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
(28706, 3040, 22970, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Request for participation submitted online.   Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.  ', NULL, NULL, '2021-05-27 16:08:51', '2021-05-27 16:08:51'),
(28707, 11056, 22970, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Sent follow up email @ pr.south@healthsmart.com:  Sub: Enrollment status - NUCC/ IVUC - Health Smart  \"Good morning!  What is the status of enrollment for our providers under the below mentioned group their information is given below:- Group Name: Normandy Urgent Care CenterMain Address: 779 Normandy St Ste 114, Houston, TX 77015-3441Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060TIN: 27-0796429      NPI: 1407171077 Provider Name: Paul, SigiProvider NPI# 1033623616 Provider Name: Jacob,JayaProvider NPI# 1194336149 Provider Name:Chennemkara,MiniProvider NPI#  1841755956 Please get back to me as soon as possible. Thank you!\" ', NULL, NULL, '2021-06-16 10:51:37', '2021-06-16 10:51:37'),
(28708, 11056, 22970, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment status Updates Hi,   Below providers are currently in the credentialing process.  Providers Name Chennemkara, Mini P FNP PAUL, SIGI FNP Jacob, Jaya FNP  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-18 11:11:13', '2021-06-18 11:11:13'),
(28709, 3040, 22970, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Greetings,  Hope you are doing well . I wanted to know the enrollment status for the below mentioned group & providers under below locations.   Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 15:15:54', '2021-07-06 15:15:54'),
(28710, 3040, 22970, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,  Please see below providers effective date.  Providers Name	Effective Date JACOB, JAYA 01/01/2021 STEPHEN, ANI 01/01/2021', NULL, NULL, '2021-07-12 08:54:14', '2021-07-12 08:54:14'),
(28711, 3046, 22971, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:34', '2021-03-17 16:52:34'),
(28712, 3040, 22971, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Katrina) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date:  07/01/2020', NULL, NULL, '2021-05-27 15:01:04', '2021-05-27 15:01:04'),
(28713, 3046, 22972, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:35', '2021-03-17 16:52:35'),
(28714, 3040, 22972, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Katrina) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date:  02/05/2020', NULL, NULL, '2021-05-27 14:55:46', '2021-05-27 14:55:46'),
(28715, 3046, 22973, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:37', '2021-03-17 16:52:37'),
(28716, 3040, 22973, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Katrina) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date:  10/28/2019', NULL, NULL, '2021-05-27 15:03:21', '2021-05-27 15:03:21'),
(28717, 3046, 22974, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:38', '2021-03-17 16:52:38'),
(28718, 3040, 22974, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Request for participation submitted online.  Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.', NULL, NULL, '2021-05-27 15:50:19', '2021-05-27 15:50:19'),
(28719, 11056, 22974, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Sent follow up email @ pr.south@healthsmart.com:  Sub: Enrollment status - NUCC/ IVUC - Health Smart  \"Good morning!  What is the status of enrollment for our providers under the below mentioned group their information is given below:- Group Name: Normandy Urgent Care CenterMain Address: 779 Normandy St Ste 114, Houston, TX 77015-3441Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060TIN: 27-0796429      NPI: 1407171077 Provider Name: Paul, SigiProvider NPI# 1033623616 Provider Name: Jacob,JayaProvider NPI# 1194336149 Provider Name:Chennemkara,MiniProvider NPI#  1841755956 Please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-16 10:49:36', '2021-06-16 10:49:36'),
(28720, 11056, 22974, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Sent follow up email @ pr.south@healthsmart.com:  Sub: Enrollment status - NUCC/ IVUC - Health Smart  \"Good morning!  What is the status of enrollment for our providers under the below mentioned group their information is given below:- Group Name: Normandy Urgent Care CenterMain Address: 779 Normandy St Ste 114, Houston, TX 77015-3441Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060TIN: 27-0796429      NPI: 1407171077 Provider Name: Paul, SigiProvider NPI# 1033623616 Provider Name: Jacob,JayaProvider NPI# 1194336149 Provider Name:Chennemkara,MiniProvider NPI#  1841755956 Please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-16 10:49:36', '2021-06-16 10:49:36'),
(28721, 11056, 22974, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment status Updates Hi,   Below providers are currently in the credentialing process.  Providers Name Chennemkara, Mini P FNP PAUL, SIGI FNP Jacob, Jaya FNP  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-18 11:11:21', '2021-06-18 11:11:21'),
(28722, 3040, 22974, NULL, '2021-07-09 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,   1. Please see below providers effective date.  Providers Name  Effective Date  PAUL, SIGI C  06/01/2021  CHENNEMKARA, MINI P  06/17/2021  ', NULL, NULL, '2021-07-02 09:37:29', '2021-07-02 09:37:29'),
(28723, 3046, 22975, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:40', '2021-03-17 16:52:40'),
(28724, 3040, 22975, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Katrina) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date:  12/01/2018 ', NULL, NULL, '2021-05-27 15:02:29', '2021-05-27 15:02:29'),
(28725, 3046, 22976, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:42', '2021-03-17 16:52:42'),
(28726, 3040, 22976, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Katrina) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date:  02/01/2018  Ref: 2044922', NULL, NULL, '2021-05-27 15:35:05', '2021-05-27 15:35:05'),
(28727, 3046, 22977, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:44', '2021-03-17 16:52:44'),
(28728, 3040, 22977, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Katrina) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date:  12/30/2020  Ref: 2044922', NULL, NULL, '2021-05-27 15:05:35', '2021-05-27 15:05:35'),
(28729, 3046, 22978, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:45', '2021-03-17 16:52:45'),
(28730, 3040, 22978, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Katrina) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date: 02/28/2020', NULL, NULL, '2021-05-27 14:49:57', '2021-05-27 14:49:57'),
(28731, 3046, 22979, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:58:52', '2021-03-17 16:58:52'),
(28732, 1006, 22979, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:16:53', '2021-05-20 16:16:53'),
(28733, 3040, 22979, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group has an ancillary contract. Please see attachments.  ', NULL, NULL, '2021-06-08 16:50:17', '2021-06-08 16:50:17'),
(28734, 3046, 22980, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:58:54', '2021-03-17 16:58:54'),
(28735, 1006, 22980, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:17:01', '2021-05-20 16:17:01'),
(28736, 3040, 22980, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-06-08 16:51:16', '2021-06-08 16:51:16'),
(28737, 3046, 22981, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:58:55', '2021-03-17 16:58:55'),
(28738, 1006, 22981, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:17:10', '2021-05-20 16:17:10'),
(28739, 3040, 22981, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 16:52:13', '2021-06-08 16:52:13'),
(28740, 3046, 22982, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:58:56', '2021-03-17 16:58:56'),
(28741, 1006, 22982, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:17:16', '2021-05-20 16:17:16'),
(28742, 3040, 22982, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 16:52:16', '2021-06-08 16:52:16'),
(28743, 3046, 22983, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:58:58', '2021-03-17 16:58:58'),
(28744, 1006, 22983, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:17:21', '2021-05-20 16:17:21'),
(28745, 3040, 22983, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 16:52:19', '2021-06-08 16:52:19'),
(28746, 3046, 22984, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:59:06', '2021-03-17 16:59:06'),
(28747, 1006, 22984, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:17:26', '2021-05-20 16:17:26'),
(28748, 3040, 22984, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 16:52:21', '2021-06-08 16:52:21'),
(28749, 3046, 22985, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:59:08', '2021-03-17 16:59:08'),
(28750, 1006, 22985, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:17:32', '2021-05-20 16:17:32'),
(28751, 3040, 22985, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 16:52:24', '2021-06-08 16:52:24'),
(28752, 3046, 22986, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:59:09', '2021-03-17 16:59:09'),
(28753, 1006, 22986, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:17:37', '2021-05-20 16:17:37'),
(28754, 3040, 22986, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 16:52:27', '2021-06-08 16:52:27'),
(28755, 3046, 22987, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:59:11', '2021-03-17 16:59:11'),
(28756, 1006, 22987, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:17:42', '2021-05-20 16:17:42'),
(28757, 3040, 22987, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 16:52:30', '2021-06-08 16:52:30'),
(28758, 3046, 22988, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:59:12', '2021-03-17 16:59:12'),
(28759, 1006, 22988, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:17:49', '2021-05-20 16:17:49'),
(28760, 3040, 22988, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 16:52:33', '2021-06-08 16:52:33'),
(28761, 3046, 22989, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:59:14', '2021-03-17 16:59:14'),
(28762, 1006, 22989, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:18:03', '2021-05-20 16:18:03'),
(28763, 3040, 22989, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 16:52:35', '2021-06-08 16:52:35'),
(28764, 3046, 22990, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:59:15', '2021-03-17 16:59:15'),
(28765, 1006, 22990, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:18:10', '2021-05-20 16:18:10'),
(28766, 3040, 22990, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 16:52:37', '2021-06-08 16:52:37'),
(28767, 3046, 22991, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:59:20', '2021-03-17 16:59:20'),
(28768, 1006, 22991, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:18:22', '2021-05-20 16:18:22'),
(28769, 3040, 22991, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 16:52:40', '2021-06-08 16:52:40'),
(28770, 3046, 22992, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:59:22', '2021-03-17 16:59:22'),
(28771, 1006, 22992, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:18:29', '2021-05-20 16:18:29'),
(28772, 1006, 22992, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:18:36', '2021-05-20 16:18:36'),
(28773, 3040, 22992, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 16:52:51', '2021-06-08 16:52:51'),
(28774, 3046, 22993, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:59:23', '2021-03-17 16:59:23'),
(28775, 1006, 22993, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Sent f/u email @ HumanaHoustonPD humanahoustonpd@humana.com  to verify location enrollment :  Sub: Facility Enrollment/Location Status - NUCC - Humana  \"Hello,   I wanted to verify if the following facility has the listed locations coming up under it or not? Information is as follows:  Group name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Address 1: 779 Normandy St Ste 114, Houston, TX 77015-3441 Address 2: 9504 LONG POINT RD STE E, Houston, TX 77055-4226 Address 3: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-05-20 16:18:48', '2021-05-20 16:18:48'),
(28776, 3040, 22993, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 16:52:54', '2021-06-08 16:52:54'),
(28777, 3046, 22994, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 17:02:45', '2021-03-17 17:02:45'),
(28778, 1006, 22994, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 01/06/2015', NULL, NULL, '2021-05-17 10:51:20', '2021-05-17 10:51:20'),
(28779, 3046, 22995, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 17:02:47', '2021-03-17 17:02:47'),
(28780, 1006, 22995, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 05/01/2019  ', NULL, NULL, '2021-05-17 10:54:53', '2021-05-17 10:54:53'),
(28781, 3046, 22996, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 17:02:50', '2021-03-17 17:02:50'),
(28782, 1006, 22996, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 01/29/2020 ', NULL, NULL, '2021-05-17 10:56:27', '2021-05-17 10:56:27'),
(28783, 3046, 22997, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 17:03:04', '2021-03-17 17:03:04'),
(28784, 1006, 22997, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 03/01/2020 ', NULL, NULL, '2021-05-17 10:57:53', '2021-05-17 10:57:53'),
(28785, 3046, 22998, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 17:03:09', '2021-03-17 17:03:09'),
(28786, 1006, 22998, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 03/01/2020', NULL, NULL, '2021-05-17 11:00:46', '2021-05-17 11:00:46'),
(28787, 3046, 22999, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 17:03:10', '2021-03-17 17:03:10'),
(28788, 1006, 22999, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 02/11/2020 ', NULL, NULL, '2021-05-17 11:24:08', '2021-05-17 11:24:08'),
(28789, 3046, 23000, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 17:03:12', '2021-03-17 17:03:12'),
(28790, 1006, 23000, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 01/22/2020 ', NULL, NULL, '2021-05-17 11:25:43', '2021-05-17 11:25:43'),
(28791, 3046, 23001, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 17:03:14', '2021-03-17 17:03:14'),
(28792, 3040, 23001, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Application Status Submitted		  PEP Ticket Number 17715367 ', NULL, NULL, '2021-04-14 08:07:29', '2021-04-14 08:07:29'),
(28793, 1006, 23001, NULL, '2021-05-18 00:00:00.000', 'Approved', 'The provider is approved in Medicaid, approval confirmation and location confirmation are attached for reference.  Eff: 01/01/2021 ', NULL, NULL, '2021-05-11 12:21:05', '2021-05-11 12:21:05'),
(28794, 3046, 23002, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 17:03:16', '2021-03-17 17:03:16'),
(28795, 1006, 23002, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 08/13/2018 ', NULL, NULL, '2021-05-17 11:27:30', '2021-05-17 11:27:30'),
(28796, 3046, 23003, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 17:03:18', '2021-03-17 17:03:18'),
(28797, 1006, 23003, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 01/06/2015 ', NULL, NULL, '2021-05-17 11:29:12', '2021-05-17 11:29:12'),
(28798, 3046, 23004, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 17:03:20', '2021-03-17 17:03:20'),
(28799, 1006, 23004, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 02/07/2020 ', NULL, NULL, '2021-05-17 11:30:37', '2021-05-17 11:30:37'),
(28800, 3046, 23005, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 17:03:22', '2021-03-17 17:03:22'),
(28801, 1006, 23005, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 03/19/2020 ', NULL, NULL, '2021-05-17 11:31:52', '2021-05-17 11:31:52'),
(28802, 3046, 23006, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 17:04:42', '2021-03-17 17:04:42'),
(28803, 1006, 23006, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 04/22/2017 ', NULL, NULL, '2021-05-17 11:36:18', '2021-05-17 11:36:18'),
(28804, 3046, 23007, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:25:01', '2021-03-18 08:25:01'),
(28805, 1006, 23007, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicare, approval confirmation attached for reference.  Eff: 05/01/2019 Provider ID# 829002', NULL, NULL, '2021-05-17 09:51:31', '2021-05-17 09:51:31'),
(28806, 3046, 23008, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:25:03', '2021-03-18 08:25:03'),
(28807, 1006, 23008, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicare, approval confirmation attached for reference.  Eff: 01/06/2015 Provider ID# 396951 ', NULL, NULL, '2021-05-17 09:52:36', '2021-05-17 09:52:36'),
(28808, 3046, 23009, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:25:04', '2021-03-18 08:25:04'),
(28809, 1006, 23009, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicare, approval confirmation attached for reference.  Eff: 04/22/2017 Provider ID# 573349ZM1S ', NULL, NULL, '2021-05-17 10:02:24', '2021-05-17 10:02:24'),
(28810, 3046, 23010, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:25:07', '2021-03-18 08:25:07'),
(28811, 1006, 23010, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicare, approval confirmation attached for reference.  Eff: 01/22/2020 Provider ID# 930809 ', NULL, NULL, '2021-05-17 10:03:07', '2021-05-17 10:03:07'),
(28812, 3046, 23011, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:25:09', '2021-03-18 08:25:09'),
(28813, 1006, 23011, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicare, approval confirmation attached for reference.  Eff: 08/13/2018 Provider ID# 719085 ', NULL, NULL, '2021-05-17 10:05:59', '2021-05-17 10:05:59'),
(28814, 3046, 23012, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:25:11', '2021-03-18 08:25:11'),
(28815, 1006, 23012, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicare, approval confirmation attached for reference.  Eff: 01/06/2015 Provider ID# 396952ZM1S ', NULL, NULL, '2021-05-17 10:08:26', '2021-05-17 10:08:26'),
(28816, 3046, 23013, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:25:12', '2021-03-18 08:25:12'),
(28817, 1006, 23013, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicare, approval confirmation attached for reference.  Eff: 02/07/2020 Provider ID# 937821 ', NULL, NULL, '2021-05-17 10:09:06', '2021-05-17 10:09:06'),
(28818, 3046, 23030, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:07', '2021-03-18 08:35:07'),
(28819, 3040, 23030, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:25', '2021-05-28 14:12:25'),
(28820, 3040, 23030, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:22', '2021-06-17 09:06:22'),
(28821, 3040, 23030, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:44', '2021-07-06 09:22:44'),
(28822, 11056, 23030, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:11:38', '2021-08-11 10:11:38'),
(28823, 3040, 23030, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:13:18', '2021-08-18 15:13:18'),
(28824, 10057, 23030, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:41:40', '2021-10-08 11:41:40'),
(28825, 10057, 23030, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:13:01', '2021-11-19 18:13:01'),
(28826, 10057, 23030, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From: Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,  Thank you for your inquiry.  Please complete the attached contract request form for each provider and submit with a valid W9.   The forms and the W9 must be sent together to the contracting mailbox MHTContractrequest@Molinahealthcare.com.', NULL, NULL, '2021-12-01 13:38:27', '2021-12-01 13:38:27'),
(28827, 10057, 23030, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon Michele,  Thank you for reaching out and providing the updated information. I have filled out both provider forms and email on the mentioned email address.  Meanwhile if you need any other details please let me know.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:59:11', '2021-12-08 10:59:11'),
(28828, 10057, 23030, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com, MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Please let me know the updated status for the below mentioned request.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:36:29', '2021-12-14 11:36:29'),
(28829, 10057, 23030, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  The request hasn’t been assigned for processing at this time.   Please allow time for the intake coordinator to process the request.', NULL, NULL, '2021-12-21 11:02:09', '2021-12-21 11:02:09'),
(28830, 10057, 23030, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thank you for your response. Please let me know once you get any update.  Regards,', NULL, NULL, '2021-12-28 15:06:24', '2021-12-28 15:06:24'),
(28831, 20067, 23030, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning, Hope this Email finds you well. Any update on the below-mentioned request.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 12:15:31', '2022-01-12 12:15:31'),
(28832, 20067, 23030, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Jaya Jacob - The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.     Jeena Abraham -  The provider was loaded effective 12/1/2017 under all plans – welcome letter sent previously.     Thank You,', NULL, NULL, '2022-01-12 12:41:09', '2022-01-12 12:41:09');
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
(28833, 20067, 23030, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thanks for the update,  What about Brittany Brown NPI: 1275163537', NULL, NULL, '2022-01-12 12:43:19', '2022-01-12 12:43:19'),
(28834, 20067, 23030, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:  Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Hi Michele! Hope you are doing great. Any update on the previous request.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 17:46:47', '2022-01-18 17:46:47'),
(28835, 20067, 23030, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Good Morning,    Thank you for your inquiry.   There hasn’t been any updates.  The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.', NULL, NULL, '2022-01-27 18:05:28', '2022-01-27 18:05:28'),
(28836, 20067, 23030, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good afternoon!  Hope you are doing well. I would like to know the enrollment status of the below-mentioned provider with the mentioned locations.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Brittany Brown	1275163537  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 17:22:11', '2022-02-02 17:22:11'),
(28837, 20067, 23030, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to:  Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || Molina Health ||  Hey Michele!  Hope all is well with you. I would like to add the secondary location under the below-mentioned providers.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Brittany Brown	1275163537  Thank you,', NULL, NULL, '2022-03-01 14:40:09', '2022-03-01 14:40:09'),
(28838, 20067, 23030, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Good Afternoon!  Hope this email finds you in good health. I want the welcome letter for Jeny John.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493   Thank you,', NULL, NULL, '2022-03-09 14:32:07', '2022-03-09 14:32:07'),
(28839, 20067, 23030, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health    Good Afternoon!  Hope this email finds you in good condition. Can you please confirm the locations for provider Jeny John?  Is a Secondary location added to the provider profile?  Location: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Thank you,', NULL, NULL, '2022-03-21 15:35:27', '2022-03-21 15:35:27'),
(28840, 22077, 23030, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Contract Request || NUCC & IVUC || Ancy Kurian || Molina Health ||  Hi,  I would like to know the enrollment process for the provider Ancy Kurian.  I am looking forward to your kind response. Have a great day!  Thanks & Regards, Alex. ', NULL, NULL, '2022-04-15 10:59:26', '2022-04-15 10:59:26'),
(28841, 3046, 23031, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:15', '2021-03-18 08:35:15'),
(28842, 3040, 23031, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:27', '2021-05-28 14:12:27'),
(28843, 3040, 23031, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:19', '2021-06-17 09:06:19'),
(28844, 3040, 23031, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:42', '2021-07-06 09:22:42'),
(28845, 3040, 23031, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 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 for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:33', '2021-07-26 15:03:33'),
(28846, 11056, 23031, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good morning!  Record # 179917  Hope you are doing well. I am facing an issue regarding the providers mentioned below. I can\'t find the providers on the directory for the additional locations of Longpoint Medical Center & Imperial Valley Urgent Care Center. All of them are showing only for the location of the Normandy Urgent Care centre. Please assist us soon related to the additional locations.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 09:23:59', '2021-08-11 09:23:59'),
(28847, 3040, 23031, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,   Hope you are doing well. Please note I checked the above mentioned providers on the Molina Healthcare provider directory but I couldn\'t find the providers overthere. Would it be possible that you can send me the any confirmation stated that the providers participating under the below locations.   Waiting for your reply.   Thank you ', NULL, NULL, '2021-08-18 14:58:25', '2021-08-18 14:58:25'),
(28848, 10057, 23031, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:41:33', '2021-10-08 11:41:33'),
(28849, 10057, 23031, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:12:55', '2021-11-19 18:12:55'),
(28850, 10057, 23031, NULL, '2021-11-29 00:00:00.000', 'Approved', 'From: Michele.Thomas-Martin@molinahealthcare.com  Record # 166471 & 165924  Provider: Glory Abraham & Vibitha Joseph  Good Afternoon,  Thank you for your inquiry.  The provider has been loaded in the billing system under all plans effective 7/15/2020.  Please see the attached welcome letters.   Thank You,', NULL, NULL, '2021-11-22 17:56:50', '2021-11-22 17:56:50'),
(28851, 3046, 23032, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:16', '2021-03-18 08:35:16'),
(28852, 3040, 23032, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:29', '2021-05-28 14:12:29'),
(28853, 3040, 23032, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:16', '2021-06-17 09:06:16'),
(28854, 3040, 23032, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:41', '2021-07-06 09:22:41'),
(28855, 3040, 23032, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 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 for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:34', '2021-07-26 15:03:34'),
(28856, 11056, 23032, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good morning!  Record # 179917  Hope you are doing well. I am facing an issue regarding the providers mentioned below. I can\'t find the providers on the directory for the additional locations of Longpoint Medical Center & Imperial Valley Urgent Care Center. All of them are showing only for the location of the Normandy Urgent Care centre. Please assist us soon related to the additional locations.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 09:51:10', '2021-08-11 09:51:10'),
(28857, 3040, 23032, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,   Hope you are doing well. Please note I checked the above mentioned providers on the Molina Healthcare provider directory but I couldn\'t find the providers overthere. Would it be possible that you can send me the any confirmation stated that the providers participating under the below locations.   Waiting for your reply.   Thank you ', NULL, NULL, '2021-08-18 14:58:28', '2021-08-18 14:58:28'),
(28858, 10057, 23032, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:41:26', '2021-10-08 11:41:26'),
(28859, 10057, 23032, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:12:49', '2021-11-19 18:12:49'),
(28860, 10057, 23032, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From: Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,  Thank you for your inquiry.  Please complete the attached contract request form for each provider and submit with a valid W9.   The forms and the W9 must be sent together to the contracting mailbox MHTContractrequest@Molinahealthcare.com.', NULL, NULL, '2021-12-01 13:38:18', '2021-12-01 13:38:18'),
(28861, 10057, 23032, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon Michele,  Thank you for reaching out and providing the updated information. I have filled out both provider forms and email on the mentioned email address.  Meanwhile if you need any other details please let me know.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:59:05', '2021-12-08 10:59:05'),
(28862, 10057, 23032, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com, MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Please let me know the updated status for the below mentioned request.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:36:23', '2021-12-14 11:36:23'),
(28863, 10057, 23032, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  The request hasn’t been assigned for processing at this time.   Please allow time for the intake coordinator to process the request.', NULL, NULL, '2021-12-21 11:02:01', '2021-12-21 11:02:01'),
(28864, 10057, 23032, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Molina Provider Contract Update # 185460 - 185463  Good Afternoon,  The provider Jeena Abraham was loaded eff 12/1/17 under all plans ( Medicaid, Dual MMP, Marketplace and Medicare).  Please see a copy of the welcome letter sent in 2017.  The provider listed under all 3 locations.  - Molina ID #’s  Medicaid & Marketplace plans ID # - QMP000005310637  Medicare plan ID #  - QMP000005462770  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-12-21 14:24:54', '2021-12-21 14:24:54'),
(28865, 3046, 23033, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:18', '2021-03-18 08:35:18'),
(28866, 3040, 23033, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:31', '2021-05-28 14:12:31'),
(28867, 3040, 23033, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:14', '2021-06-17 09:06:14'),
(28868, 3040, 23033, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:41', '2021-07-06 09:22:41'),
(28869, 3040, 23033, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 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 for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:32', '2021-07-26 15:03:32'),
(28870, 11056, 23033, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good morning!  Record # 179917  Hope you are doing well. I am facing an issue regarding the providers mentioned below. I can\'t find the providers on the directory for the additional locations of Longpoint Medical Center & Imperial Valley Urgent Care Center. All of them are showing only for the location of the Normandy Urgent Care centre. Please assist us soon related to the additional locations.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 09:20:42', '2021-08-11 09:20:42'),
(28871, 3040, 23033, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,   Hope you are doing well. Please note I checked the above mentioned providers on the Molina Healthcare provider directory but I couldn\'t find the providers overthere. Would it be possible that you can send me the any confirmation stated that the providers participating under the below locations.   Waiting for your reply.   Thank you ', NULL, NULL, '2021-08-18 14:58:24', '2021-08-18 14:58:24'),
(28872, 10057, 23033, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:41:07', '2021-10-08 11:41:07'),
(28873, 10057, 23033, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:12:42', '2021-11-19 18:12:42'),
(28874, 10057, 23033, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From: Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,  Thank you for your inquiry.  Please complete the attached contract request form for each provider and submit with a valid W9.   The forms and the W9 must be sent together to the contracting mailbox MHTContractrequest@Molinahealthcare.com.', NULL, NULL, '2021-12-01 13:36:44', '2021-12-01 13:36:44'),
(28875, 10057, 23033, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon Michele,  Thank you for reaching out and providing the updated information. I have filled out both provider forms and email on the mentioned email address.  Meanwhile if you need any other details please let me know.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:58:59', '2021-12-08 10:58:59'),
(28876, 10057, 23033, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com, MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Please let me know the updated status for the below mentioned request.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:36:17', '2021-12-14 11:36:17'),
(28877, 10057, 23033, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  The request hasn’t been assigned for processing at this time.   Please allow time for the intake coordinator to process the request.', NULL, NULL, '2021-12-21 11:01:56', '2021-12-21 11:01:56'),
(28878, 10057, 23033, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thank you for your response. Please let me know once you get any update.  Regards,', NULL, NULL, '2021-12-28 15:06:18', '2021-12-28 15:06:18');
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
(28879, 20067, 23033, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning, Hope this Email finds you well. Any update on the below-mentioned request.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 12:15:15', '2022-01-12 12:15:15'),
(28880, 20067, 23033, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Jaya Jacob - The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.     Jeena Abraham -  The provider was loaded effective 12/1/2017 under all plans – welcome letter sent previously.     Thank You,', NULL, NULL, '2022-01-12 12:40:55', '2022-01-12 12:40:55'),
(28881, 20067, 23033, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thanks for the update,  What about Brittany Brown NPI: 1275163537', NULL, NULL, '2022-01-12 12:43:05', '2022-01-12 12:43:05'),
(28882, 20067, 23033, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Brittany Brown has been loaded in the system effective 9/15/20.  The welcome letter was sent previously.   Please see the attached welcome letter.  Please advise if another request was submitted for the provider.      Thank You', NULL, NULL, '2022-01-12 13:18:49', '2022-01-12 13:18:49'),
(28883, 20067, 23033, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thanks for the update. Can you please resend me the welcome letter for Brittany Brown  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 13:23:32', '2022-01-12 13:23:32'),
(28884, 20067, 23033, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:  Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Hi Michele! Hope you are doing great. Any update on the previous request.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 17:46:40', '2022-01-18 17:46:40'),
(28885, 20067, 23033, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Good Morning,    Thank you for your inquiry.   There hasn’t been any updates.  The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.', NULL, NULL, '2022-01-27 18:05:33', '2022-01-27 18:05:33'),
(28886, 20067, 23033, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good afternoon!  Hope you are doing well. I would like to know the enrollment status of the below-mentioned provider with the mentioned locations.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Brittany Brown	1275163537  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 17:19:45', '2022-02-02 17:19:45'),
(28887, 20067, 23033, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to:  Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || Molina Health ||  Hey Michele!  Hope all is well with you. I would like to add the secondary location under the below-mentioned providers.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Brittany Brown	1275163537  Thank you,', NULL, NULL, '2022-03-01 14:40:01', '2022-03-01 14:40:01'),
(28888, 20067, 23033, NULL, '2022-03-15 00:00:00.000', 'Approved', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || Molina Health ||   Good Afternoon,     The providers have  already been  listed under both service locations.     Primary Location      779 Normandy St Ste 114 Houston , TX 77015-3441  Secondary Location 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060     Thank You,', NULL, NULL, '2022-03-08 14:34:42', '2022-03-08 14:34:42'),
(28889, 3046, 23034, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:19', '2021-03-18 08:35:19'),
(28890, 3040, 23034, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:33', '2021-05-28 14:12:33'),
(28891, 3040, 23034, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:10', '2021-06-17 09:06:10'),
(28892, 3040, 23034, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:40', '2021-07-06 09:22:40'),
(28893, 3040, 23034, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 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 for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:22', '2021-07-26 15:03:22'),
(28894, 11056, 23034, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:11:50', '2021-08-11 10:11:50'),
(28895, 11056, 23034, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:12:26', '2021-08-11 10:12:26'),
(28896, 3040, 23034, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:06', '2021-08-18 15:07:06'),
(28897, 10057, 23034, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:39:25', '2021-10-08 11:39:25'),
(28898, 10057, 23034, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:42:22', '2021-11-15 10:42:22'),
(28899, 3046, 23035, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:20', '2021-03-18 08:35:20'),
(28900, 3040, 23035, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:36', '2021-05-28 14:12:36'),
(28901, 3040, 23035, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:08', '2021-06-17 09:06:08'),
(28902, 3040, 23035, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:39', '2021-07-06 09:22:39'),
(28903, 3040, 23035, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 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 for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:24', '2021-07-26 15:03:24'),
(28904, 11056, 23035, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:12:41', '2021-08-11 10:12:41'),
(28905, 3040, 23035, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:08', '2021-08-18 15:07:08'),
(28906, 10057, 23035, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:38:58', '2021-10-08 11:38:58'),
(28907, 10057, 23035, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:42:44', '2021-11-15 10:42:44'),
(28908, 3046, 23036, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:22', '2021-03-18 08:35:22'),
(28909, 3040, 23036, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:38', '2021-05-28 14:12:38'),
(28910, 3040, 23036, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:05', '2021-06-17 09:06:05'),
(28911, 3040, 23036, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:38', '2021-07-06 09:22:38'),
(28912, 11056, 23036, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:23:43', '2021-08-11 10:23:43'),
(28913, 10057, 23036, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status about the request for provider locations.  Provider Name	NPI Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189   Please feel free to reach out to us for any further questions.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:04:07', '2021-10-06 14:04:07'),
(28914, 10057, 23036, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:12:35', '2021-11-19 18:12:35'),
(28915, 10057, 23036, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From: Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,  Thank you for your inquiry.  Please complete the attached contract request form for each provider and submit with a valid W9.   The forms and the W9 must be sent together to the contracting mailbox MHTContractrequest@Molinahealthcare.com.', NULL, NULL, '2021-12-01 13:36:37', '2021-12-01 13:36:37');
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
(28916, 10057, 23036, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon Michele,  Thank you for reaching out and providing the updated information. I have filled out both provider forms and email on the mentioned email address.  Meanwhile if you need any other details please let me know.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:58:51', '2021-12-08 10:58:51'),
(28917, 10057, 23036, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com, MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Please let me know the updated status for the below mentioned request.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:36:12', '2021-12-14 11:36:12'),
(28918, 10057, 23036, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  The request hasn’t been assigned for processing at this time.   Please allow time for the intake coordinator to process the request.', NULL, NULL, '2021-12-21 11:01:50', '2021-12-21 11:01:50'),
(28919, 10057, 23036, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thank you for your response. Please let me know once you get any update.  Regards,', NULL, NULL, '2021-12-28 15:06:13', '2021-12-28 15:06:13'),
(28920, 20067, 23036, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning, Hope this Email finds you well. Any update on the below-mentioned request.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 12:15:00', '2022-01-12 12:15:00'),
(28921, 20067, 23036, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Jaya Jacob - The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.     Jeena Abraham -  The provider was loaded effective 12/1/2017 under all plans – welcome letter sent previously.     Thank You,', NULL, NULL, '2022-01-12 12:40:30', '2022-01-12 12:40:30'),
(28922, 20067, 23036, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thanks for the update,  What about Brittany Brown NPI: 1275163537', NULL, NULL, '2022-01-12 12:42:27', '2022-01-12 12:42:27'),
(28923, 20067, 23036, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:  Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Hi Michele! Hope you are doing great. Any update on the previous request.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 17:46:34', '2022-01-18 17:46:34'),
(28924, 20067, 23036, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Good Morning,    Thank you for your inquiry.   There hasn’t been any updates.  The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.', NULL, NULL, '2022-01-27 18:05:39', '2022-01-27 18:05:39'),
(28925, 20067, 23036, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good afternoon!  Hope you are doing well. I would like to know the enrollment status of the below-mentioned provider with the mentioned locations.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Brittany Brown	1275163537  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 17:16:51', '2022-02-02 17:16:51'),
(28926, 20067, 23036, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to:  Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || Molina Health ||  Hey Michele!  Hope all is well with you. I would like to add the secondary location under the below-mentioned providers.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Brittany Brown	1275163537  Thank you,', NULL, NULL, '2022-03-01 14:39:53', '2022-03-01 14:39:53'),
(28927, 20067, 23036, NULL, '2022-03-15 00:00:00.000', 'Approved', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || Molina Health ||   Good Afternoon,     The providers have  already been  listed under both service locations.     Primary Location      779 Normandy St Ste 114 Houston , TX 77015-3441  Secondary Location 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060     Thank You,', NULL, NULL, '2022-03-08 14:34:08', '2022-03-08 14:34:08'),
(28928, 3046, 23037, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:23', '2021-03-18 08:35:23'),
(28929, 3040, 23037, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:41', '2021-05-28 14:12:41'),
(28930, 3040, 23037, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:02', '2021-06-17 09:06:02'),
(28931, 3040, 23037, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:38', '2021-07-06 09:22:38'),
(28932, 3040, 23037, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 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 for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:30', '2021-07-26 15:03:30'),
(28933, 11056, 23037, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good morning!  Record # 179917  Hope you are doing well. I am facing an issue regarding the providers mentioned below. I can\'t find the providers on the directory for the additional locations of Longpoint Medical Center & Imperial Valley Urgent Care Center. All of them are showing only for the location of the Normandy Urgent Care centre. Please assist us soon related to the additional locations.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 09:18:02', '2021-08-11 09:18:02'),
(28934, 3040, 23037, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,   Hope you are doing well. Please note I checked the above mentioned providers on the Molina Healthcare provider directory but I couldn\'t find the providers overthere. Would it be possible that you can send me the any confirmation stated that the providers participating under the below locations.   Waiting for your reply.   Thank you ', NULL, NULL, '2021-08-18 14:58:29', '2021-08-18 14:58:29'),
(28935, 10057, 23037, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:28:33', '2021-10-08 11:28:33'),
(28936, 10057, 23037, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:12:30', '2021-11-19 18:12:30'),
(28937, 10057, 23037, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 09/01/2020', NULL, NULL, '2021-11-22 18:01:35', '2021-11-22 18:01:35'),
(28938, 3046, 23038, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:25', '2021-03-18 08:35:25'),
(28939, 3040, 23038, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:43', '2021-05-28 14:12:43'),
(28940, 3040, 23038, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:00', '2021-06-17 09:06:00'),
(28941, 3040, 23038, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:37', '2021-07-06 09:22:37'),
(28942, 3040, 23038, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 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 for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:35', '2021-07-26 15:03:35'),
(28943, 11056, 23038, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good morning!  Record # 179917  Hope you are doing well. I am facing an issue regarding the providers mentioned below. I can\'t find the providers on the directory for the additional locations of Longpoint Medical Center & Imperial Valley Urgent Care Center. All of them are showing only for the location of the Normandy Urgent Care centre. Please assist us soon related to the additional locations.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 09:49:45', '2021-08-11 09:49:45'),
(28944, 3040, 23038, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,   Hope you are doing well. Please note I checked the above mentioned providers on the Molina Healthcare provider directory but I couldn\'t find the providers overthere. Would it be possible that you can send me the any confirmation stated that the providers participating under the below locations.   Waiting for your reply.   Thank you ', NULL, NULL, '2021-08-18 14:58:28', '2021-08-18 14:58:28'),
(28945, 10057, 23038, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:28:17', '2021-10-08 11:28:17'),
(28946, 10057, 23038, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:12:23', '2021-11-19 18:12:23'),
(28947, 10057, 23038, NULL, '2021-11-29 00:00:00.000', 'Approved', 'From: Michele.Thomas-Martin@molinahealthcare.com  Record # 166471 & 165924  Provider: Glory Abraham & Vibitha Joseph  Good Afternoon,  Thank you for your inquiry.  The provider has been loaded in the billing system under all plans effective 7/15/2020.  Please see the attached welcome letters.   Thank You,', NULL, NULL, '2021-11-22 17:59:41', '2021-11-22 17:59:41'),
(28948, 3046, 23039, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:26', '2021-03-18 08:35:26'),
(28949, 3040, 23039, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:45', '2021-05-28 14:12:45'),
(28950, 3040, 23039, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:05:57', '2021-06-17 09:05:57'),
(28951, 3040, 23039, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:36', '2021-07-06 09:22:36'),
(28952, 3040, 23039, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 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 for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:26', '2021-07-26 15:03:26'),
(28953, 11056, 23039, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from :  Michele.Thomas-Martin@molinahealthcare.com  Sub  :  RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Odette Kourouma – The request has been sent to credentialing for processing.  Thank You,  Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2021-08-11 09:06:47', '2021-08-11 09:06:47'),
(28954, 3040, 23039, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:09', '2021-08-18 15:07:09'),
(28955, 10057, 23039, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:27:39', '2021-10-08 11:27:39'),
(28956, 10057, 23039, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:41:26', '2021-11-15 10:41:26'),
(28957, 3046, 23040, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:28', '2021-03-18 08:35:28'),
(28958, 3040, 23040, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:48', '2021-05-28 14:12:48');
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
(28959, 3040, 23040, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:05:54', '2021-06-17 09:05:54'),
(28960, 3040, 23040, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:36', '2021-07-06 09:22:36'),
(28961, 3040, 23040, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 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 for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:29', '2021-07-26 15:03:29'),
(28962, 11056, 23040, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:12:55', '2021-08-11 10:12:55'),
(28963, 3040, 23040, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:12', '2021-08-18 15:07:12'),
(28964, 10057, 23040, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:27:22', '2021-10-08 11:27:22'),
(28965, 10057, 23040, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:40:55', '2021-11-15 10:40:55'),
(28966, 3046, 23041, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:29', '2021-03-18 08:35:29'),
(28967, 3040, 23041, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:50', '2021-05-28 14:12:50'),
(28968, 3040, 23041, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:05:51', '2021-06-17 09:05:51'),
(28969, 3040, 23041, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:35', '2021-07-06 09:22:35'),
(28970, 3040, 23041, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 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 for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:43', '2021-07-26 15:03:43'),
(28971, 11056, 23041, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from :  Michele.Thomas-Martin@molinahealthcare.com  Sub  :  RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  James Piccione – The request has been sent to credentialing under Emergency Medicine.  Thank You,  Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2021-08-11 09:09:26', '2021-08-11 09:09:26'),
(28972, 3040, 23041, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:05', '2021-08-18 15:07:05'),
(28973, 12062, 23041, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Received email from Michele.Thomas-Martin@molinahealthcare.com on AUG 19,2021;  Subject: RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,   Thank you for your inquiry.  Please see the status updates listed below.   Provider 1:   Provider Name: Stephen, Ani – The request under final step, the request has been sent for loading in the billing system.  Please allow 2-4 weeks for processing. Provider NPI# 1588959118   Provider 2:   Provider Name: Piccione JR, James M – I’m waiting on response to the email submitted 8/4/21 - Thank you for submitting the contract request to add the provider as Emergency Medicine.   Please confirm if the provider will only be seeing patients in Urgent Care outpatient setting.   Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini Philip – The request complete, the request has been loaded under all plans and locations effective 9/1/2021.  Please see the attached welcome letter. Provider NPI# 1841755956   Provider 4:   Provider Name: Fernandus, Limy - The request under final step, the request has been sent for loading in the billing system.  Please allow 2-4 weeks for processing. Provider NPI# 1972005189   Provider 5:   Provider Name: Kourouma , Odette Tiranke – The request is under credentialing.  Please allow a few more weeks for the credentialing application to process. Provider NPI# 1134525868   Provider 6:   Provider Name: Thomas, Cini - The request under final step, the request has been sent for loading in the billing system.  Please allow 2-4 weeks for processing. Provider NPI# 1134777238   Provider 7:   Provider Name: PAUL, SIGI - The request under final step, the request has been sent for loading in the billing system.  Please allow 2-4 weeks for processing. Provider NPI# 1033623616   Thank You, ', NULL, NULL, '2021-09-17 13:05:40', '2021-09-17 13:05:40'),
(28974, 12062, 23041, NULL, '2021-09-24 00:00:00.000', 'In Process', 'RESPONDED TO EMAIL ON SEPTEMBER 15,2021;  TO:Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Dear Michele,  Please find my response in green highlighted below;  Provider 2:   Provider Name: Piccione JR, James M – I’m waiting on response to the email submitted 8/4/21 - Thank you for submitting the contract request to add the provider as Emergency Medicine.   Please confirm if the provider will only be seeing patients in Urgent Care outpatient setting.  The provider will only see patients in urgent care. ', NULL, NULL, '2021-09-17 13:10:50', '2021-09-17 13:10:50'),
(28975, 12062, 23041, NULL, '2021-09-24 00:00:00.000', 'In Process', 'RECEIVED EMAIL ON SEPTEMBER 17,2021  FROM:Michele.Thomas-Martin@molinahealthcare.com  Subject: RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Record # 179982  Good Morning,  Thank you for your response.   The contract request has been sent to credentialing for processing.  Please allow 30 days for credentialing to process the request.  Thank You,  Michele Thomas-Martin  Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com  Your Extended Family ', NULL, NULL, '2021-09-17 13:14:30', '2021-09-17 13:14:30'),
(28976, 10057, 23041, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:27:04', '2021-10-08 11:27:04'),
(28977, 10057, 23041, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Michele,  Hope you are doing well. Could you please update me with the current status of James Piccione request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-08 11:46:05', '2021-11-08 11:46:05'),
(28978, 10057, 23041, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.  The request for James Piccione has been loaded in the billing system effective 11/1/21.  Please see the attached welcome letter.  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:48:31', '2021-11-15 10:48:31'),
(28979, 3046, 23042, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:31', '2021-03-18 08:35:31'),
(28980, 3040, 23042, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:53', '2021-05-28 14:12:53'),
(28981, 3040, 23042, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:05:47', '2021-06-17 09:05:47'),
(28982, 3040, 23042, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:35', '2021-07-06 09:22:35'),
(28983, 11056, 23042, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good morning!  Record # 179917  Hope you are doing well. I am facing an issue regarding the providers mentioned below. I can\'t find the providers on the directory for the additional locations of Longpoint Medical Center & Imperial Valley Urgent Care Center. All of them are showing only for the location of the Normandy Urgent Care centre. Please assist us soon related to the additional locations.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 09:25:44', '2021-08-11 09:25:44'),
(28984, 3040, 23042, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Email rcvd from: Michele.Thomas-Martin@molinahealthcare.com  Subject: RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Record # 179917  Good Morning,  Thank you for submitting the roster.  The request to add the below providers under all locations was previously submitted 7/6/21.   The request is complete all of the providers listed below have been added under all 3 locations  effective 7/15/21.   Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  ', NULL, NULL, '2021-08-17 16:53:40', '2021-08-17 16:53:40'),
(28985, 3046, 23043, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:33', '2021-03-18 08:35:33'),
(28986, 3040, 23043, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:55', '2021-05-28 14:12:55'),
(28987, 3040, 23043, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:05:44', '2021-06-17 09:05:44'),
(28988, 3040, 23043, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:34', '2021-07-06 09:22:34'),
(28989, 3040, 23043, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 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 for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:19', '2021-07-26 15:03:19');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(28990, 11056, 23043, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:06:53', '2021-08-11 10:06:53'),
(28991, 3040, 23043, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:03', '2021-08-18 15:07:03'),
(28992, 10057, 23043, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:26:35', '2021-10-08 11:26:35'),
(28993, 10057, 23043, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:40:29', '2021-11-15 10:40:29'),
(28994, 3046, 23044, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:35:34', '2021-03-18 08:35:34'),
(28995, 3040, 23044, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:58', '2021-05-28 14:12:58'),
(28996, 3040, 23044, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:04:22', '2021-06-17 09:04:22'),
(28997, 3040, 23044, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:32', '2021-07-06 09:22:32'),
(28998, 3040, 23044, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 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 for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:27', '2021-07-26 15:03:27'),
(28999, 11056, 23044, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:05:37', '2021-08-11 10:05:37'),
(29000, 3040, 23044, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:11', '2021-08-18 15:07:11'),
(29001, 10057, 23044, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:26:03', '2021-10-08 11:26:03'),
(29002, 10057, 23044, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:39:56', '2021-11-15 10:39:56'),
(29003, 3046, 23045, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:31', '2021-03-18 08:44:31'),
(29004, 3040, 23045, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:22:28', '2021-05-28 16:22:28'),
(29005, 3040, 23045, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-18 08:50:55', '2021-06-18 08:50:55'),
(29006, 3040, 23045, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:20', '2021-07-06 11:57:20'),
(29007, 11056, 23045, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:40:57', '2021-08-09 12:40:57'),
(29008, 11056, 23045, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:43:56', '2021-08-09 12:43:56'),
(29009, 3040, 23045, NULL, '2021-08-30 00:00:00.000', 'In Process', 'I had a word with Multiplan representative and she said the group request is still pending. ', NULL, NULL, '2021-08-23 14:30:03', '2021-08-23 14:30:03'),
(29010, 10057, 23045, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Evening!  Hope this email finds you well. I want to inquire about the updated enrollment status of the following providers and practices for the Multiplan.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Abraham, Jeena	1467901587 Kourouma , Odette Tiranke	1134525868 Fernandus, Limy	1972005189 Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493  Looking forward to your response. Have a great evening!  Thanks & Regards,', NULL, NULL, '2021-10-07 16:51:15', '2021-10-07 16:51:15'),
(29011, 10057, 23045, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:33:17', '2021-11-22 09:33:17'),
(29012, 10057, 23045, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:46:18', '2021-12-02 13:46:18'),
(29013, 10057, 23045, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:15:53', '2021-12-09 11:15:53'),
(29014, 10057, 23045, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:42:40', '2021-12-16 14:42:40'),
(29015, 10057, 23045, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:27:19', '2021-12-22 11:27:19'),
(29016, 10057, 23045, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:56:41', '2021-12-29 11:56:41'),
(29017, 20067, 23045, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:43:09', '2022-01-12 17:43:09'),
(29018, 20067, 23045, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 16:59:46', '2022-01-18 16:59:46'),
(29019, 20067, 23045, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Sub: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Good Evening!  Hope this email finds you well. I want to add the listed locations under mentioned providers attached are the W9 for both locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Ani Stephen	1588959118	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Ani Stephen	1588959118	779 Normandy St Ste 114 Houston , TX 77015-3441 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	779 Normandy St Ste 114 Houston , TX 77015-3441 Sigi Paul	1033623616	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Sigi Paul	1033623616	779 Normandy St Ste 114 Houston , TX 77015-3441 James Piccione JR	1356321509	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 James Piccione JR	1356321509	779 Normandy St Ste 114 Houston , TX 77015-3441    Thank you,', NULL, NULL, '2022-03-09 16:58:28', '2022-03-09 16:58:28'),
(29020, 22077, 23045, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: 	Re: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Hi,  Any update on the previously mentioned request?  I am looking forward to your kind response,  Thanks & regards, Alex. ', NULL, NULL, '2022-04-15 14:50:38', '2022-04-15 14:50:38'),
(29021, 3046, 23046, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:32', '2021-03-18 08:44:32'),
(29022, 3040, 23046, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:22:32', '2021-05-28 16:22:32'),
(29023, 3040, 23046, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Location Addition || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Multiplan ||   Greetings,   Hope you are doing well. I wanted to add the location under the below mentioned providers in Multiplan for our 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  Provider 01:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441    Provider 02:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 03:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 11:55:01', '2021-06-17 11:55:01'),
(29024, 3040, 23046, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:19', '2021-07-06 11:57:19'),
(29025, 3040, 23046, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:05', '2021-07-27 16:42:05'),
(29026, 11056, 23046, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:40:37', '2021-08-09 12:40:37'),
(29027, 3040, 23046, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:46:21', '2021-08-20 16:46:21'),
(29028, 3046, 23047, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:33', '2021-03-18 08:44:33'),
(29029, 3040, 23047, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:22:38', '2021-05-28 16:22:38'),
(29030, 3040, 23047, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Location Addition || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Multiplan ||   Greetings,   Hope you are doing well. I wanted to add the location under the below mentioned providers in Multiplan for our 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  Provider 01:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441    Provider 02:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 03:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 11:54:56', '2021-06-17 11:54:56'),
(29031, 3040, 23047, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:18', '2021-07-06 11:57:18');
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
(29032, 3040, 23047, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:41:50', '2021-07-27 16:41:50'),
(29033, 11056, 23047, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:40:15', '2021-08-09 12:40:15'),
(29034, 3040, 23047, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:46:03', '2021-08-20 16:46:03'),
(29035, 3046, 23048, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:34', '2021-03-18 08:44:34'),
(29036, 3040, 23048, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:22:42', '2021-05-28 16:22:42'),
(29037, 3040, 23048, NULL, '2021-06-24 00:00:00.000', 'Approved', 'Provider participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-06-17 10:59:29', '2021-06-17 10:59:29'),
(29038, 3046, 23049, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:36', '2021-03-18 08:44:36'),
(29039, 3040, 23049, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:22:46', '2021-05-28 16:22:46'),
(29040, 3040, 23049, NULL, '2021-06-24 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment.', NULL, NULL, '2021-06-17 10:12:01', '2021-06-17 10:12:01'),
(29041, 3046, 23050, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:37', '2021-03-18 08:44:37'),
(29042, 3040, 23050, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:22:49', '2021-05-28 16:22:49'),
(29043, 3040, 23050, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 11:49:27', '2021-06-17 11:49:27'),
(29044, 3040, 23050, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:18', '2021-07-06 11:57:18'),
(29045, 3040, 23050, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:05', '2021-07-27 16:42:05'),
(29046, 1006, 23050, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:31:09', '2021-08-03 10:31:09'),
(29047, 11056, 23050, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:39:50', '2021-08-09 12:39:50'),
(29048, 3040, 23050, NULL, '2021-08-30 00:00:00.000', 'In Process', 'I had a with Multiplan representative and she said the provider profile is not created so she will request to create a provider profile.   Case # 7660656', NULL, NULL, '2021-08-23 13:49:56', '2021-08-23 13:49:56'),
(29049, 12062, 23050, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Replied to a below email via fax; See attached file faxed.  From: noreplycustserv@multiplan.com Subject: Initial request for additional information regarding case number 7612872  Thank you for your inquiry. To expedite your request we will need additional information. For your convenience we have listed the required documents below and attached coversheet(s) to be used when faxing in your documents.  In order for us to complete your inquiry, we must receive all requested documentation by 09/02/2021 or your case will be closed. Once all documents are received, your case will be re-opened and researched in full.  Documentation Required	Additional Description	Status Misc Application Missing Materials	Jacob, Jaya - Professional liability insurance; Admitting privileges or other admitting arrangements with participating hospital	Not Received Thank you, Service Operations   ', NULL, NULL, '2021-09-23 16:30:29', '2021-09-23 16:30:29'),
(29050, 10057, 23050, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Evening!  Hope this email finds you well. I want to inquire about the updated enrollment status of the following providers and practices for the Multiplan.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Abraham, Jeena	1467901587 Kourouma , Odette Tiranke	1134525868 Fernandus, Limy	1972005189 Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493  Looking forward to your response. Have a great evening!  Thanks & Regards,', NULL, NULL, '2021-10-07 16:50:53', '2021-10-07 16:50:53'),
(29051, 10057, 23050, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:33:11', '2021-11-22 09:33:11'),
(29052, 10057, 23050, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:46:12', '2021-12-02 13:46:12'),
(29053, 10057, 23050, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:15:47', '2021-12-09 11:15:47'),
(29054, 10057, 23050, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:42:33', '2021-12-16 14:42:33'),
(29055, 10057, 23050, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:27:13', '2021-12-22 11:27:13'),
(29056, 10057, 23050, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:56:37', '2021-12-29 11:56:37'),
(29057, 20067, 23050, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:43:02', '2022-01-12 17:43:02'),
(29058, 20067, 23050, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 16:59:40', '2022-01-18 16:59:40'),
(29059, 20067, 23050, NULL, '2022-02-10 00:00:00.000', 'In Process', 'Application submitted through portal Case Number: 7901374    Submitter Name: Steve Albert Date of Submission: 02/03/2022    TIN: 27-0796429    Provider Name: Jacob, Jaya Group Name: Normandy Urgent Care Center Inquiry Type: Credentialing Status • Application Status    Priority: Standard', NULL, NULL, '2022-02-03 14:11:26', '2022-02-03 14:11:26'),
(29060, 20067, 23050, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Sub: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Good Evening!  Hope this email finds you well. I want to add the listed locations under mentioned providers attached are the W9 for both locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Ani Stephen	1588959118	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Ani Stephen	1588959118	779 Normandy St Ste 114 Houston , TX 77015-3441 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	779 Normandy St Ste 114 Houston , TX 77015-3441 Sigi Paul	1033623616	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Sigi Paul	1033623616	779 Normandy St Ste 114 Houston , TX 77015-3441 James Piccione JR	1356321509	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 James Piccione JR	1356321509	779 Normandy St Ste 114 Houston , TX 77015-3441    Thank you,', NULL, NULL, '2022-03-09 16:58:22', '2022-03-09 16:58:22'),
(29061, 22077, 23050, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: 	Re: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Hi,  Any update on the previously mentioned request?  I am looking forward to your kind response,  Thanks & regards, Alex. ', NULL, NULL, '2022-04-15 14:58:07', '2022-04-15 14:58:07'),
(29062, 3046, 23051, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:39', '2021-03-18 08:44:39'),
(29063, 3040, 23051, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:22:53', '2021-05-28 16:22:53'),
(29064, 3040, 23051, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 11:50:01', '2021-06-17 11:50:01'),
(29065, 3040, 23051, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:17', '2021-07-06 11:57:17'),
(29066, 3040, 23051, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:05', '2021-07-27 16:42:05'),
(29067, 11056, 23051, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:39:41', '2021-08-09 12:39:41'),
(29068, 3040, 23051, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. For more details please see attachment. ', NULL, NULL, '2021-08-20 16:41:56', '2021-08-20 16:41:56'),
(29069, 3040, 23051, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:45:52', '2021-08-20 16:45:52'),
(29070, 3046, 23052, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:41', '2021-03-18 08:44:41'),
(29071, 3040, 23052, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:22:56', '2021-05-28 16:22:56'),
(29072, 3040, 23052, NULL, '2021-06-24 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-06-17 10:00:57', '2021-06-17 10:00:57'),
(29073, 3046, 23053, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:42', '2021-03-18 08:44:42'),
(29074, 3040, 23053, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:23:01', '2021-05-28 16:23:01'),
(29075, 3040, 23053, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 11:49:37', '2021-06-17 11:49:37'),
(29076, 3040, 23053, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:16', '2021-07-06 11:57:16'),
(29077, 3040, 23053, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:07', '2021-07-27 16:42:07'),
(29078, 1006, 23053, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:32:04', '2021-08-03 10:32:04'),
(29079, 11056, 23053, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:39:34', '2021-08-09 12:39:34'),
(29080, 3040, 23053, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:47:40', '2021-08-20 16:47:40'),
(29081, 3046, 23054, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:44', '2021-03-18 08:44:44'),
(29082, 3040, 23054, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:23:05', '2021-05-28 16:23:05');
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
(29083, 3040, 23054, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 11:49:19', '2021-06-17 11:49:19'),
(29084, 3040, 23054, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:16', '2021-07-06 11:57:16'),
(29085, 3040, 23054, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:06', '2021-07-27 16:42:06'),
(29086, 1006, 23054, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:32:38', '2021-08-03 10:32:38'),
(29087, 11056, 23054, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:39:25', '2021-08-09 12:39:25'),
(29088, 3040, 23054, NULL, '2021-08-30 00:00:00.000', 'In Process', 'I had a with Multiplan representative and she said the provider profile is not created so she will request to create a provider profile.   Case # 7660656', NULL, NULL, '2021-08-23 13:50:01', '2021-08-23 13:50:01'),
(29089, 10057, 23054, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Evening!  Hope this email finds you well. I want to inquire about the updated enrollment status of the following providers and practices for the Multiplan.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Abraham, Jeena	1467901587 Kourouma , Odette Tiranke	1134525868 Fernandus, Limy	1972005189 Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493  Looking forward to your response. Have a great evening!  Thanks & Regards,', NULL, NULL, '2021-10-07 16:50:06', '2021-10-07 16:50:06'),
(29090, 10057, 23054, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:33:05', '2021-11-22 09:33:05'),
(29091, 10057, 23054, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:46:06', '2021-12-02 13:46:06'),
(29092, 10057, 23054, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:15:41', '2021-12-09 11:15:41'),
(29093, 10057, 23054, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:42:27', '2021-12-16 14:42:27'),
(29094, 10057, 23054, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:27:07', '2021-12-22 11:27:07'),
(29095, 10057, 23054, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:56:32', '2021-12-29 11:56:32'),
(29096, 20067, 23054, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:42:56', '2022-01-12 17:42:56'),
(29097, 20067, 23054, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 16:59:34', '2022-01-18 16:59:34'),
(29098, 20067, 23054, NULL, '2022-02-10 00:00:00.000', 'In Process', ' Application submitted through portal Case Number: 7901382    Submitter Name: Steve Albert Date of Submission: 02/03/2022    TIN: 27-0796429    Provider Name: PAUL, SIGI Group Name: Normandy Urgent Care Center Inquiry Type: Credentialing Status • Application Status    Priority: Standard', NULL, NULL, '2022-02-03 14:15:13', '2022-02-03 14:15:13'),
(29099, 20067, 23054, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Sub: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Good Evening!  Hope this email finds you well. I want to add the listed locations under mentioned providers attached are the W9 for both locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Ani Stephen	1588959118	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Ani Stephen	1588959118	779 Normandy St Ste 114 Houston , TX 77015-3441 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	779 Normandy St Ste 114 Houston , TX 77015-3441 Sigi Paul	1033623616	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Sigi Paul	1033623616	779 Normandy St Ste 114 Houston , TX 77015-3441 James Piccione JR	1356321509	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 James Piccione JR	1356321509	779 Normandy St Ste 114 Houston , TX 77015-3441    Thank you,', NULL, NULL, '2022-03-09 16:58:16', '2022-03-09 16:58:16'),
(29100, 22077, 23054, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: 	Re: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Hi,  Any update on the previously mentioned request?  I am looking forward to your kind response,  Thanks & regards, Alex. ', NULL, NULL, '2022-04-15 14:57:21', '2022-04-15 14:57:21'),
(29101, 3046, 23055, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:45', '2021-03-18 08:44:45'),
(29102, 3040, 23055, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:23:08', '2021-05-28 16:23:08'),
(29103, 3040, 23055, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 11:49:13', '2021-06-17 11:49:13'),
(29104, 3040, 23055, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:15', '2021-07-06 11:57:15'),
(29105, 3040, 23055, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:05', '2021-07-27 16:42:05'),
(29106, 11056, 23055, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:39:17', '2021-08-09 12:39:17'),
(29107, 3040, 23055, NULL, '2021-08-30 00:00:00.000', 'Approved', 'I had a word with Multiplan representative and she said the provider is participating with Multiplan. ', NULL, NULL, '2021-08-23 14:05:43', '2021-08-23 14:05:43'),
(29108, 3046, 23056, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:46', '2021-03-18 08:44:46'),
(29109, 3040, 23056, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:23:12', '2021-05-28 16:23:12'),
(29110, 3040, 23056, NULL, '2021-06-24 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-06-17 09:53:23', '2021-06-17 09:53:23'),
(29111, 3046, 23057, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:48', '2021-03-18 08:44:48'),
(29112, 3040, 23057, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:23:18', '2021-05-28 16:23:18'),
(29113, 3040, 23057, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 11:49:05', '2021-06-17 11:49:05'),
(29114, 3040, 23057, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:15', '2021-07-06 11:57:15'),
(29115, 3040, 23057, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:41:47', '2021-07-27 16:41:47'),
(29116, 1006, 23057, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:30:27', '2021-08-03 10:30:27'),
(29117, 11056, 23057, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:39:08', '2021-08-09 12:39:08'),
(29118, 3040, 23057, NULL, '2021-08-30 00:00:00.000', 'In Process', 'I had a with Multiplan representative and she said the provider profile is not created so she will request to create a provider profile.   Case # 7660656', NULL, NULL, '2021-08-23 13:49:53', '2021-08-23 13:49:53'),
(29119, 10057, 23057, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Evening!  Hope this email finds you well. I want to inquire about the updated enrollment status of the following providers and practices for the Multiplan.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Abraham, Jeena	1467901587 Kourouma , Odette Tiranke	1134525868 Fernandus, Limy	1972005189 Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493  Looking forward to your response. Have a great evening!  Thanks & Regards,', NULL, NULL, '2021-10-07 16:49:52', '2021-10-07 16:49:52'),
(29120, 10057, 23057, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:32:59', '2021-11-22 09:32:59'),
(29121, 10057, 23057, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:46:00', '2021-12-02 13:46:00'),
(29122, 10057, 23057, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:15:34', '2021-12-09 11:15:34'),
(29123, 10057, 23057, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:42:21', '2021-12-16 14:42:21'),
(29124, 10057, 23057, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:27:02', '2021-12-22 11:27:02'),
(29125, 10057, 23057, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:56:27', '2021-12-29 11:56:27'),
(29126, 20067, 23057, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:42:49', '2022-01-12 17:42:49'),
(29127, 20067, 23057, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 16:59:28', '2022-01-18 16:59:28'),
(29128, 20067, 23057, NULL, '2022-02-10 00:00:00.000', 'In Process', 'Application submitted through portal. Case Number: 7901313    Submitter Name: Steve Albert Date of Submission: 02/03/2022    TIN: 27-0796429    Provider Name: Stephen, Ani Group Name: Normandy Urgent Care Center Inquiry Type: Credentialing Status • Application Status    Priority: Standard', NULL, NULL, '2022-02-03 13:56:27', '2022-02-03 13:56:27'),
(29129, 20067, 23057, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Sub: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Good Evening!  Hope this email finds you well. I want to add the listed locations under mentioned providers attached are the W9 for both locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Ani Stephen	1588959118	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Ani Stephen	1588959118	779 Normandy St Ste 114 Houston , TX 77015-3441 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	779 Normandy St Ste 114 Houston , TX 77015-3441 Sigi Paul	1033623616	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Sigi Paul	1033623616	779 Normandy St Ste 114 Houston , TX 77015-3441 James Piccione JR	1356321509	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 James Piccione JR	1356321509	779 Normandy St Ste 114 Houston , TX 77015-3441    Thank you,', NULL, NULL, '2022-03-09 16:58:10', '2022-03-09 16:58:10'),
(29130, 22077, 23057, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: 	Re: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Hi,  Any update on the previously mentioned request?  I am looking forward to your kind response,  Thanks & regards, Alex. ', NULL, NULL, '2022-04-15 14:56:48', '2022-04-15 14:56:48'),
(29131, 19067, 23057, NULL, '2022-04-29 00:00:00.000', 'Not Eligible', 'The provider is no longer with the group.', NULL, NULL, '2022-04-22 11:26:29', '2022-04-22 11:26:29'),
(29132, 3046, 23058, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:44:50', '2021-03-18 08:44:50'),
(29133, 3040, 23058, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:23:23', '2021-05-28 16:23:23'),
(29134, 3040, 23058, NULL, '2021-06-24 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-06-17 09:48:32', '2021-06-17 09:48:32'),
(29135, 3046, 23059, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:55:46', '2021-03-18 08:55:46'),
(29136, 3040, 23059, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 15:47:37', '2021-06-02 15:47:37'),
(29137, 3040, 23059, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under 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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 2:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-10 09:25:02', '2021-06-10 09:25:02'),
(29138, 3040, 23059, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings,   Hope you are doing well. Please find the attached Individual Provider Contracting form as per above requested email for the below mentioned providers 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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider 1: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 2:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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, '2021-06-29 10:06:04', '2021-06-29 10:06:04');
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
(29139, 3040, 23059, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health 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# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:33', '2021-07-16 17:05:33'),
(29140, 11056, 23059, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:56:26', '2021-08-12 08:56:26'),
(29141, 10057, 23059, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in Superior Health in our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Chennemkara, Mini Philip	1841755956 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Thomas, Cini	1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks & Regards,', NULL, NULL, '2021-10-07 11:29:23', '2021-10-07 11:29:23'),
(29142, 10057, 23059, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello Veronica,  Hope this email finds you in good health. Can you please check the below mentioned remaining providers status along with the facility group contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Joseph, Molly - NUCC - IVUC - LPMC	1396380077 PAUL, SIGI - IVUC - LPMC	1033623616 Jacob, Jaya - IVUC - LPMC	1194336149  Kindly get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-22 11:41:16', '2021-11-22 11:41:16'),
(29143, 10057, 23059, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #69503 for Normandy Urgent Care Center and #69505 for Longpoint Medical Center.   Thank you,  Lionel Negrete Provider Account Manager', NULL, NULL, '2021-11-23 10:07:50', '2021-11-23 10:07:50'),
(29144, 10057, 23059, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello,  Can I get the update on provider Sigi Paul & Molly Joseph enrollment status?  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-03 15:58:01', '2021-12-03 15:58:01'),
(29145, 10057, 23059, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Called to check the status: 800-656-4817. Still in the process.  Need to check after 10 days.  Call Reference - 71689 - TIM', NULL, NULL, '2021-12-10 14:55:26', '2021-12-10 14:55:26'),
(29146, 10057, 23059, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Will Follow-up in Next Week.  Please see previous Call Comments. Thank you', NULL, NULL, '2021-12-17 10:59:03', '2021-12-17 10:59:03'),
(29147, 10057, 23059, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello Steve,  I hope this message finds you well.  Please find below the information requested.  Group Name:  NORMANDY URGENT CARE CENTER PA  TIN:  270796429  Provider(s):   MOLLY JOSEPH, NPI:  1396380077, contract status- pending completion.  Tentative effective date:  01/01/2022 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  09/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  10/01/2021  Group Name:  LONG POINT MEDICAL CENTER  TIN:  760612416  MOLLY JOSEPH, NPI:  1396380077, contract complete.  Effective date:  07/01/2021 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  07/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  07/01/2021.  Happy Holidays.  Thank you, Yvette Hernandez', NULL, NULL, '2021-12-23 10:54:27', '2021-12-23 10:54:27'),
(29148, 10057, 23059, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Thank you for your response Yvette. Is there any way that I can get welcome letters for all of them?  I really appreciate your kind assistance. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:17:29', '2021-12-30 13:17:29'),
(29149, 19067, 23059, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505     Good afternoon Steve,     Thank you for your email. Unfortunately, our department does not disperses Welcome Letters for providers.     I have sent our ECM team with your request to have welcome letters be issued out to you. Please await on a response from them with letters requested.    Thank you,   Yesenia Prado  Provider Account Manager  Nueces, Harris & Jefferson SDA', NULL, NULL, '2022-01-03 17:47:42', '2022-01-03 17:47:42'),
(29150, 20067, 23059, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@SuperiorHealthPlan.com  Sub: Fwd: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Hope this email finds you well.Any update on the previously mentioned request.  Thanks and regards Syed Ahad. ', NULL, NULL, '2022-01-12 15:22:54', '2022-01-12 15:22:54'),
(29151, 20067, 23059, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Sub:  [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505   Good afternoon,      This issue was resolved and Welcome Letters were sent out to provider on 1/7/2022. See attached email.        Thank you,', NULL, NULL, '2022-01-18 18:01:37', '2022-01-18 18:01:37'),
(29152, 20067, 23059, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good Morning!  I would like to know the effective date of the below mentioned Groups and Providers. Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 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 Jaya Jacob	1194336149 SIGI PAUL	1033623616  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-28 11:27:46', '2022-01-28 11:27:46'),
(29153, 20067, 23059, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: ${SECURE}{secure} RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good Afternoon!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-mentioned providers. Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Sigi Paul	1033623616 Jeny John	1073019493  Thank you,', NULL, NULL, '2022-03-02 12:10:35', '2022-03-02 12:10:35'),
(29154, 20067, 23059, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505   Good Afternoon!  Hope this email finds you well. I would like to know the status of the Listed providers with mentioned locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jeny John	1073019493	779 Normandy St Ste 114 Houston , TX 77015-3441 Sigi Paul	1033623616	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Thank you, Syed.', NULL, NULL, '2022-03-18 15:21:49', '2022-03-18 15:21:49'),
(29155, 20067, 23059, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email received from: txps-coord@superiorhealthplan.com  Sub: RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello,     Thank you for contacting Superior Health Plan. Your reference# is R-16163706.     Below is the requested credentialing status under Tax ID  270796429.     Provider Name:  Jeny John  Provider NPI: 1073019493  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Effective date: 04/01/2022  We do show this address on file for this provider. Please allow up to  30 days to receive a welcome letter.     Provider Name:  Jeny John  Provider NPI: Jeny John  Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Effective date: 04/01/2022  We do show this address on file for this provider. Please allow up to  30 days to receive a welcome letter.     Provider Name:  Sigi Paul  Provider NPI: 1033623616  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  We do not show this address on file for this provider. Should you  have additional questions or concerns, please contact your regional  account manager at AM.Houston@superiorhealthplan.com.     Provider Name:  Jaya Jacob  Provider NPI: 1194336149  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 7706  We do not show this address on file for this provider. Should you  have additional questions or concerns, please contact your regional  account manager at AM.Houston@superiorhealthplan.com.', NULL, NULL, '2022-03-22 13:07:52', '2022-03-22 13:07:52'),
(29156, 20067, 23059, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Demographic Update || Providers || NUCC & IVUC || SHP  Good Afternoon!  I would like to add the secondary location for the below-listed providers. Attached is the W9 of the location.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Sigi Paul	1033623616   Thank you,', NULL, NULL, '2022-03-22 13:13:00', '2022-03-22 13:13:00'),
(29157, 3046, 23060, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:55:47', '2021-03-18 08:55:47'),
(29158, 3040, 23060, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Superior Healthplan. Please see attachment. ', NULL, NULL, '2021-05-21 09:04:59', '2021-05-21 09:04:59'),
(29159, 3046, 23061, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:55:49', '2021-03-18 08:55:49'),
(29160, 3040, 23061, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Superior Healthplan. Please see attachment. ', NULL, NULL, '2021-05-21 08:45:12', '2021-05-21 08:45:12'),
(29161, 3046, 23062, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:55:50', '2021-03-18 08:55:50'),
(29162, 3040, 23062, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Superior Healthplan. Please see attachment. ', NULL, NULL, '2021-05-21 08:50:26', '2021-05-21 08:50:26'),
(29163, 3046, 23063, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:55:51', '2021-03-18 08:55:51'),
(29164, 3040, 23063, NULL, '2021-05-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-21 14:11:17', '2021-05-21 14:11:17'),
(29165, 3040, 23063, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject:  Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under 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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 2:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-10 12:47:45', '2021-06-10 12:47:45'),
(29166, 3040, 23063, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings,   Hope you are doing well. Please find the attached Individual Provider Contracting form as per above requested email for the below mentioned providers 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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider 1: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 2:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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, '2021-06-28 17:09:01', '2021-06-28 17:09:01'),
(29167, 3040, 23063, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health 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# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:26', '2021-07-16 17:05:26'),
(29168, 11056, 23063, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:56:20', '2021-08-12 08:56:20'),
(29169, 3040, 23063, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings Brittney,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Superior Health 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# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thank you   ', NULL, NULL, '2021-08-27 11:53:12', '2021-08-27 11:53:12'),
(29170, 3040, 23063, NULL, '2021-09-16 00:00:00.000', 'Approved', 'Email rcvd from: ECMExecutionTeam@superiorhealthplan.com  Subject: Fwd: MINI PHILIP CHENNEMKARA WELCOME LETTER  MINI PHILIP CHENNEMKARA  NORMANDY URGENT CARE CENTER PA  ASK@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: 08/01/2021                                                    C/ 53561', NULL, NULL, '2021-09-09 14:01:10', '2021-09-09 14:01:10'),
(29171, 3046, 23064, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:55:52', '2021-03-18 08:55:52'),
(29172, 3040, 23064, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and the effective date is 11/01/2020 ', NULL, NULL, '2021-05-21 09:21:40', '2021-05-21 09:21:40'),
(29173, 3046, 23065, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:55:56', '2021-03-18 08:55:56'),
(29174, 3040, 23065, NULL, '2021-05-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-21 14:12:12', '2021-05-21 14:12:12'),
(29175, 3040, 23065, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under 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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 2:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-10 09:25:33', '2021-06-10 09:25:33'),
(29176, 3040, 23065, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings,   Hope you are doing well. Please find the attached Individual Provider Contracting form as per above requested email for the below mentioned providers 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# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider 1: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 2:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  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, '2021-06-28 17:09:10', '2021-06-28 17:09:10'),
(29177, 3040, 23065, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health 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# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:30', '2021-07-16 17:05:30'),
(29178, 11056, 23065, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:56:13', '2021-08-12 08:56:13'),
(29179, 3040, 23065, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings Brittney,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Superior Health 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# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thank you   ', NULL, NULL, '2021-08-27 11:53:18', '2021-08-27 11:53:18'),
(29180, 12062, 23065, NULL, '2021-09-27 00:00:00.000', 'In Process', 'sent Collaborating Physicians Addendum  as requested on below mail. from :shaqueetta.blanchard@SuperiorHealthPlan.com  Sent mail is attached in attachments  Subject:Re: OutreachAttempt#2: Credentialing Request; Jaya Jacob_1194336149 Good afternoon,  I attempted to call today and was advised that the credentialing contact was not in. I have received a response in regards to the providers missing information. May you assist with information in order to avoid delay in credentialing.    We received your credentialing application for Jaya Jacob;  however, we did not receive all of the documentation necessary to complete the credentialing process.  Please submit the information marked below: ☐ Collaborating Physicians Addendum                                   *Piccione,James is not currently contracted.   You may fax or email the requested information to the contact information listed below.   Fax: 866-702-4831               Phone: 1-800-820-5686   Thank you, Renay Blanchard Credentialing Specialist | Superior Health Plan Image 5900 Ben White Blvd  Austin, TX 78741 Phone: 800-218-7453 Ext 89185 Fax: 866-702-4831 shaqueetta.blanchard@SuperiorHealthPlan.com  ', NULL, NULL, '2021-09-20 09:34:21', '2021-09-20 09:34:21'),
(29181, 12062, 23065, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Received  below email ;  From:Credentialing@superiorhealthplan.com  Subject : RE: OutreachAttempt#2: Credentialing Request; Jaya Jacob_1194336149  Good afternoon,              I am currently reflecting that this provider is awaiting approval by the medical director. If all goes well, the anticipated effective date will be 10/01/2021.   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 ', NULL, NULL, '2021-09-21 12:42:35', '2021-09-21 12:42:35'),
(29182, 10057, 23065, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings for the day!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-10-18 09:54:21', '2021-10-18 09:54:21'),
(29183, 10057, 23065, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello Veronica,  Hope this email finds you in good health. Can you please check the below mentioned remaining providers status along with the facility group contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Joseph, Molly - NUCC - IVUC - LPMC	1396380077 PAUL, SIGI - IVUC - LPMC	1033623616 Jacob, Jaya - IVUC - LPMC	1194336149  Kindly get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-22 11:41:10', '2021-11-22 11:41:10'),
(29184, 10057, 23065, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #69503 for Normandy Urgent Care Center and #69505 for Longpoint Medical Center.   Thank you,  Lionel Negrete Provider Account Manager', NULL, NULL, '2021-11-23 10:07:02', '2021-11-23 10:07:02'),
(29185, 10057, 23065, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello,  Can I get the update on provider Sigi Paul & Molly Joseph enrollment status?  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-03 15:57:55', '2021-12-03 15:57:55'),
(29186, 10057, 23065, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Called to check the status: 800-656-4817. Still in the process.  Need to check after 10 days.  Call Reference - 71689 - TIM', NULL, NULL, '2021-12-10 14:55:20', '2021-12-10 14:55:20'),
(29187, 10057, 23065, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Will Follow-up in Next Week.  Please see previous Call Comments. Thank you', NULL, NULL, '2021-12-17 10:58:57', '2021-12-17 10:58:57'),
(29188, 10057, 23065, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello Steve,  I hope this message finds you well.  Please find below the information requested.  Group Name:  NORMANDY URGENT CARE CENTER PA  TIN:  270796429  Provider(s):   MOLLY JOSEPH, NPI:  1396380077, contract status- pending completion.  Tentative effective date:  01/01/2022 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  09/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  10/01/2021  Group Name:  LONG POINT MEDICAL CENTER  TIN:  760612416  MOLLY JOSEPH, NPI:  1396380077, contract complete.  Effective date:  07/01/2021 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  07/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  07/01/2021.  Happy Holidays.  Thank you, Yvette Hernandez', NULL, NULL, '2021-12-23 10:54:22', '2021-12-23 10:54:22'),
(29189, 10057, 23065, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Thank you for your response Yvette. Is there any way that I can get welcome letters for all of them?  I really appreciate your kind assistance. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:17:24', '2021-12-30 13:17:24'),
(29190, 19067, 23065, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505     Good afternoon Steve,     Thank you for your email. Unfortunately, our department does not disperses Welcome Letters for providers.     I have sent our ECM team with your request to have welcome letters be issued out to you. Please await on a response from them with letters requested.    Thank you,   Yesenia Prado  Provider Account Manager  Nueces, Harris & Jefferson SDA', NULL, NULL, '2022-01-03 17:47:52', '2022-01-03 17:47:52'),
(29191, 20067, 23065, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@SuperiorHealthPlan.com  Sub: Fwd: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Hope this email finds you well.Any update on the previously mentioned request.  Thanks and regards Syed Ahad. ', NULL, NULL, '2022-01-12 15:22:43', '2022-01-12 15:22:43'),
(29192, 20067, 23065, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Sub:  [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505   Good afternoon,      This issue was resolved and Welcome Letters were sent out to provider on 1/7/2022. See attached email.        Thank you,', NULL, NULL, '2022-01-18 18:01:29', '2022-01-18 18:01:29'),
(29193, 20067, 23065, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good Morning!  I would like to know the effective date of the below mentioned Groups and Providers. Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 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 Jaya Jacob	1194336149 SIGI PAUL	1033623616  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-28 11:27:52', '2022-01-28 11:27:52'),
(29194, 20067, 23065, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: ${SECURE}{secure} RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good Afternoon!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-mentioned providers. Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Sigi Paul	1033623616 Jeny John	1073019493  Thank you,', NULL, NULL, '2022-03-02 12:10:42', '2022-03-02 12:10:42'),
(29195, 20067, 23065, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505   Good Afternoon!  Hope this email finds you well. I would like to know the status of the Listed providers with mentioned locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jeny John	1073019493	779 Normandy St Ste 114 Houston , TX 77015-3441 Sigi Paul	1033623616	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Thank you, Syed.', NULL, NULL, '2022-03-18 15:21:43', '2022-03-18 15:21:43'),
(29196, 20067, 23065, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email received from: txps-coord@superiorhealthplan.com  Sub: RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello,     Thank you for contacting Superior Health Plan. Your reference# is R-16163706.     Below is the requested credentialing status under Tax ID  270796429.     Provider Name:  Jeny John  Provider NPI: 1073019493  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Effective date: 04/01/2022  We do show this address on file for this provider. Please allow up to  30 days to receive a welcome letter.     Provider Name:  Jeny John  Provider NPI: Jeny John  Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Effective date: 04/01/2022  We do show this address on file for this provider. Please allow up to  30 days to receive a welcome letter.     Provider Name:  Sigi Paul  Provider NPI: 1033623616  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  We do not show this address on file for this provider. Should you  have additional questions or concerns, please contact your regional  account manager at AM.Houston@superiorhealthplan.com.     Provider Name:  Jaya Jacob  Provider NPI: 1194336149  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 7706  We do not show this address on file for this provider. Should you  have additional questions or concerns, please contact your regional  account manager at AM.Houston@superiorhealthplan.com.', NULL, NULL, '2022-03-22 13:07:41', '2022-03-22 13:07:41'),
(29197, 20067, 23065, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Demographic Update || Providers || NUCC & IVUC || SHP  Good Afternoon!  I would like to add the secondary location for the below-listed providers. Attached is the W9 of the location.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Sigi Paul	1033623616   Thank you,', NULL, NULL, '2022-03-22 13:12:55', '2022-03-22 13:12:55'),
(29198, 22077, 23065, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject:  Demographic Update || Providers || NUCC & IVUC || SHP #87031  Hello,        The W9 that was sent in is outdated. Per the cred team, it must be dated within the last six months. Please send in an updated w9 so that we can have this completed.     Adriano Garcia; CPhT', NULL, NULL, '2022-04-07 14:22:49', '2022-04-07 14:22:49'),
(29199, 22077, 23065, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: 	Re: Demographic Update || Providers || NUCC & IVUC || SHP #87031  Hi,  Attached is the updated W9 as requested.  Thanks', NULL, NULL, '2022-04-07 14:24:26', '2022-04-07 14:24:26'),
(29200, 22077, 23065, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: RE: Demographic Update || Providers || NUCC & IVUC || SHP #87031  Thank you. this has been forwarded to the team for review.', NULL, NULL, '2022-04-08 07:39:20', '2022-04-08 07:39:20'),
(29201, 3046, 23066, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:55:57', '2021-03-18 08:55:57'),
(29202, 3040, 23066, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider is now showing linked with insurance and effective date is 11/01/2020 ', NULL, NULL, '2021-05-21 10:15:41', '2021-05-21 10:15:41'),
(29203, 3046, 23067, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:55:59', '2021-03-18 08:55:59'),
(29204, 3040, 23067, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Superior Healthplan. Please see attachment. ', NULL, NULL, '2021-05-21 10:25:08', '2021-05-21 10:25:08'),
(29205, 3046, 23068, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:56:01', '2021-03-18 08:56:01'),
(29206, 3040, 23068, NULL, '2021-05-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-21 14:10:33', '2021-05-21 14:10:33'),
(29207, 3040, 23068, NULL, '2021-06-17 00:00:00.000', 'Approved', 'Provider added under the location. Please see attachment. ', NULL, NULL, '2021-06-10 09:18:42', '2021-06-10 09:18:42'),
(29208, 3046, 23069, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:56:02', '2021-03-18 08:56:02');
