796429     Group NPI  1407171077     Provider Name  NPI  Location  AGP Notes  Jeny John  1073019493  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190140  Jeny John  1073019493  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Molly Joseph  1396380077  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Molly Joseph  1396380077  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Cini Thomas  1134777238  779 Normandy St STE 114, Houston, TX 77015-3441  Not par at this location, include phone and Fax  Cini Thomas  1134777238  16272 Imperial Valley DR STE K, Houston, TX 77060  -                                        Eff date 11/22/2021 P# 10869221  Ani Stephen  1588959118  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 12/20/2021.  P# 12190275  Ani Stephen  1588959118  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Abdur Rauf  1497726202  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 01641188  Abdur Rauf  1497726202  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 01641188  James Piccione JR  1356321509  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  James Piccione JR  1356321509  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Odette Kourouma  1134525868  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190157  Odette Kourouma  1134525868  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Vibitha Joseph  1952931560  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12221497  Vibitha Joseph  1952931560  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12221497  Julie Jose  1447883061  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 09807037  Julie Jose  1447883061  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 09807037  Jaya Jacob  1194336149  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12205914  Jaya Jacob  1194336149  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12205914  Jeemol George  1497219067  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 05/29/2020 (Amerivantage only) – 09805666   - not par at the Imperial Valley location, include the phone and fax  Limy Fernandus  1972005189  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190801  Limy Fernandus  1972005189  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Brittany Brown  1275163537  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 11/11/2021.  P# 09808410 (not par at the Imperial Valley location, include the phone and fax)  Jeena Abraham  1467901587  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 10286831  Jeena Abraham  1467901587  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Mini Chennemkara  1841755956  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190610  Mini Chennemkara  1841755956  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax', NULL, NULL, '2022-01-24 17:16:44', '2022-01-24 17:16:44'),
(26260, 20067, 22650, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-02-02 14:42:34', '2022-02-02 14:42:34'),
(26261, 20067, 22650, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Afternoon!  Hope you are doing well. Attached are the LOI for the Non-Par Providers. Can you please tell me how I can add a location under the remaining providers?  Thank you,', NULL, NULL, '2022-03-09 15:58:51', '2022-03-09 15:58:51'),
(26262, 20067, 22650, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: txcredentialing@amerigroup.com  Sub: FW: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Does this provider wish to be in the directory?  If so, please resend the lOI', NULL, NULL, '2022-03-18 17:00:00', '2022-03-18 17:00:00'),
(26263, 22077, 22650, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com  Subject: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hi,  Any update on the mentioned request?  Looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 13:55:48', '2022-04-14 13:55:48'),
(26264, 1006, 22651, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 15:56:02', '2021-03-17 15:56:02'),
(26265, 1006, 22651, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:07:30', '2021-05-31 15:07:30'),
(26266, 11056, 22651, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 10:58:36', '2021-06-17 10:58:36'),
(26267, 3040, 22651, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:38', '2021-07-06 09:58:38'),
(26268, 3040, 22651, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:24', '2021-07-26 15:24:24'),
(26269, 11056, 22651, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:13:59', '2021-08-13 14:13:59'),
(26270, 3040, 22651, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:00', '2021-08-25 15:00:00'),
(26271, 3040, 22651, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:39', '2021-09-09 13:07:39'),
(26272, 10057, 22651, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI 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 15:15:27', '2021-10-18 15:15:27'),
(26273, 10057, 22651, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:00:07', '2021-11-11 13:00:07');
