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
(47637, 11056, 31593, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:56:53', '2021-08-11 13:56:53'),
(47638, 3040, 31593, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:27:52', '2021-09-07 16:27:52'),
(47639, 10057, 31593, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:51:20', '2021-10-19 11:51:20'),
(47640, 10057, 31593, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-11-22 14:13:15', '2021-11-22 14:13:15'),
(47641, 10057, 31593, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 15:10:03', '2021-12-02 15:10:03'),
(47642, 10057, 31593, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:19:18', '2021-12-09 13:19:18'),
(47643, 10057, 31593, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:09:36', '2021-12-17 14:09:36'),
(47644, 10057, 31593, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:20:27', '2021-12-23 11:20:27'),
(47645, 10057, 31593, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:52:48', '2021-12-30 13:52:48'),
(47646, 20067, 31593, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare   Hello,  Hope you are doing great. I would like to know the enrollment status of the below-mentioned providers under these locations, and if any of the provider is enrolled kindly send me the welcome letter.  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 Glory Abraham	1194206490 Jeena Abraham	1467901587 Brittany Brown	1275163537 Mini Chennemkara	1841755956 Limy Fernandus	1972005189 Jeemol George	1497219067 Jaya Jacob	1194336149 Jeny John	1073019493 Julie Jose	1447883061 Molly Joseph	1396380077 Vibitha Joseph	1952931560 Odette Kourouma	1134525868 SIGI PAUL	1033623616 James Piccione JR	1356321509 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-06 12:29:34', '2022-01-06 12:29:34'),
(47647, 20067, 31593, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Good afternoon!  Hope you are doing well. Any update on the previous request? Your Early response will be highly appreciated  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 16:37:04', '2022-01-14 16:37:04'),
(47648, 20067, 31593, NULL, '2022-01-27 00:00:00.000', 'Approved', 'Received the following email from: ashley.stevens@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Please see welcome letter attached for roster of par providers.  Effective Date: 11/19/2021 Attached is the group roster and welcome letter for the provider', NULL, NULL, '2022-01-20 17:19:43', '2022-01-20 17:19:43'),
(47649, 3040, 31594, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47650, 1005, 31594, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:46:14', '2021-06-07 16:46:14'),
(47651, 11056, 31594, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Railroad Medicare PTAN has been assigned. Please allow three business days for the activation of this new PTAN. Please see the attachment Ref no : 21180001174', NULL, NULL, '2021-06-29 14:22:53', '2021-06-29 14:22:53'),
(47652, 3040, 31594, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	MOLLY JOSEPH NP PROVIDER PTAN	Q00092288 PROVIDER NPI	1396380077 EFFECTIVE DATE	05/01/2021 END DATE	', NULL, NULL, '2021-07-12 09:13:21', '2021-07-12 09:13:21'),
(47653, 3040, 31595, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47654, 3040, 31595, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Enrollment Tracking Information Applicant Name: MOLLY JOSEPH  Tracking ID: T060720210004282  Reassignment Tracking ID: T060720210004394  Submitted Date: MON - JUNE 07 2021 06:18:22 PM EST  Submitted By: Molly joseph  Contact Email(s): NUCC@CLAIMSMEDINC.COM MOLLYJOSEPH60@YAHOO.COM', NULL, NULL, '2021-06-07 17:19:44', '2021-06-07 17:19:44'),
(47655, 3040, 31595, NULL, '2021-06-29 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: MOLLY JOSEPH Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1396380077 Individual Provider Transaction Access Number (PTAN): 1Q2511 Group Legal Business Name (LBN): NORMANDY URGENT CARE CENTER PA Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: MAY 01, 2021', NULL, NULL, '2021-06-22 14:17:30', '2021-06-22 14:17:30'),
(47656, 3040, 31596, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47657, 3040, 31596, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:Dmarley@ghn-mci.com  Subject:Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Galaxy Health ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: 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 Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 19:03:39', '2021-06-07 19:03:39'),
(47658, 3040, 31596, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Hello Adil,  I am writing you in response to an e-mail that you sent requesting to add providers to Normandy Urgent Care and Imperial Valley Urgent Care.  After review, I do show a contract for Normandy Urgent Care and if that group wishes your company, Claims Med Inc to be able to add providers etc. then you will need to return written notice signed by an authorized signatory of the group stating that your company Claims Med Inc is authorized to add new providers, etc. to their agreement. We will also need full credentialing for all new providers. This information can be faxed to 1-800-645-0154 for processing.  I do not show an agreement for Imperial Valley Urgent Care. If this group would like a contract, please let me know, however, can you please confirm that these two different groups are using the same tin? If this is to be the case the providers will have to submit written notice for one group affiliation to take precedence over the other.  Please do not hesitate to contact me with any question or concerns I am happy to help.  Thanks,  Daniel M. Contract Specialist Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-06-15 14:36:21', '2021-06-15 14:36:21'),
(47659, 3040, 31596, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com  Subject: Normandy Urgent Care  Greetings,  Hope you are doing well. Please find attached Letter of intent to enroll the providers in Galaxy Health. They requested the authorized person\'s signature on the letterhead in which it stated we need to enroll the providers individually with Galaxy Health. For your reference please review the above email.   Kindly sign it and send it back to me so we can start the credentialing process.   Thank you ', NULL, NULL, '2021-07-05 10:03:48', '2021-07-05 10:03:48'),
(47660, 3040, 31596, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Normandy Urgent Care   Hello Daniel,   Hope you are doing well. As per our phone conversation please find below the list of the providers and see which providers are participating with Galaxy Health and need the effective date. For the remaining providers please send me the credentialing application form so I can fill it out and send it through fax.  Also advise that below mentioned addresses are updated in the contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-22 10:01:16', '2021-07-22 10:01:16'),
(47661, 11056, 31596, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health.  Thanks, Daniel M. Contract Specialist  Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-08-12 11:39:26', '2021-08-12 11:39:26'),
(47662, 10057, 31596, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:38:53', '2021-10-08 10:38:53'),
(47663, 10057, 31596, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-09 15:24:45', '2021-11-09 15:24:45'),
(47664, 10057, 31596, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 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 Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:37:11', '2021-11-30 13:37:11'),
(47665, 10057, 31596, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-06 17:46:47', '2021-12-06 17:46:47'),
(47666, 10057, 31596, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-13 12:50:49', '2021-12-13 12:50:49'),
(47667, 10057, 31596, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:15:23', '2021-12-20 13:15:23'),
(47668, 10057, 31596, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-27 11:24:29', '2021-12-27 11:24:29'),
(47669, 19067, 31596, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Galaxy Health.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:40:19', '2022-01-04 17:40:19'),
(47670, 20067, 31596, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Afternoon! Hope this email finds you in good health.Any update on the below mentioned request?  Your Early response will be highly appreciated Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-14 15:27:17', '2022-01-14 15:27:17'),
(47671, 20067, 31596, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Morning!   Hope you had a great weekend. Kindly update me on the previous request which was sent on 01/04/2022.  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-24 10:04:04', '2022-01-24 10:04:04'),
(47672, 20067, 31596, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com,   Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good afternoon!  This is my SECOND REMINDER on the previous request. Kindly respond promptly  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 16:03:48', '2022-02-02 16:03:48'),
(47673, 20067, 31596, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Good Afternoon!  Hope this email finds you well. I would like to know the enrollment status of the group and providers below.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Thank you,', NULL, NULL, '2022-03-01 15:07:10', '2022-03-01 15:07:10'),
(47674, 20067, 31596, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Karen Avalos, Daniel Marley, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hello!  Kindly update me on the request which was sent on 03/01/2022.  Thank you, Syed ', NULL, NULL, '2022-03-17 17:59:50', '2022-03-17 17:59:50'),
(47675, 22077, 31596, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: \"dmarley@ghn-mci.com,kavalos@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-15 08:02:44', '2022-04-15 08:02:44'),
(47676, 22077, 31596, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Subject: RE: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Dear Alex,     Please be advised that I am currently working with Syed Ahad to resolve issues with the Long Point Medical Center Agreement. Once those issues are resolved then we can move forward and address issues with your company’s other groups.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-04-19 13:15:48', '2022-04-19 13:15:48'),
(47677, 22077, 31596, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Unfortunately, Syed Ahad no longer works here, I will be handling the credentialing now. Do update me about the queries and whenever you want some document or information I\'d be happy to assist you on that.', NULL, NULL, '2022-04-19 13:27:05', '2022-04-19 13:27:05'),
(47678, 3040, 31597, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47679, 3040, 31597, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:SWHPEXPEDITES@bswhealth.org  Subject:Enroll Providers || Longpoint Medical Center || Providers || Scott & White ||   Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: 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 Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:50:05', '2021-06-07 18:50:05'),
(47680, 3040, 31597, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Success! Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 8bdf2a63-e978-4741-81a8-f1070c4dfb2a', NULL, NULL, '2021-06-18 11:24:05', '2021-06-18 11:24:05'),
(47681, 3040, 31597, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:08', '2021-07-08 09:49:08'),
(47682, 3040, 31597, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202   Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:44', '2021-07-28 16:43:44'),
(47683, 11056, 31597, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:47:49', '2021-08-09 14:47:49'),
(47684, 3040, 31597, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Email rcvd from: SWHPEXPEDITES@bswhealth.org  Subject: To add Joseph, Stephen, Piccione, Paul, Jacob, Fernandus, Chennemkara, Brown, Abraham, Abraham and John to Normandy Urgent Care Center  The provider information for Molly Joseph, Ani Stephen, James Piccione, Sigi Paul, Jaya Jacob, Limy Fernandus, Mini Chennemkara, Brittany Brown, Jeena Abraham, Glory Abraham and Jeny John to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 9/7/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.  Note:  For the RightCare (Medicaid) line of business:  If an active/attested TPI is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicaid RightCare Members until one is provided.    For the Medicare line of business: If an active Medicare/PTAN is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicare Members until one is provided.  Please email the Medicare/TPI once available to:  SWHPEXPEDITES@BSWHealth.org     Thank you and have a great day. Provider Services', NULL, NULL, '2021-08-25 08:43:57', '2021-08-25 08:43:57'),
(47685, 3040, 31598, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47686, 1005, 31598, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:49:01', '2021-06-07 16:49:01'),
(47687, 3040, 31598, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to:  AM.Houston@superiorhealthplan.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Health plan in our group under the below locations.   Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan 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: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 08:37:10', '2021-07-15 08:37:10'),
(47688, 11056, 31598, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:28:53', '2021-08-13 16:28:53'),
(47689, 3040, 31598, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Hello,  I wanted to know the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616    Provider 3: Provider Name: Joseph, Molly Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-08-27 16:43:27', '2021-08-27 16:43:27'),
(47690, 10057, 31598, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status Query - CUCC - Tricare  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in Ambetter.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Piccione JR, James M	1356321509 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Your earliest response will be highly appreciated. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 15:23:53', '2021-10-11 15:23:53'),
(47691, 10057, 31598, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good Morning,  Hope you are doing well. Could you please provide me with the latest enrollment updates on the below mentioned provider with all locations as per mentioned TIN\'s.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Joseph, Molly	1396380077  Please get to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-18 10:56:37', '2021-11-18 10:56:37'),
(47692, 10057, 31598, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hi,  At this time all requested information has been received for Molly Joseph (TIN: 270796429, NPI: 1396380077) and they are still being credentialed. Please reference ticket # 69130 if you have any questions.  Sincerely, Barbara McDonald  Account Manager, Provider Relations Region 7 (Harris & Jefferson) ', NULL, NULL, '2021-11-19 10:08:32', '2021-11-19 10:08:32'),
(47693, 10057, 31598, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Thank you for the update. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-01 10:00:11', '2021-12-01 10:00:11');
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
(47694, 10057, 31598, NULL, '2021-12-17 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, '2021-12-08 09:33:19', '2021-12-08 09:33:19'),
(47695, 10057, 31598, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings!  Any update on the below request. This is my second reminder.  Looking forward to your early response.  Thanks & Regards,', NULL, NULL, '2021-12-16 10:06:55', '2021-12-16 10:06:55'),
(47696, 10057, 31598, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good afternoon,  Your email was received. Your Account Manager will be contacting you to address your request. When contacting the Account Manager for updates on your issue, you can use this reference number #72511. If you need immediate assistance you can call to speak to an Account Manager by calling 1-800-656-4817 (English 1, Spanish 2) and option #3 for Provider Relations Team.  Thank you,  Teresa Rios Provider Account Manager', NULL, NULL, '2021-12-23 09:36:02', '2021-12-23 09:36:02'),
(47697, 10057, 31598, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello Teresa,  Thank you for your response. 2 weeks have passed and no one reached out.to me with the update. Please do the needful.  Looking forward to hearing from you.  Regards,', NULL, NULL, '2021-12-30 11:03:28', '2021-12-30 11:03:28'),
(47698, 20067, 31598, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||   Good Morning,  Hope you are doing well. I want to know the enrollment status of the below-mentioned provider under these 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 Molly Joseph	1396380077   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 09:59:55', '2022-01-06 09:59:55'),
(47699, 20067, 31598, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Sub: Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello Syed,  The provider is effective 1/1/2022 and is listed with both of those address you provided below.     Timothy Do  Provider Account Manager II  Region 7 (Harris & Jefferson)', NULL, NULL, '2022-01-11 15:50:31', '2022-01-11 15:50:31'),
(47700, 20067, 31598, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received to: AM.Houston@superiorhealthplan.com  Sub: Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  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 #75028        If you are in need of immediate assistance, you can call to speak to an Account Manager by phone at 1-800-656-4817 (English 1, Spanish 2), and Option 3  Provider Relations Team     Provider Services is available to help answer questions on claim payments, rejections, denials, to verify eligibility or for help escalating any issues you may have, M-F 8:00 a.m. CST – 6:00 p.m. CST. For claims related questions, be sure to have your claim number available.     Allwell  1-877-391-5921  Ambetter  1-877-687-1196  STAR, MRSA, CHIP, RSA, STAR+PLUS and STAR Kids  1-877-391-5921  STAR Health  1-866-439-2042                                            Adriano Garcia; CPhT  Provider Account Manager  Region 7 (Harris & Jefferson)', NULL, NULL, '2022-01-11 15:52:48', '2022-01-11 15:52:48'),
(47701, 20067, 31598, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good Afternoon!  Greetings,  No one has reached me till yet, kindly send me the welcome kit for Provider Joseph Molly.  Eagerly waiting for your response, Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-18 14:44:32', '2022-01-18 14:44:32'),
(47702, 20067, 31598, NULL, '2022-02-03 00:00:00.000', 'Approved', 'Received the following Email  Hello Syed,  The provider is effective 1/1/2022 and is listed with both of those address you provided below.', NULL, NULL, '2022-01-27 14:45:44', '2022-01-27 14:45:44'),
(47703, 3040, 31599, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47704, 3040, 31599, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject:Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || TRPN ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: 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 Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:47:00', '2021-06-07 18:47:00'),
(47705, 11056, 31599, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067    Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-16 17:05:11', '2021-06-16 17:05:11'),
(47706, 3040, 31599, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group under the below mentioned locations. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429  Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:- Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067   Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI : 1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 15:25:34', '2021-07-05 15:25:34'),
(47707, 3040, 31599, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Mini Chennemkara is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 03/01/2016,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider James Piccione is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 05/29/2019,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/01/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Jeemol George is Active, effective date 06/09/2020,  Provider Julie Jose is Active, effective date 06/09/2020,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com', NULL, NULL, '2021-07-20 08:32:22', '2021-07-20 08:32:22'),
(47708, 3040, 31600, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47709, 3040, 31600, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-07 18:31:34', '2021-06-07 18:31:34'),
(47710, 3040, 31601, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47711, 3040, 31601, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Christus Spohn||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: 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 Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 19:06:33', '2021-06-07 19:06:33'),
(47712, 3040, 31601, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-18 11:50:00', '2021-06-18 11:50:00'),
(47713, 3040, 31601, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: 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  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:24:15', '2021-07-06 14:24:15'),
(47714, 3040, 31601, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: 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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you   ', NULL, NULL, '2021-07-27 16:53:30', '2021-07-27 16:53:30'),
(47715, 3040, 31601, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:19', '2021-07-28 11:20:19'),
(47716, 3040, 31602, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47717, 1005, 31602, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare and Cigna\'s Enrollment.', NULL, NULL, '2021-06-07 16:39:50', '2021-06-07 16:39:50'),
(47718, 3040, 31602, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.    ', NULL, NULL, '2021-06-15 09:36:18', '2021-06-15 09:36:18'),
(47719, 3040, 31602, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned 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  Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-22 10:04:25', '2021-07-22 10:04:25'),
(47720, 11056, 31602, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hi Adil,  My apologies, I forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 08:53:01', '2021-08-09 08:53:01'),
(47721, 3040, 31602, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello!  Hope you are doing well. As per conversation with Jennifer she requested to send an email to you. I wanted to know the enrollment status for the below mentioned group as I submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-08-17 09:55:45', '2021-08-17 09:55:45'),
(47722, 10057, 31602, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned groups as we have submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails and let me know the current status of our application.  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  Please feel free to contact or email me if you have any questions or concerns.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:06:06', '2021-10-08 11:06:06'),
(47723, 10057, 31602, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:21:38', '2021-10-14 11:21:38'),
(47724, 10057, 31602, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Could you please provide me with the updated status of my application?  Response is pending since 08/09/2021. Your earliest response will be much appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 16:16:23', '2021-11-18 16:16:23'),
(47725, 10057, 31602, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Good afternoon,  Can you please send me the applications that you submitted?  Thank you.  Regards, Lilien Alvarado, MPA Provider Contracting Lead Analyst Cigna 2800 North Loop West,Ste 400', NULL, NULL, '2021-12-01 11:54:17', '2021-12-01 11:54:17'),
(47726, 10057, 31602, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello Lilien,  Thank you for reaching out to me. Kindly find the attached application for your reference.  Please let me know if you have any questions and revert back to me with the latest updates.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:33:32', '2021-12-08 10:33:32'),
(47727, 10057, 31602, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net & TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Greetings!  Hope this email finds you in good health. I\'m writing this email to check the current status of the below mentioned request.  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  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 11:08:35', '2021-12-16 11:08:35'),
(47728, 10057, 31602, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Received From : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Please see attached communication from Renaissance.  Thank you.', NULL, NULL, '2021-12-22 10:17:42', '2021-12-22 10:17:42'),
(47729, 10057, 31602, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Thank you for reaching out. The attached letter was from Renaissance. We are inquiring about credentialing status for NUCC & IVUC with Cigna Healthspring.  Please get back to me once you get a chance. Have a great day!  Regards,', NULL, NULL, '2021-12-29 11:24:55', '2021-12-29 11:24:55'),
(47730, 19067, 31602, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   Good Morning JoAnn!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060   Kindly respond at your earliest convenience.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-05 11:21:56', '2022-01-05 11:21:56'),
(47731, 19067, 31602, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   For Renaissance you are not contracted.', NULL, NULL, '2022-01-06 16:31:39', '2022-01-06 16:31:39'),
(47732, 20067, 31602, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Could you please tell me for the Renaissance contract what procedure will be followed?  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-14 14:05:51', '2022-01-14 14:05:51'),
(47733, 20067, 31602, NULL, '2022-01-21 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllies', NULL, NULL, '2022-01-14 14:36:12', '2022-01-14 14:36:12'),
(47734, 3040, 31603, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47735, 3040, 31603, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:vipproviders@anci-care.com   Subject:Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Anci Care||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: 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 Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 19:09:32', '2021-06-07 19:09:32'),
(47736, 3040, 31603, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: pdavidson@anci-care.com  Subject: RE: Enroll Providers || Longpoint Medical Center || Providers || Anci Care ||  Hi.  We have this facility contracted under Normandy Urgent Care Center.  This provider is included as long as they bill under the same Tax ID number and facility address.  Thank you,  Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121', NULL, NULL, '2021-06-24 14:58:06', '2021-06-24 14:58:06'),
(47737, 3040, 31603, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual provider. Please see group task. ', NULL, NULL, '2021-07-13 11:36:15', '2021-07-13 11:36:15'),
(47738, 3040, 31604, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47739, 3040, 31604, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:ccnprovider@triwest.com   Subject:Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Triwest ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: 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 Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 19:16:04', '2021-06-07 19:16:04'),
(47740, 3040, 31604, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-06-18 10:12:13', '2021-06-18 10:12:13'),
(47741, 3040, 31604, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Hello Jess,   Can you please check and advise if the below mentioned group is in-network with Triwest or not. If not so can you please generate a contract for the below mentioned group. For your reference I attached the W9.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-20 11:05:00', '2021-07-20 11:05:00'),
(47742, 3040, 31604, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-22 14:31:34', '2021-07-22 14:31:34'),
(47743, 3040, 31605, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47744, 1005, 31605, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Doesnt cover this area.', NULL, NULL, '2021-06-07 17:47:13', '2021-06-07 17:47:13'),
(47745, 3040, 31607, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:34', '2021-06-07 16:17:34'),
(47746, 3040, 31607, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Redundant task not cover under IVUC.', NULL, NULL, '2021-06-08 08:24:49', '2021-06-08 08:24:49'),
(47747, 3040, 31618, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:35', '2021-06-07 16:17:35'),
(47748, 3040, 31618, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:providerservices@renaissancefamily.com   Subject: Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Renaissance Physicians ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: 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 Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:53:19', '2021-06-07 18:53:19'),
(47749, 3040, 31618, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  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 14:39:17', '2021-06-17 14:39:17'),
(47750, 3040, 31618, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com cc:	catherine.chang@careallies.com, shannon.luke@careallies.com,  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  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, '2021-07-05 16:48:22', '2021-07-05 16:48:22'),
(47751, 3040, 31618, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Re: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Hello Alanis,   Hope you are doing well. Do you have any update regarding the enrollment for the below mentioned group and providers.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: 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  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:43:32', '2021-07-26 12:43:32'),
(47752, 11056, 31618, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:26:29', '2021-08-11 16:26:29'),
(47753, 3040, 31618, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:11:44', '2021-08-18 13:11:44'),
(47754, 3040, 31619, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:35', '2021-06-07 16:17:35'),
(47755, 1005, 31619, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:54:17', '2021-06-07 16:54:17'),
(47756, 10057, 31619, NULL, '2022-01-04 00:00:00.000', 'Approved', 'Call Details: (855) 322-4080   Rep: William  Reference # SF 5803071  Effective Date: 09/15/2021', NULL, NULL, '2021-12-28 14:08:02', '2021-12-28 14:08:02'),
(47757, 3040, 31620, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:35', '2021-06-07 16:17:35'),
(47758, 1005, 31620, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll || Imperial Valley Urgent Care Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below location.   Practice Details: Practice Name: 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-07 17:42:04', '2021-06-07 17:42:04'),
(47759, 3040, 31620, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Re: Need to Enroll|| Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,  Hope you are doing well. Please find the attached Prospective Provider Form along with the Letter of Intent for below mentioned providers to enroll in Christus Health Plan in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Tertiary Address: 9504 LONG POINT RD STE E, Houston , TX 77055-4226  Provider 1: 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, '2021-06-22 14:14:12', '2021-06-22 14:14:12');
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
(47760, 11056, 31620, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enroll Request Group & Providers || Normandy Urgent Care Center || Christus Health Plan ||  Greetings,  Hope you are doing well. I want to know enrollment status of the following groups and providers. Respond this as soon as possible.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Providers: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a good day!', NULL, NULL, '2021-06-29 12:54:32', '2021-06-29 12:54:32'),
(47761, 3040, 31620, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:21', '2021-07-19 09:23:21'),
(47762, 3040, 31620, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information please let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:05', '2021-07-28 11:39:05'),
(47763, 11056, 31620, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:06:55', '2021-08-11 17:06:55'),
(47764, 3040, 31620, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:39', '2021-08-17 15:02:39'),
(47765, 3040, 31620, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:38', '2021-09-14 16:14:38'),
(47766, 12062, 31620, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:08:55', '2021-09-22 13:08:55'),
(47767, 10057, 31620, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:37:28', '2021-10-18 16:37:28'),
(47768, 10057, 31620, NULL, '2021-12-02 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good Afternoon,  Hope you are doing well. Can I have the latest update on the below mentioned request. Also welcome letters?  Looking forward to your kind response. Have a great day!   Thanks & Regards,', NULL, NULL, '2021-11-18 13:50:42', '2021-11-18 13:50:42'),
(47769, 10057, 31620, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can I get the update on the below mentioned request, also I have not yet received any welcome letters yet.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-01 10:59:01', '2021-12-01 10:59:01'),
(47770, 10057, 31620, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-14 09:52:34', '2021-12-14 09:52:34'),
(47771, 10057, 31620, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 13:40:56', '2021-12-20 13:40:56'),
(47772, 10057, 31620, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 11:57:03', '2021-12-28 11:57:03'),
(47773, 19067, 31620, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:23:55', '2022-01-04 17:23:55'),
(47774, 19067, 31620, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Sonia.Gonzales@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||     Good Morning All,     Thank you for the request below, I do show contract for USFHP was signed and executed.   Information was sent over to get configuration of contract rates entered.       Once we have this process is completed we can have this sent to Credentialing to get group loaded with effective date.  When I get further updates will pass along!     Please remove Hunter Barrette from communications, unfortunately he is no longer with us, I am covering in the interim.       Thanks and appreciate your patience,     Respectfully,     Sonia D. Gonzales  CHRISTUS Health Plan – Physician Relations Consultant II/ Contracting  505-569-4856  sonia.gonzales@christushealth.org', NULL, NULL, '2022-01-05 11:32:59', '2022-01-05 11:32:59'),
(47775, 20067, 31620, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good Afternoon, Hope this email finds you in good health. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 13:23:12', '2022-01-14 13:23:12'),
(47776, 20067, 31620, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good afternoon! Hope you are doing well. I haven\'t heard from your side, Kindly respond to the previous mail. If the process is complete, kindly send me the contract letter along with the effective date.  Thanks and Regards, Syed Ahad  ', NULL, NULL, '2022-01-21 16:45:17', '2022-01-21 16:45:17'),
(47777, 20067, 31620, NULL, '2022-02-01 00:00:00.000', 'Approved', 'Received the Ancillary contract from Christus Health Plan  Effective Date: 01/01/2022 Expiration Date: 12/31/9999', NULL, NULL, '2022-01-25 17:05:52', '2022-01-25 17:05:52'),
(47778, 3040, 31621, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-09 12:45:57', '2021-06-09 12:45:57'),
(47779, 3040, 31621, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 12:51:20', '2021-06-09 12:51:20'),
(47780, 3040, 31621, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Thank you, I have sent this over to our Updates department to complete.  Best,  Austin Owens Provider Contracting Specialist', NULL, NULL, '2021-06-09 12:52:01', '2021-06-09 12:52:01'),
(47781, 3040, 31621, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject:  Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   Hope you are doing well. I wanted to know if there is any update regarding the enrollment that was requested in my previous email.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 13:01:01', '2021-06-09 13:01:01'),
(47782, 3040, 31621, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   I didn\'t receive any email from your department regarding the request that was sent out 05/20/2021. Can you please check and advise how to proceed with enrollment?  Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-28 13:41:52', '2021-06-28 13:41:52'),
(47783, 3040, 31621, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: updates@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-16 16:49:09', '2021-07-16 16:49:09'),
(47784, 11056, 31621, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	austin.owens@primehealthservices.com  Sub : Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning!  Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 12 : Provider Name : John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!    I have called Prime Health services thrice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:05:28', '2021-08-05 11:05:28'),
(47785, 10057, 31621, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : austin.owens@primehealthservices.com  Sub : Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings for the day!  I wanted to check the current status of the below mentioned providers request, Columbus Urgent Care PA under the below location.  Group Name	Columbus Urgent Care PA Tax ID	47-1914151 Group NPI	1215330501 Primary Location	926 Walnut St, Columbus , TX 78934-2215 Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Rauf, Abdur 	1497726202 Joseph, Vibitha 	1952931560 Abraham, Jeena 	1467901587 PAUL, SIGI 	1033623616 Jacob, Jaya 	1194336149 Joseph, Molly 	1073019493 John, Jeny 	1073019493   If you need any further information please let me know, waiting for your prompt response.  Thanks & Regards,', NULL, NULL, '2021-10-06 12:43:43', '2021-10-06 12:43:43'),
(47786, 10057, 31621, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Sent To :  austin.owens@primehealthservices.com, providerrelations@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Hope you are doing great. I\'m writing this email to get the latest update on below mentioned providers under facility.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-11-09 17:20:23', '2021-11-09 17:20:23'),
(47787, 10057, 31621, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Received From : providerrelations@primehealthservices.com  Sub : Fwd: RE: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning,  Can you please provide that request on official letterhead? Requests for contracts typically come directly from the provider group.  Thanks so much, Provider Relations', NULL, NULL, '2021-11-15 15:48:19', '2021-11-15 15:48:19'),
(47788, 10057, 31621, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : providerrelations@primehealthservices.com updates@primehealthservices.com & austin.owens@primehealthservices.com  Sub : Fwd: RE: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Hope you are doing well. Please find the attached letter for your reference.  Looking forward to your kind response. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-15 15:49:57', '2021-11-15 15:49:57'),
(47789, 10057, 31621, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Email Received From : providerrelations@primehealthservices.com  Sub : Fwd: RE: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good afternoon Steve,  Please see attached contract effective 08/10/2020 per your request.', NULL, NULL, '2021-11-30 14:37:28', '2021-11-30 14:37:28'),
(47790, 3040, 31622, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-18 11:58:31', '2021-06-18 11:58:31'),
(47791, 3040, 31622, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: 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: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 10:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 11:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 12:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 13:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 14:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 15:     Provider Name:  Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 12:07:01', '2021-06-18 12:07:01'),
(47792, 3040, 31622, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Nancy,   Hope you are doing well. Please note that I am sending you the CAQH ID for the providers so you can access them. We already allowed the insurance companies to access the CAQH ID for the providers.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067 CAQH# 14466957  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 CAQH# 14636793  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 CAQH# 12327279  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 CAQH# 11469023  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 CAQH# 14612332   Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 CAQH# 14634461  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 CAQH# 14381983  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 CAQH# 14564137  Provider 9:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 CAQH# 13558256  Provider 10:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 CAQH# 14618053  Provider 11:   Provider Name: Thomas, Cini Provider NPI# 1134777238 CAQH# 14573031  Provider 12:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 CAQH# 13909329  Provider 13:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 CAQH# 15097678  Provider 14:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 CAQH# 15096463  Provider 15:     Provider Name:  Joseph, Molly Provider NPI# 1396380077 CAQH# 15162165  If 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 16:26:07', '2021-07-06 16:26:07'),
(47793, 3040, 31622, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email rcvd from: credentialing@primehealthservices.com  Subject: Re: Re: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hi,  We cannot access CAQH applications.  This is why we are asking for them to be emailed to us.  Thank you, Nancy', NULL, NULL, '2021-07-22 10:59:14', '2021-07-22 10:59:14'),
(47794, 3040, 31622, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Re: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Nancy,   Hope you are doing well. Please find attached the CAQH application as per your previous email requested.   If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 11:01:55', '2021-07-22 11:01:55'),
(47795, 3040, 31622, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: megan.wherry@primehealthservices.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Megan,   Hope you are doing well. Can you please send the roster because I am trying to find out the providers on the Prime Health Services directory and it\'s not showing up.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-14 17:07:55', '2021-09-14 17:07:55'),
(47796, 10057, 31622, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, megan.wherry@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the enrollment status with Prime Health for our providers under the below mentioned practice.  Group Name Longpoint Medical Center Tax ID	76-0612416 Group NPI 1770763815 Primary Location 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI George, Jeemol 1497219067 Jose, Julie1447883061 Stephen, Ani 1588959118 Piccione JR, James M 1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip 1841755956 Abraham, Glory 1194206490 Fernandus, Limy	1972005189 Kourouma , Odette Tiranke1134525868 Joseph, Vibitha	1952931560 Thomas, Cini 1134777238 Abraham, Jeena 1467901587 PAUL, SIGI 1033623616 Jacob, Jaya 1194336149 John, Jeny 1073019493 Joseph, Molly1396380077  Please let me know the updated status. Furthermore, if you have any questions, please feel free to contact me.  Thanks & Regards,', NULL, NULL, '2021-10-19 14:25:38', '2021-10-19 14:25:38'),
(47797, 10057, 31622, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, megan.wherry@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello,  Greetings for the day!  Any update on the below mentioned enrollment request?  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:54:16', '2021-11-22 10:54:16'),
(47798, 10057, 31622, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : providerrelations@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Follow-up Sent.', NULL, NULL, '2021-12-02 14:09:51', '2021-12-02 14:09:51'),
(47799, 10057, 31622, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : providerrelations@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Follow-up Sent.', NULL, NULL, '2021-12-02 14:11:15', '2021-12-02 14:11:15'),
(47800, 10057, 31622, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Good Afternoon,  Please see the attached Credentialing status roster.  The dates given are for Credentialing purposes only and not the effective date.  Please refer inquiries regarding the effective dates, Tax ID links and locations to: updates@primehealthservices.com  Thank you, Nancy', NULL, NULL, '2021-12-15 11:17:15', '2021-12-15 11:17:15'),
(47801, 10057, 31622, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Nancy,  Thank you for the update. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:10:55', '2021-12-22 12:10:55'),
(47802, 10057, 31622, NULL, '2022-01-05 00:00:00.000', 'Approved', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 15:14:38', '2021-12-29 15:14:38'),
(47803, 3040, 31623, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-18 13:17:34', '2021-06-18 13:17:34'),
(47804, 3040, 31623, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 13:23:46', '2021-06-18 13:23:46'),
(47805, 3040, 31623, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com,  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Has there been any update?  Thank you  ', NULL, NULL, '2021-07-07 16:52:12', '2021-07-07 16:52:12'),
(47806, 3040, 31623, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I was trying to reach out to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 11:56:10', '2021-07-22 11:56:10'),
(47807, 11056, 31623, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : Fwd: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Good Morning,  Please see below for the credentialing status for each provider.  The dates given are for credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will assist you with the effective dates.  There are two providers (highlighted) that need to be credentialed.  Please email a current CAQH Credentialing application or State Credentialing application for these providers.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  - In the process of being credentialed.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 - Needs to be credentialed.     Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 - In the process of being credentialed.   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - Last credentialed - 6-23-2020 - Not the effective date - For credentialing purposes only.   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 - In the process of being credentialed.  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 - In the process of being credentialed.   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 - In the process of being credentialed.   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - In the process of being credentialed.   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 - Last credentialed - 7-15-2020 - Not the effective date - For credentialing purposes only.  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 - In the process of being credentialed.   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 - In the process of being credentialed.   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 - In the process of being credentialed.   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - In the process of being credentialed.   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 - In the process of being credentialed.  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 - In the process of being credentialed.  Provider 16:  Provider Name: Joseph, Molly Provider NPI# 1396380077 - In the process of being credentialed.  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493 - Needs to be Credentialed.', NULL, NULL, '2021-08-12 10:07:39', '2021-08-12 10:07:39'),
(47808, 3040, 31623, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: megan.wherry@primehealthservices.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Megan,   Hope you are doing well. Can you please send the roster because I am trying to find out the providers on the Prime Health Services directory and it\'s not showing up.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-14 17:07:55', '2021-09-14 17:07:55'),
(47809, 12062, 31623, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to:megan.wherry@primehealthservices.com; colbee.snyder@primehealthservices.com; credentialing@primehealthservices.com; nucc@claimsmedinc.com; ivuc@claimsmedinc.com; Credentialing - Claims Med credentialing@claimsmedinc.com  Hi Wherry,  Hope you are doing well !   May I have any updated status for the enrollment application of below providers under the Prime Health Services Network?  I would be glad to have your response as soon as possible. The practice\'s and provider\'s details are as follows;   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: 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   Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077   Thanking You in advance.', NULL, NULL, '2021-09-17 12:35:47', '2021-09-17 12:35:47'),
(47810, 10057, 31623, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the updated status for the mentioned request. Please get back to me as soon as you get a chance.  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-28 15:14:15', '2021-10-28 15:14:15'),
(47811, 10057, 31623, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Hope this email finds you in good health. Can I get the latest update on all the below mentioned groups and providers enrollment status?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please respond back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:33:19', '2021-11-22 10:33:19'),
(47812, 10057, 31623, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello,  Can I get the latest updates on the below mentioned providers enrollment request under the TIN?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:56:26', '2021-12-02 13:56:26'),
(47813, 10057, 31623, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Please see attached Credentialing Status Roster.  The dates given are for Credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will respond regarding the effective dates.  Thank you, Nancy', NULL, NULL, '2021-12-15 10:39:15', '2021-12-15 10:39:15'),
(47814, 10057, 31623, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello Nancy,  Thank you for your prompt response. I really appreciate your support. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:05:53', '2021-12-22 12:05:53'),
(47815, 10057, 31623, NULL, '2022-01-05 00:00:00.000', 'Approved', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 15:14:48', '2021-12-29 15:14:48'),
(47816, 3040, 31624, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-18 13:17:41', '2021-06-18 13:17:41');
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
(47817, 3040, 31624, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 13:23:42', '2021-06-18 13:23:42'),
(47818, 3040, 31624, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com,  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Has there been any update?  Thank you  ', NULL, NULL, '2021-07-07 16:52:11', '2021-07-07 16:52:11'),
(47819, 3040, 31624, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I was trying to reach out to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 11:56:10', '2021-07-22 11:56:10'),
(47820, 11056, 31624, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : Fwd: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Good Morning,  Please see below for the credentialing status for each provider.  The dates given are for credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will assist you with the effective dates.  There are two providers (highlighted) that need to be credentialed.  Please email a current CAQH Credentialing application or State Credentialing application for these providers.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  - In the process of being credentialed.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 - Needs to be credentialed.     Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 - In the process of being credentialed.   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - Last credentialed - 6-23-2020 - Not the effective date - For credentialing purposes only.   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 - In the process of being credentialed.  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 - In the process of being credentialed.   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 - In the process of being credentialed.   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - In the process of being credentialed.   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 - Last credentialed - 7-15-2020 - Not the effective date - For credentialing purposes only.  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 - In the process of being credentialed.   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 - In the process of being credentialed.   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 - In the process of being credentialed.   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - In the process of being credentialed.   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 - In the process of being credentialed.  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 - In the process of being credentialed.  Provider 16:  Provider Name: Joseph, Molly Provider NPI# 1396380077 - In the process of being credentialed.  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493 - Needs to be Credentialed.', NULL, NULL, '2021-08-12 10:14:41', '2021-08-12 10:14:41'),
(47821, 3040, 31624, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: megan.wherry@primehealthservices.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Megan,   Hope you are doing well. Can you please send the roster because I am trying to find out the providers on the Prime Health Services directory and it\'s not showing up.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-14 17:07:56', '2021-09-14 17:07:56'),
(47822, 12062, 31624, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to:megan.wherry@primehealthservices.com; colbee.snyder@primehealthservices.com; credentialing@primehealthservices.com; nucc@claimsmedinc.com; ivuc@claimsmedinc.com; Credentialing - Claims Med credentialing@claimsmedinc.com  Hi Wherry,  Hope you are doing well !   May I have any updated status for the enrollment application of below providers under the Prime Health Services Network?  I would be glad to have your response as soon as possible. The practice\'s and provider\'s details are as follows;   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: 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   Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077   Thanking You in advance.', NULL, NULL, '2021-09-17 12:35:31', '2021-09-17 12:35:31'),
(47823, 10057, 31624, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the updated status for the mentioned request. Please get back to me as soon as you get a chance.  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-28 15:22:52', '2021-10-28 15:22:52'),
(47824, 10057, 31624, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Hope this email finds you in good health. Can I get the latest update on all the below mentioned groups and providers enrollment status?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please respond back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:39:35', '2021-11-22 10:39:35'),
(47825, 10057, 31624, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello,  Can I get the latest updates on the below mentioned providers enrollment request under the TIN?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 14:01:58', '2021-12-02 14:01:58'),
(47826, 10057, 31624, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Please see attached Credentialing Status Roster.  The dates given are for Credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will respond regarding the effective dates.  Thank you, Nancy', NULL, NULL, '2021-12-15 10:49:49', '2021-12-15 10:49:49'),
(47827, 10057, 31624, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello Nancy,  Thank you for your prompt response. I really appreciate your support. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:08:02', '2021-12-22 12:08:02'),
(47828, 10057, 31624, NULL, '2022-01-05 00:00:00.000', 'Approved', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 15:14:59', '2021-12-29 15:14:59'),
(47829, 11056, 31625, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 09:18:31', '2021-06-25 09:18:31'),
(47830, 11056, 31625, NULL, '2021-07-02 00:00:00.000', 'Initiated', 'Email sent to : contracting@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health    Good morning !  Hope you are doing well. I want to inquire about the enrollment status of the provider & group. What is the status of the last email ? You haven\'t responded yet.  Practice: Group Name: Nasa Health Clinic. Practice NPI # : 1740661453 Practice TIN # : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider:   Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able to.   Thank you. ', NULL, NULL, '2021-06-25 09:25:17', '2021-06-25 09:25:17'),
(47831, 1006, 31625, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ contracting@ghn-mci.com:  Sub: Enrollment Request - NASA Health Clinic- Galaxy Health  \"Hello,   I hope you\'re doing well, I wanted to get an update on the status of this request.   Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-07-14 17:40:09', '2021-07-14 17:40:09'),
(47832, 11056, 31625, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health  Good morning !  Hope you are doing well. I want to inquire about the enrollment status of the provider & group. What is the status of the last email ? You haven\'t responded yet.  Practice: Group Name: Nasa Health Clinic. Practice NPI # : 1740661453 Practice TIN # : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider:   Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.   Thank you! Have a nice day!', NULL, NULL, '2021-08-02 11:46:18', '2021-08-02 11:46:18'),
(47833, 11056, 31625, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Approval Email received from : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health  Good Morning,  Attached please find a copy of the fully executed agreement for NASA Health Clinic, the effective date for the group is 8/2/21, Dr. Adeoye has been added to the Group/TIN effective 8/2/21 at both locations as well.   Please feel free to contact me with any questions…  Thank you and have a good day!   Please see the attachment.', NULL, NULL, '2021-08-18 10:11:56', '2021-08-18 10:11:56'),
(47834, 11056, 31625, NULL, '2021-08-25 00:00:00.000', 'Approved', 'Approval Email received from : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health  Good Morning,  Attached please find a copy of the fully executed agreement for NASA Health Clinic, the effective date for the group is 8/2/21, Dr. Adeoye has been added to the Group/TIN effective 8/2/21 at both locations as well.   Please feel free to contact me with any questions…  Thank you and have a good day!   Please see the attachment.', NULL, NULL, '2021-08-18 10:13:14', '2021-08-18 10:13:14'),
(47835, 11056, 31625, NULL, '2021-08-25 00:00:00.000', 'Approved', 'Approval Email received from : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health  Good Morning,  Attached please find a copy of the fully executed agreement for NASA Health Clinic, the effective date for the group is 8/2/21, Dr. Adeoye has been added to the Group/TIN effective 8/2/21 at both locations as well.   Please feel free to contact me with any questions…  Thank you and have a good day!   Please see the attachment.', NULL, NULL, '2021-08-18 10:13:15', '2021-08-18 10:13:15'),
(47836, 11056, 31626, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 09:18:40', '2021-06-25 09:18:40'),
(47837, 11056, 31626, NULL, '2021-07-02 00:00:00.000', 'Initiated', 'Email sent to : contracting@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health    Good morning !  Hope you are doing well. I want to inquire about the enrollment status of the provider & group. What is the status of the last email ? You haven\'t responded yet.  Practice: Group Name: Nasa Health Clinic. Practice NPI # : 1740661453 Practice TIN # : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider:   Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able to.   Thank you. ', NULL, NULL, '2021-06-25 09:25:47', '2021-06-25 09:25:47'),
(47838, 1006, 31626, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ contracting@ghn-mci.com:  Sub: Enrollment Request - NASA Health Clinic- Galaxy Health  \"Hello,   I hope you\'re doing well, I wanted to get an update on the status of this request.   Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-07-14 17:40:06', '2021-07-14 17:40:06'),
(47839, 11056, 31626, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health  Good morning !  Hope you are doing well. I want to inquire about the enrollment status of the provider & group. What is the status of the last email ? You haven\'t responded yet.  Practice: Group Name: Nasa Health Clinic. Practice NPI # : 1740661453 Practice TIN # : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider:   Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.   Thank you! Have a nice day!', NULL, NULL, '2021-08-02 11:46:09', '2021-08-02 11:46:09'),
(47840, 11056, 31626, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Approval Email received from : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health  Good Morning,  Attached please find a copy of the fully executed agreement for NASA Health Clinic, the effective date for the group is 8/2/21, Dr. Adeoye has been added to the Group/TIN effective 8/2/21 at both locations as well.   Please feel free to contact me with any questions…  Thank you and have a good day!   Please see the attachment.', NULL, NULL, '2021-08-18 10:11:29', '2021-08-18 10:11:29'),
(47841, 11056, 31626, NULL, '2021-08-25 00:00:00.000', 'Approved', 'Approval Email received from : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Health Clinic- Galaxy Health  Good Morning,  Attached please find a copy of the fully executed agreement for NASA Health Clinic, the effective date for the group is 8/2/21, Dr. Adeoye has been added to the Group/TIN effective 8/2/21 at both locations as well.   Please feel free to contact me with any questions…  Thank you and have a good day!   Please see the attachment.', NULL, NULL, '2021-08-18 10:13:04', '2021-08-18 10:13:04'),
(47842, 11056, 31627, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 10:30:26', '2021-06-25 10:30:26'),
(47843, 11056, 31627, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Update - NASA HEALTH CLINIC - WELLCARE  Hello,   I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Thank you!', NULL, NULL, '2021-06-25 10:37:19', '2021-06-25 10:37:19'),
(47844, 1006, 31627, NULL, '2021-07-22 00:00:00.000', 'In Process', 'We received the following update from .ProspectiveProviderTX ProspectiveProviderTX@wellcare.com:  Sub; RE: Become A Provider - Unsecured - General Practice - Texas  \"Hello,  This provider is already PAR with NASA HEALTH CLINIC effective 5/1/2021.\"  Sent query:  \"Hello,   I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Thank you!\"', NULL, NULL, '2021-07-15 16:10:04', '2021-07-15 16:10:04'),
(47845, 11056, 31627, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : RE: Become A Provider - Unsecured - General Practice - Texas  Hello,   I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Thank you', NULL, NULL, '2021-07-30 17:19:30', '2021-07-30 17:19:30'),
(47846, 11056, 31627, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Hello,  I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Practice: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Thank you! Have a great day!', NULL, NULL, '2021-08-17 08:48:34', '2021-08-17 08:48:34'),
(47847, 11056, 31627, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Good morning!  Hope all is well. I appreciate the update. I just wanted to verify if the secondary address is also listed for the group and provider? Please inform me soon.  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you have any questions or queries let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-26 16:11:15', '2021-08-26 16:11:15'),
(47848, 11056, 31627, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.   Online Application has been submitted.', NULL, NULL, '2021-09-15 09:35:19', '2021-09-15 09:35:19'),
(47849, 11056, 31627, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : webuser@wellcare.com & ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Provider First Name Segun  Provider Last Name Adeoye  Degree Type MD  Check to add provider to existing agreement: False  Check to join as a group: True  Check if you service more than one state: False  Group Name Nasa Health Clinic  Tax Identification Number 47-2682655  Specialty Internal Medicine  Line of Business All  Street Address 985 NASA Parkway  City Houston  State Texas  ZIP Code 77058  County Harris  Facility Walk in clinic  NPI 1629418025  CAQH Number 12779522  Medicare Number 746150  Medicaid Number 391190102  License Number R7637  Primary Contact Name Ahmed Talha  Email nasa@claimsmedinc.com  Phone Number (713) 893-6214  Please provide any additional information Secondary Location : 3623 S. Main St. Suite 109 Stafford , TX 77477-5406 Please list the secondary location too under same Tax I.D and NPI.', NULL, NULL, '2021-09-28 15:30:04', '2021-09-28 15:30:04'),
(47850, 11056, 31627, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope all is well with you. Please let us know who is our provider Relations representative and provide us with his contact no. and email address as soon as possible.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 15:51:09', '2021-10-08 15:51:09'),
(47851, 11056, 31627, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-10-15 16:48:00', '2021-10-15 16:48:00'),
(47852, 11056, 31627, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Hello-   I have responded before… Dr. Adeoye is loaded properly and so are both addresses.   You will be able to see that using our directory as well. His Provider ID is 2504675.    Kindest Regards, Macy Mertens, LL.M. Network Performance Advisor', NULL, NULL, '2021-10-22 15:48:00', '2021-10-22 15:48:00'),
(47853, 11056, 31627, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope this email finds you well. My question is simply that the effective date mentioned in the agreement is for both locations and the provider or not? Kindly, also do assist me in finding the provider in the Wellcare provider directory.  Take Care of Yourself!  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 12:27:51', '2021-11-11 12:27:51'),
(47854, 11056, 31627, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email received from: Macy.Mertens@wellcare.com  Sub:  Re: Become A Provider - Unsecured - Internal Medicine - Texas   Dr. Adeoye is effective 5/1/21 for UXR, which is the WellCare LOB.  I understand. NASA Health is loaded and so is the provider.  His Provider ID is 2504675.  Hi-     Locations are added. Update is completed.', NULL, NULL, '2021-11-15 16:34:45', '2021-11-15 16:34:45'),
(47855, 11056, 31628, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 12:10:50', '2021-06-25 12:10:50'),
(47856, 11056, 31628, NULL, '2021-07-02 00:00:00.000', 'Initiated', 'Email sent to : info@usamco.com  Sub : Enrollment Query - Nasa Urgent Care - MCO  Hello,   We wanted to verify if the following group and provider were enrolled with MCO under the given addresses, their information is as follows:  Practice:  Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 12:13:43', '2021-06-25 12:13:43'),
(47857, 1006, 31628, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ info@usamco.com:  Sub: Enrollment Query - Nasa Urgent Care - MCO  \"Hello,   I hope you\'re doing good, I wanted to get an update regarding the status of my request.   Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-15 15:51:46', '2021-07-15 15:51:46'),
(47858, 11056, 31628, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from :  info@usamco.com  &   HIPOLITJ@usamco.com  Sub :  Enrollment Query - Nasa Urgent Care - MCO  Thank you , Nasa Urgent Care Inc is contracted in our network for an ancillary. Providers are automatically contracted when billing under The facility’s information, no required documents are required.  To add addt’l locations to a facility record you will need to complete our MFA. Please see attachment for  Copy of our MFA. Please complete and fwd back so we add to facility’s record and requested location/s.  If any questions please let us know  Thank You, Jackie Hipolito Provider Relations.', NULL, NULL, '2021-07-16 13:28:50', '2021-07-16 13:28:50'),
(47859, 11056, 31628, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to : HIPOLITJ@usamco.com  &   info@usamco.com,  Sub : Enrollment Query - Nasa Urgent Care - MCO  Good Morning,  Hope you are doing well. Here is the filled and signed MFA for provider and group to addi additional locations to the facility . Please see the attachment.  Practice:  Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  If you need any information or documents further, please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-28 13:47:17', '2021-07-28 13:47:17'),
(47860, 11056, 31628, NULL, '2021-08-05 00:00:00.000', 'Approved', 'Email received from : HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Urgent Care - MCO  Thank you , Nasa Urgent Care Inc is contracted in our network for an ancillary. Providers are automatically contracted when billing under The facility’s information, no required documents are required. eff date is : 11/30/2016  Great, thank you the addt’l location site has been added effective 07/16/2021 per original update recv’d.  If any questions please contact us…a confirmation for you records.  Please see the attachment.', NULL, NULL, '2021-07-28 16:17:42', '2021-07-28 16:17:42'),
(47861, 11056, 31628, NULL, '2021-08-05 00:00:00.000', 'Approved', 'Email received from : HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Urgent Care - MCO  Thank you , Nasa Urgent Care Inc is contracted in our network for an ancillary. Providers are automatically contracted when billing under The facility’s information, no required documents are required. eff date is : 11/30/2016  Great, thank you the addt’l location site has been added effective 07/16/2021 per original update recv’d.  If any questions please contact us…a confirmation for you records.  Please see the attachment.', NULL, NULL, '2021-07-28 16:17:43', '2021-07-28 16:17:43'),
(47862, 11056, 31629, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 12:11:00', '2021-06-25 12:11:00'),
(47863, 11056, 31629, NULL, '2021-07-02 00:00:00.000', 'Initiated', 'Email sent to : info@usamco.com  Sub : Enrollment Query - Nasa Urgent Care - MCO  Hello,   We wanted to verify if the following group and provider were enrolled with MCO under the given addresses, their information is as follows:  Practice:  Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 12:13:00', '2021-06-25 12:13:00'),
(47864, 1006, 31629, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ info@usamco.com:  Sub: Enrollment Query - Nasa Urgent Care - MCO  \"Hello,   I hope you\'re doing good, I wanted to get an update regarding the status of my request.   Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-15 15:51:49', '2021-07-15 15:51:49'),
(47865, 11056, 31629, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from :  info@usamco.com  &   HIPOLITJ@usamco.com  Sub :  Enrollment Query - Nasa Urgent Care - MCO  Thank you , Nasa Urgent Care Inc is contracted in our network for an ancillary. Providers are automatically contracted when billing under The facility’s information, no required documents are required.  To add addt’l locations to a facility record you will need to complete our MFA. Please see attachment for  Copy of our MFA. Please complete and fwd back so we add to facility’s record and requested location/s.  If any questions please let us know  Thank You, Jackie Hipolito Provider Relations', NULL, NULL, '2021-07-16 13:25:04', '2021-07-16 13:25:04'),
(47866, 11056, 31629, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to : HIPOLITJ@usamco.com  &   info@usamco.com,  Sub : Enrollment Query - Nasa Urgent Care - MCO  Good Morning,  Hope you are doing well. Here is the filled and signed MFA for provider and group to addi additional locations to the facility . Please see the attachment.  Practice:  Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  If you need any information or documents further, please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-28 13:47:38', '2021-07-28 13:47:38'),
(47867, 11056, 31629, NULL, '2021-08-05 00:00:00.000', 'Approved', 'Email received from : HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Urgent Care - MCO  Thank you , Nasa Urgent Care Inc is contracted in our network for an ancillary. Providers are automatically contracted when billing under The facility’s information, no required documents are required. eff date is : 11/30/2016  Great, thank you the addt’l location site has been added effective 07/16/2021 per original update recv’d.  If any questions please contact us…a confirmation for you records.  Please see the attachment.', NULL, NULL, '2021-07-28 16:18:10', '2021-07-28 16:18:10'),
(47868, 11056, 31630, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 12:21:23', '2021-06-25 12:21:23'),
(47869, 11056, 31630, NULL, '2021-07-02 00:00:00.000', 'Initiated', 'Email sent to : info@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Hello,   We wanted to verify if the following group and provider were enrolled with MCO under the given addresses, their information is as follows:  Practice:  Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider:  Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as possible.  Thank you!', NULL, NULL, '2021-06-25 12:30:04', '2021-06-25 12:30:04'),
(47870, 1006, 31630, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ providerinfo@usamco.com;   Sub: Enrollment Query - Nasa Health Clinic - MCO  \"Hello,   I hope you\'re doing well, I wanted to check in on the status of enrollment for the following group and provider:  Practice: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able.  Thanks!\"', NULL, NULL, '2021-07-14 17:47:41', '2021-07-14 17:47:41'),
(47871, 1006, 31630, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Rcvd response from Jackie, replied:  \"Hello Jackie,   Yes, please go ahead and send us the provider application so we can initiate the enrollment process for the provider.   Thank you!\"', NULL, NULL, '2021-07-14 17:50:10', '2021-07-14 17:50:10'),
(47872, 11056, 31630, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : HIPOLITJ@usamco.com   &     providerinfo@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Good morning!  I hope you\'re doing well. I wanted to check in on the status of enrollment for the following group and provider:  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 12:08:51', '2021-08-02 12:08:51'),
(47873, 11056, 31630, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email received from : HIPOLITJ@usamco.com  Sub  : Enrollment Query - Nasa Health Clinic - MCO  Good afternoon, we do currently show the provider Segun Adeoye par through two IPAs’s but not contracted for the group NASA HEALTH CLINIC.  I will fwd your email to our network development dept so an application can be sent to you.              Thank You,     Jackie Hipolito  Provider Relations', NULL, NULL, '2021-08-17 16:54:18', '2021-08-17 16:54:18'),
(47874, 11056, 31630, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email sent to : HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Great, thank you so much! Please forward our request soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-27 16:28:28', '2021-08-27 16:28:28'),
(47875, 11056, 31630, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email received from : ProviderMarketingInfo@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Attached is the application and checklist needed to add the provider to the group.     Please let us know if you have any other questions.     Thank you,     Austin Meador  Network Development Coordinator', NULL, NULL, '2021-09-07 13:28:27', '2021-09-07 13:28:27'),
(47876, 11056, 31630, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Email sent to : ProviderMarketingInfo@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Good morning!  I hope you\'re doing well. Sorry for the delay. Please accept my apology.  Here is the attached form for the credentialing process with Managed Care Organization. Please see the attachment  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able.  Thank you! Have a great day!', NULL, NULL, '2021-09-16 10:12:50', '2021-09-16 10:12:50'),
(47877, 11056, 31630, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : ProviderMarketingInfo@usamco.com & HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO   Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 16:34:55', '2021-09-28 16:34:55'),
(47878, 11056, 31630, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : turnere@usamco.com  Sub : 	RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon Ahmed,     Thank you for submitting the application for Segun Adeoye, we look forward to adding your provider to the network. I apologize, the original application that was sent to you is not for Texas providers. I’ve transferred all information into the attached (Texas) provider application for Segun Aedoye. Again sorry for any inconveniences. Please feel free to reach out with any questions.   Thank you,        Erin Turner  Provider Network Development Representative  Ext: 4174', NULL, NULL, '2021-10-08 14:05:12', '2021-10-08 14:05:12'),
(47879, 11056, 31630, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Email received from : noreply@barracuda.com & turnere@usamco.com  Sub : Encrypted Message from USA Managed Care Organization RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon!  Please provide me with the application. I didn\'t find any attachments.   Thank you!', NULL, NULL, '2021-10-13 09:31:53', '2021-10-13 09:31:53'),
(47880, 11056, 31630, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : turnere@usamco.com  Sub : RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Hello,  Please see attached and let em know if you have any questions or issues viewing.  Thank you,', NULL, NULL, '2021-10-20 12:34:31', '2021-10-20 12:34:31'),
(47881, 11056, 31630, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: turnere@usamco.com  Sub:RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon Ahmed,  Thank you for submitting the application for Segun Adeoye, we look forward to adding your provider to the network. I apologize, the original application that was sent to you is not for Texas providers. I’ve transferred all information into the attached (Texas) provider application for Segun Aedoye. Again sorry for any inconveniences. Please feel free to reach out with any questions.   Thank you,  Erin Turner Provider Network Development Representative Ext: 4174 attachment : Microsoft Word - USA103HATIN - TX 11-05-20', NULL, NULL, '2021-11-10 10:00:57', '2021-11-10 10:00:57'),
(47882, 11056, 31630, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email sent to:  ProviderMarketingInfo@usamco.com  Sub: Enrollment Query - Nasa Health Clinic - MCO   Good morning!  Hope all is well with you. Please provide me with the latest updates regarding the credentialing process of the below-mentioned provider and facility.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-18 17:58:09', '2021-11-18 17:58:09'),
(47883, 11056, 31630, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email received from:  turnere@usamco.com  Sub:  Encrypted Message from USA Managed Care Organization   Good morning,     The application for Segun Adeoya is pending, all we need to complete the application process is the attached supplemental information form. Let me know if you have any questions.     Thank you,     Erin Turner  Provider Network Development Representative  Ext: 4174', NULL, NULL, '2021-12-03 17:00:43', '2021-12-03 17:00:43'),
(47884, 11056, 31630, NULL, '2021-12-22 00:00:00.000', 'Approved', 'Email received from: HIPOLITJ@usamco.com  Sub:  Encrypted Message from USA Managed Care Organization  Subject: NASA HEALTH CLINIC  Good afternoon,  The USA appreciates the participation of the following provider below. The provider is now contracted through  The group contract for NASA HEALTH CLINIC.     USA                        PROVIDER                              EFFECTIVE  1221886   ADEOYE, SEGUN PATRICK MD           09/16/2021        Also included is a copy of our quick reference guide and client listing for your records.  If any questions please let us know.   	 Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:    P: 512.306.0201 F: 512.306.1921  Please see the attachments as well.', NULL, NULL, '2021-12-15 10:43:00', '2021-12-15 10:43:00'),
(47885, 11056, 31631, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 12:22:12', '2021-06-25 12:22:12'),
(47886, 11056, 31631, NULL, '2021-07-02 00:00:00.000', 'Initiated', 'Email sent to : info@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Hello,   We wanted to verify if the following group and provider were enrolled with MCO under the given addresses, their information is as follows:  Practice:  Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider:  Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as possible.  Thank you!', NULL, NULL, '2021-06-25 12:30:23', '2021-06-25 12:30:23'),
(47887, 1006, 31631, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ providerinfo@usamco.com;   Sub: Enrollment Query - Nasa Health Clinic - MCO  \"Hello,   I hope you\'re doing well, I wanted to check in on the status of enrollment for the following group and provider:  Practice: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able.  Thanks!\"', NULL, NULL, '2021-07-14 17:47:36', '2021-07-14 17:47:36'),
(47888, 1006, 31631, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Rcvd response from Jackie, replied:  \"Hello Jackie,   Yes, please go ahead and send us the provider application so we can initiate the enrollment process for the provider.   Thank you!\"', NULL, NULL, '2021-07-14 17:50:07', '2021-07-14 17:50:07'),
(47889, 11056, 31631, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : HIPOLITJ@usamco.com   &     providerinfo@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Good morning!  I hope you\'re doing well. I wanted to check in on the status of enrollment for the following group and provider:  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 12:08:41', '2021-08-02 12:08:41'),
(47890, 11056, 31631, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email received from : HIPOLITJ@usamco.com  Sub  : Enrollment Query - Nasa Health Clinic - MCO  Good afternoon, we do currently show the provider Segun Adeoye par through two IPAs’s but not contracted for the group NASA HEALTH CLINIC.  I will fwd your email to our network development dept so an application can be sent to you.              Thank You,     Jackie Hipolito  Provider Relations', NULL, NULL, '2021-08-17 16:54:27', '2021-08-17 16:54:27'),
(47891, 11056, 31631, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email sent to : HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Great, thank you so much! Please forward our request soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-27 16:28:13', '2021-08-27 16:28:13'),
(47892, 11056, 31631, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email received from : ProviderMarketingInfo@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO  Attached is the application and checklist needed to add the provider to the group.     Please let us know if you have any other questions.     Thank you,     Austin Meador  Network Development Coordinator', NULL, NULL, '2021-09-07 13:28:09', '2021-09-07 13:28:09');
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
(47893, 11056, 31631, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Good morning!  I hope you\'re doing well. Sorry for the delay. Please accept my apology.  Here is the attached form for the credentialing process with Managed Care Organization. Please see the attachment  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Please get back to me as soon as you\'re able.  Thank you! Have a great day! ', NULL, NULL, '2021-09-16 10:11:50', '2021-09-16 10:11:50'),
(47894, 11056, 31631, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : ProviderMarketingInfo@usamco.com & HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO   Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 16:34:17', '2021-09-28 16:34:17'),
(47895, 11056, 31631, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : ProviderMarketingInfo@usamco.com & HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Health Clinic - MCO   Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 16:34:17', '2021-09-28 16:34:17'),
(47896, 11056, 31631, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : turnere@usamco.com  Sub : 	RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon Ahmed,     Thank you for submitting the application for Segun Adeoye, we look forward to adding your provider to the network. I apologize, the original application that was sent to you is not for Texas providers. I’ve transferred all information into the attached (Texas) provider application for Segun Aedoye. Again sorry for any inconveniences. Please feel free to reach out with any questions.   Thank you,        Erin Turner  Provider Network Development Representative  Ext: 4174', NULL, NULL, '2021-10-08 14:02:46', '2021-10-08 14:02:46'),
(47897, 11056, 31631, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : noreply@barracuda.com & turnere@usamco.com  Sub : Encrypted Message from USA Managed Care Organization RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon!  Please provide me with the application. I didn\'t find any attachments.   Thank you!', NULL, NULL, '2021-10-12 16:37:46', '2021-10-12 16:37:46'),
(47898, 11056, 31631, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : noreply@barracuda.com & turnere@usamco.com  Sub : Encrypted Message from USA Managed Care Organization RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon!  Please provide me with the application. I didn\'t find any attachments.   Thank you!', NULL, NULL, '2021-10-12 16:58:41', '2021-10-12 16:58:41'),
(47899, 11056, 31631, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : turnere@usamco.com  Sub : RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Hello,  Please see attached and let em know if you have any questions or issues viewing.  Thank you,', NULL, NULL, '2021-10-20 12:33:59', '2021-10-20 12:33:59'),
(47900, 11056, 31631, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email: turnere@usamco.com  Sub:RE: [External]Enrollment Query - Nasa Health Clinic - MCO  Good afternoon Ahmed,  Thank you for submitting the application for Segun Adeoye, we look forward to adding your provider to the network. I apologize, the original application that was sent to you is not for Texas providers. I’ve transferred all information into the attached (Texas) provider application for Segun Aedoye. Again sorry for any inconveniences. Please feel free to reach out with any questions.   Thank you,  Erin Turner Provider Network Development Representative Ext: 4174 attachment : Microsoft Word - USA103HATIN - TX 11-05-20', NULL, NULL, '2021-11-10 10:00:30', '2021-11-10 10:00:30'),
(47901, 11056, 31631, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email sent to:  ProviderMarketingInfo@usamco.com  Sub: Enrollment Query - Nasa Health Clinic - MCO   Good morning!  Hope all is well with you. Please provide me with the latest updates regarding the credentialing process of the below-mentioned provider and facility.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a wonderful day! ', NULL, NULL, '2021-11-18 17:57:52', '2021-11-18 17:57:52'),
(47902, 11056, 31631, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email received from:  turnere@usamco.com  Sub:  Encrypted Message from USA Managed Care Organization   Good morning,     The application for Segun Adeoya is pending, all we need to complete the application process is the attached supplemental information form. Let me know if you have any questions.     Thank you,     Erin Turner  Provider Network Development Representative  Ext: 4174', NULL, NULL, '2021-12-03 17:00:28', '2021-12-03 17:00:28'),
(47903, 11056, 31631, NULL, '2021-12-22 00:00:00.000', 'Approved', 'Email received from: HIPOLITJ@usamco.com  Sub:  Encrypted Message from USA Managed Care Organization  Subject: NASA HEALTH CLINIC  Good afternoon,  The USA appreciates the participation of the following provider below. The provider is now contracted through  The group contract for NASA HEALTH CLINIC.     USA                        PROVIDER                              EFFECTIVE  1221886   ADEOYE, SEGUN PATRICK MD           09/16/2021        Also included is a copy of our quick reference guide and client listing for your records.  If any questions please let us know.   	 Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:    P: 512.306.0201 F: 512.306.1921  Please see the attachments as well.', NULL, NULL, '2021-12-15 10:45:48', '2021-12-15 10:45:48'),
(47904, 11056, 31632, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 12:38:12', '2021-06-25 12:38:12'),
(47905, 11056, 31632, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'It is not in our service area. Please see the attached link  https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area', NULL, NULL, '2021-06-25 12:40:35', '2021-06-25 12:40:35'),
(47906, 11056, 31633, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 12:38:27', '2021-06-25 12:38:27'),
(47907, 11056, 31633, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'It is not in our service area. Please see the attached link  https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area', NULL, NULL, '2021-06-25 12:40:48', '2021-06-25 12:40:48'),
(47908, 11056, 31634, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 12:44:32', '2021-06-25 12:44:32'),
(47909, 11056, 31634, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'It is not in our service area. Please see the attached link  https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area', NULL, NULL, '2021-06-25 12:47:54', '2021-06-25 12:47:54'),
(47910, 11056, 31635, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 12:45:34', '2021-06-25 12:45:34'),
(47911, 11056, 31635, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'It is not in our service area. Please see the attached link  https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area', NULL, NULL, '2021-06-25 12:48:08', '2021-06-25 12:48:08'),
(47912, 11056, 31636, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 12:45:48', '2021-06-25 12:45:48'),
(47913, 11056, 31636, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'It is not in our service area. Please see the attached link  https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area', NULL, NULL, '2021-06-25 12:47:18', '2021-06-25 12:47:18'),
(47914, 11056, 31637, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 14:13:19', '2021-06-25 14:13:19'),
(47915, 11056, 31637, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to :  MHHPContracting@memorialhermann.org   Sub : New Provider Enrollment Request - NASA Health Clinic - Memorial Hermann  Greetings,  Hope you are doing well. As per your guideline,  I have filled out the form for participation & enrollment .Please see the attachment.  If any additional information or document needed regarding the enrollment process please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 14:17:18', '2021-06-25 14:17:18'),
(47916, 1006, 31637, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: New Provider Enrollment Request - NASA Health Clinic - Memorial Hermann  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and provider. Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-15 16:57:45', '2021-07-15 16:57:45'),
(47917, 1006, 31637, NULL, '2021-08-02 00:00:00.000', 'In Process', 'We received the following query from MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"We are in receipt of Segun Adeoye, MD’s request to become a participating provider with Memorial Hermann Health Plans and need additional information to proceed with your request.  Please provide the following information:  List of services provided ·         Do you provide Virtual Health Services? Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee   Your participation request will be presented at the next NAAC meeting following receipt of the additional information.  Best Regards, MHHP Network Contracting  MHH HealthPlan-Ins_SM_4C  Network Contracting Memorial Hermann Health Plan 929 Gessner Road, Suite 1500 Houston, TX 77024 MHHPContracting@memorialhermann.org\"  Responded to the queries. ', NULL, NULL, '2021-07-26 14:20:41', '2021-07-26 14:20:41'),
(47918, 1006, 31637, NULL, '2021-08-05 00:00:00.000', 'In Process', 'We received the following response from MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"Hi Brad. This request for participation came over as Segun Adeoye, MD at Nasa Health Clinic. Does this Urgent Care bill as an Urgent Care or do the individual practitioners bill individually? Please advise.  Thank you. Camilla\"  Replied: \"Hello Camilla,   I apologize, Nasa Health Clinic is not an urgent care, and the claims are billed with rendering providers NPI and the TIN. Please let me know if you have any other questions.  Thank you. \"', NULL, NULL, '2021-07-29 13:54:56', '2021-07-29 13:54:56'),
(47919, 11056, 31637, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Memorial Hermann Health Plan Request to Participate  Good morning Camilla!  Hope you are doing well. I want to get the enrollment status updates regarding the below mentioned provider and group :   Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 14:55:16', '2021-08-02 14:55:16'),
(47920, 11056, 31637, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: Memorial Hermann Health Plan Request to Participate  Thank you. Could you please update the services provided below?', NULL, NULL, '2021-08-17 09:59:34', '2021-08-17 09:59:34'),
(47921, 11056, 31637, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Good morning!  Hope all is well. Nasa Health Clinic is a walking clinic not an urgent care. Nasa Urgent care is an urgent care. Both are different Clinics with different NPI and Tax I.D.   Feel free to reach out to me If you have further queries related to this. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-25 16:29:30', '2021-08-25 16:29:30'),
(47922, 11056, 31637, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Hi Ahmed. I need these additional questions (listed below) updated for Nasa Health Clinic. As stated below, I will need them by the end of the day today to go to our committee on Friday. If it’s later than that, they will have to wait until next month. Please let me know if you have any questions.     Please provide the following information:  List of services provided Do you provide Virtual Health Services? Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee    Your participation request will be presented at the next NAAC meeting following receipt of the additional information.     Thank you.     Camilla', NULL, NULL, '2021-09-07 17:07:13', '2021-09-07 17:07:13'),
(47923, 11056, 31637, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Hey Camilla!  Hope you are doing well. Here is the information you requested for Nasa Health Clinic.  Practice Details: Practice Name : Nasa Health Clinic Practice TIN # : 47-2682655 Practice NPI # : 1740661453 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406   ·  List of services provided Walk in Clinic   · Do you provide Virtual Health Services? Yes, telehealth services are provided.  ·Current service area and/or list of locations 985 NASA Parkway, Houston, TX 77058-3039 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  ·List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) Name: Segun Adeoye NPI# 1629418025  ·What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years 0~99+ years  ·Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. N/A  ·Link to website N/A  ·Current W-9 Attached  ·Current quality and outcomes data N/A  ·Any additional information you would like presented to the Network Access and Adequacy Committee N/A', NULL, NULL, '2021-09-15 16:54:20', '2021-09-15 16:54:20'),
(47924, 11056, 31637, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate   Hello,  Memorial Hermann Health Plan (MHHP) has accepted your request to participate in our health plan. Please find attached the Provider Agreement. Please have the agreement signed. Please complete the attached Schedule C Tables 1 and 2 and Schedule D, as applicable. Once all items are complete, please return.  Once the completed documents are received, MHHP’s Credentialing Department will send the provider(s) a credentialing application. The agreement will be fully executed by MHHP and a copy sent to you once the provider is approved by the MHHP Credentialing Committee. The effective date will be assigned by MHHP upon approval of the MHHP Credentialing Committee.   We look forward to welcoming you into our network in the near future.  Best Regards, Camilla Paige', NULL, NULL, '2021-09-27 13:13:12', '2021-09-27 13:13:12'),
(47925, 11056, 31637, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Good afternoon!  Hope all is well. Here are the filled and signed provider agreement,Schedule C Tables 1 and 2 and Schedule D. Please see the attachment.  Practice Details: Practice Name : Nasa Urgent Care Inc Practice TIN # : 81-3237149 Practice NPI # : 1821542432 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  If you further need any additional information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 12:23:09', '2021-10-08 12:23:09'),
(47926, 11056, 31637, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Hello,   Memorial Hermann Health Plan (MHHP) has accepted your request to participate in our health plan. Please find attached the Provider Agreement. Please have the agreement signed. Please complete the attached Schedule C Tables 1 and 2 and Schedule D, as applicable. Once all items are complete, please return.   Once the completed documents are received, MHHP’s Credentialing Department will send the provider(s) a credentialing application. The agreement will be fully executed by MHHP and a copy sent to you once the provider is approved by the MHHP Credentialing Committee. The effective date will be assigned by MHHP upon approval of the MHHP Credentialing Committee.   We look forward to welcoming you into our network in the near future.   Best Regards,  Camilla Paige', NULL, NULL, '2021-10-15 16:09:18', '2021-10-15 16:09:18'),
(47927, 11056, 31637, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Good morning!  Hope you had a great and safe weekend. Please provide the latest updates regarding the agreement and credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-10-22 16:31:18', '2021-10-22 16:31:18'),
(47928, 11056, 31637, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate   Good afternoon. Credentialing takes 30-45 days. Once I receive the credentialing approvals, I will send the agreement to my leadership team for full execution.', NULL, NULL, '2021-11-11 09:23:37', '2021-11-11 09:23:37'),
(47929, 11056, 31637, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  jcalderon@symplr.com  Sub : RE: 3st & Final Request/ Memorial Hermann Health plan/ Nasa Urgent Care Inc   Hi Ahmed,     The Professional Liability that you forward previously is coverage for the provider only we are still pending the following documents:     Facility Professional Liability Insurance   Facility General Liability Insurance Business Licenses or Certificate of Occupancy Accreditation Certificate CLIA (If applicable) If you are not the person that handles the above documentation can you please direct me to who is.     Thank you,   Johanna Calderon                           Credentialing Specialist  Work: +1 (516) 593-1380 Ext. 287  Fax: 516-620-3054  Email: jcalderon@symplr.com symplr.com', NULL, NULL, '2021-11-15 15:28:26', '2021-11-15 15:28:26'),
(47930, 11056, 31638, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 14:13:27', '2021-06-25 14:13:27'),
(47931, 11056, 31638, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to :  MHHPContracting@memorialhermann.org   Sub : New Provider Enrollment Request - NASA Health Clinic - Memorial Hermann  Greetings,  Hope you are doing well. As per your guideline,  I have filled out the form for participation & enrollment .Please see the attachment.  If any additional information or document needed regarding the enrollment process please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 14:17:08', '2021-06-25 14:17:08'),
(47932, 1006, 31638, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: New Provider Enrollment Request - NASA Health Clinic - Memorial Hermann  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and provider. Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-15 16:57:38', '2021-07-15 16:57:38'),
(47933, 1006, 31638, NULL, '2021-08-02 00:00:00.000', 'In Process', 'We received the following query from MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"We are in receipt of Segun Adeoye, MD’s request to become a participating provider with Memorial Hermann Health Plans and need additional information to proceed with your request.  Please provide the following information:  List of services provided ·         Do you provide Virtual Health Services? Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee   Your participation request will be presented at the next NAAC meeting following receipt of the additional information.  Best Regards, MHHP Network Contracting  MHH HealthPlan-Ins_SM_4C  Network Contracting Memorial Hermann Health Plan 929 Gessner Road, Suite 1500 Houston, TX 77024 MHHPContracting@memorialhermann.org\"  Responded to the queries. ', NULL, NULL, '2021-07-26 14:20:38', '2021-07-26 14:20:38'),
(47934, 1006, 31638, NULL, '2021-08-05 00:00:00.000', 'In Process', 'We received the following response from MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"Hi Brad. This request for participation came over as Segun Adeoye, MD at Nasa Health Clinic. Does this Urgent Care bill as an Urgent Care or do the individual practitioners bill individually? Please advise.  Thank you. Camilla\"  Replied: \"Hello Camilla,   I apologize, Nasa Health Clinic is not an urgent care, and the claims are billed with rendering providers NPI and the TIN. Please let me know if you have any other questions.  Thank you. \"', NULL, NULL, '2021-07-29 13:55:05', '2021-07-29 13:55:05'),
(47935, 11056, 31638, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Memorial Hermann Health Plan Request to Participate  Good morning Camilla!  Hope you are doing well. I want to get the enrollment status updates regarding the below mentioned provider and group :   Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 14:55:12', '2021-08-02 14:55:12'),
(47936, 11056, 31638, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: Memorial Hermann Health Plan Request to Participate  Thank you. Could you please update the services provided below?', NULL, NULL, '2021-08-17 09:59:27', '2021-08-17 09:59:27'),
(47937, 11056, 31638, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Good morning!  Hope all is well. Nasa Health Clinic is a walking clinic not an urgent care. Nasa Urgent care is an urgent care. Both are different Clinics with different NPI and Tax I.D.   Feel free to reach out to me If you have further queries related to this. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-25 16:29:23', '2021-08-25 16:29:23'),
(47938, 11056, 31638, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Hi Ahmed. I need these additional questions (listed below) updated for Nasa Health Clinic. As stated below, I will need them by the end of the day today to go to our committee on Friday. If it’s later than that, they will have to wait until next month. Please let me know if you have any questions.     Please provide the following information:  List of services provided Do you provide Virtual Health Services? Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee    Your participation request will be presented at the next NAAC meeting following receipt of the additional information.     Thank you.     Camilla', NULL, NULL, '2021-09-07 17:07:08', '2021-09-07 17:07:08'),
(47939, 11056, 31638, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Hey Camilla!  Hope you are doing well. Here is the information you requested for Nasa Health Clinic.  Practice Details: Practice Name : Nasa Health Clinic Practice TIN # : 47-2682655 Practice NPI # : 1740661453 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406   ·  List of services provided Walk in Clinic   · Do you provide Virtual Health Services? Yes, telehealth services are provided.  ·Current service area and/or list of locations 985 NASA Parkway, Houston, TX 77058-3039 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  ·List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) Name: Segun Adeoye NPI# 1629418025  ·What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years 0~99+ years  ·Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. N/A  ·Link to website N/A  ·Current W-9 Attached  ·Current quality and outcomes data N/A  ·Any additional information you would like presented to the Network Access and Adequacy Committee N/A', NULL, NULL, '2021-09-15 16:54:15', '2021-09-15 16:54:15'),
(47940, 11056, 31638, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate   Hello,  Memorial Hermann Health Plan (MHHP) has accepted your request to participate in our health plan. Please find attached the Provider Agreement. Please have the agreement signed. Please complete the attached Schedule C Tables 1 and 2 and Schedule D, as applicable. Once all items are complete, please return.  Once the completed documents are received, MHHP’s Credentialing Department will send the provider(s) a credentialing application. The agreement will be fully executed by MHHP and a copy sent to you once the provider is approved by the MHHP Credentialing Committee. The effective date will be assigned by MHHP upon approval of the MHHP Credentialing Committee.   We look forward to welcoming you into our network in the near future.  Best Regards, Camilla Paige', NULL, NULL, '2021-09-27 13:13:05', '2021-09-27 13:13:05'),
(47941, 11056, 31638, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate   Hello,  Memorial Hermann Health Plan (MHHP) has accepted your request to participate in our health plan. Please find attached the Provider Agreement. Please have the agreement signed. Please complete the attached Schedule C Tables 1 and 2 and Schedule D, as applicable. Once all items are complete, please return.  Once the completed documents are received, MHHP’s Credentialing Department will send the provider(s) a credentialing application. The agreement will be fully executed by MHHP and a copy sent to you once the provider is approved by the MHHP Credentialing Committee. The effective date will be assigned by MHHP upon approval of the MHHP Credentialing Committee.   We look forward to welcoming you into our network in the near future.  Best Regards, Camilla Paige', NULL, NULL, '2021-09-27 13:13:05', '2021-09-27 13:13:05'),
(47942, 11056, 31638, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Good afternoon!  Hope all is well. Here are the filled and signed provider agreement,Schedule C Tables 1 and 2 and Schedule D. Please see the attachment.  Practice Details: Practice Name : Nasa Urgent Care Inc Practice TIN # : 81-3237149 Practice NPI # : 1821542432 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  If you further need any additional information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 12:23:04', '2021-10-08 12:23:04'),
(47943, 11056, 31638, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Hello,   Memorial Hermann Health Plan (MHHP) has accepted your request to participate in our health plan. Please find attached the Provider Agreement. Please have the agreement signed. Please complete the attached Schedule C Tables 1 and 2 and Schedule D, as applicable. Once all items are complete, please return.   Once the completed documents are received, MHHP’s Credentialing Department will send the provider(s) a credentialing application. The agreement will be fully executed by MHHP and a copy sent to you once the provider is approved by the MHHP Credentialing Committee. The effective date will be assigned by MHHP upon approval of the MHHP Credentialing Committee.   We look forward to welcoming you into our network in the near future.   Best Regards,  Camilla Paige', NULL, NULL, '2021-10-15 16:09:11', '2021-10-15 16:09:11'),
(47944, 11056, 31638, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Good morning!  Hope you had a great and safe weekend. Please provide the latest updates regarding the agreement and credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-10-22 16:31:13', '2021-10-22 16:31:13'),
(47945, 11056, 31638, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate   Good afternoon. Credentialing takes 30-45 days. Once I receive the credentialing approvals, I will send the agreement to my leadership team for full execution.', NULL, NULL, '2021-11-11 09:23:02', '2021-11-11 09:23:02'),
(47946, 11056, 31638, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  jcalderon@symplr.com  Sub : RE: 3st & Final Request/ Memorial Hermann Health plan/ Nasa Urgent Care Inc   Hi Ahmed,     The Professional Liability that you forward previously is coverage for the provider only we are still pending the following documents:     Facility Professional Liability Insurance   Facility General Liability Insurance Business Licenses or Certificate of Occupancy Accreditation Certificate CLIA (If applicable) If you are not the person that handles the above documentation can you please direct me to who is.     Thank you,   Johanna Calderon                           Credentialing Specialist  Work: +1 (516) 593-1380 Ext. 287  Fax: 516-620-3054  Email: jcalderon@symplr.com symplr.com', NULL, NULL, '2021-11-15 15:28:46', '2021-11-15 15:28:46'),
(47947, 11056, 31639, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 14:13:37', '2021-06-25 14:13:37'),
(47948, 11056, 31639, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to :  MHHPContracting@memorialhermann.org   Sub : New Provider Enrollment Request - NASA Health Clinic - Memorial Hermann  Greetings,  Hope you are doing well. As per your guideline,  I have filled out the form for participation & enrollment .Please see the attachment.  If any additional information or document needed regarding the enrollment process please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 14:16:59', '2021-06-25 14:16:59'),
(47949, 1006, 31639, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: New Provider Enrollment Request - NASA Health Clinic - Memorial Hermann  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and provider. Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-15 16:57:35', '2021-07-15 16:57:35'),
(47950, 1006, 31639, NULL, '2021-08-02 00:00:00.000', 'In Process', 'We received the following query from MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"We are in receipt of Segun Adeoye, MD’s request to become a participating provider with Memorial Hermann Health Plans and need additional information to proceed with your request.  Please provide the following information:  List of services provided ·         Do you provide Virtual Health Services? Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee   Your participation request will be presented at the next NAAC meeting following receipt of the additional information.  Best Regards, MHHP Network Contracting  MHH HealthPlan-Ins_SM_4C  Network Contracting Memorial Hermann Health Plan 929 Gessner Road, Suite 1500 Houston, TX 77024 MHHPContracting@memorialhermann.org\"  Responded to the queries. ', NULL, NULL, '2021-07-26 14:20:34', '2021-07-26 14:20:34'),
(47951, 1006, 31639, NULL, '2021-08-05 00:00:00.000', 'In Process', 'We received the following response from MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"Hi Brad. This request for participation came over as Segun Adeoye, MD at Nasa Health Clinic. Does this Urgent Care bill as an Urgent Care or do the individual practitioners bill individually? Please advise.  Thank you. Camilla\"  Replied: \"Hello Camilla,   I apologize, Nasa Health Clinic is not an urgent care, and the claims are billed with rendering providers NPI and the TIN. Please let me know if you have any other questions.  Thank you. \"', NULL, NULL, '2021-07-29 13:54:51', '2021-07-29 13:54:51'),
(47952, 11056, 31639, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Memorial Hermann Health Plan Request to Participate  Good morning Camilla!  Hope you are doing well. I want to get the enrollment status updates regarding the below mentioned provider and group :   Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 14:55:06', '2021-08-02 14:55:06'),
(47953, 11056, 31639, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: Memorial Hermann Health Plan Request to Participate  Thank you. Could you please update the services provided below? ', NULL, NULL, '2021-08-17 09:59:12', '2021-08-17 09:59:12'),
(47954, 11056, 31639, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Good morning!  Hope all is well. Nasa Health Clinic is a walking clinic not an urgent care. Nasa Urgent care is an urgent care. Both are different Clinics with different NPI and Tax I.D.   Feel free to reach out to me If you have further queries related to this. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-25 16:29:16', '2021-08-25 16:29:16'),
(47955, 11056, 31639, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Hi Ahmed. I need these additional questions (listed below) updated for Nasa Health Clinic. As stated below, I will need them by the end of the day today to go to our committee on Friday. If it’s later than that, they will have to wait until next month. Please let me know if you have any questions.     Please provide the following information:  List of services provided Do you provide Virtual Health Services? Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee    Your participation request will be presented at the next NAAC meeting following receipt of the additional information.     Thank you.     Camilla', NULL, NULL, '2021-09-07 17:06:56', '2021-09-07 17:06:56'),
(47956, 11056, 31639, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Hey Camilla!  Hope you are doing well. Here is the information you requested for Nasa Health Clinic.  Practice Details: Practice Name : Nasa Health Clinic Practice TIN # : 47-2682655 Practice NPI # : 1740661453 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406   ·  List of services provided Walk in Clinic   · Do you provide Virtual Health Services? Yes, telehealth services are provided.  ·Current service area and/or list of locations 985 NASA Parkway, Houston, TX 77058-3039 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  ·List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) Name: Segun Adeoye NPI# 1629418025  ·What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years 0~99+ years  ·Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. N/A  ·Link to website N/A  ·Current W-9 Attached  ·Current quality and outcomes data N/A  ·Any additional information you would like presented to the Network Access and Adequacy Committee N/A', NULL, NULL, '2021-09-15 16:54:09', '2021-09-15 16:54:09'),
(47957, 11056, 31639, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate   Hello,  Memorial Hermann Health Plan (MHHP) has accepted your request to participate in our health plan. Please find attached the Provider Agreement. Please have the agreement signed. Please complete the attached Schedule C Tables 1 and 2 and Schedule D, as applicable. Once all items are complete, please return.  Once the completed documents are received, MHHP’s Credentialing Department will send the provider(s) a credentialing application. The agreement will be fully executed by MHHP and a copy sent to you once the provider is approved by the MHHP Credentialing Committee. The effective date will be assigned by MHHP upon approval of the MHHP Credentialing Committee.   We look forward to welcoming you into our network in the near future.  Best Regards, Camilla Paige', NULL, NULL, '2021-09-27 13:13:00', '2021-09-27 13:13:00'),
(47958, 11056, 31639, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Good afternoon!  Hope all is well. Here are the filled and signed provider agreement,Schedule C Tables 1 and 2 and Schedule D. Please see the attachment.  Practice Details: Practice Name : Nasa Urgent Care Inc Practice TIN # : 81-3237149 Practice NPI # : 1821542432 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  If you further need any additional information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 12:22:59', '2021-10-08 12:22:59'),
(47959, 11056, 31639, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Hello,   Memorial Hermann Health Plan (MHHP) has accepted your request to participate in our health plan. Please find attached the Provider Agreement. Please have the agreement signed. Please complete the attached Schedule C Tables 1 and 2 and Schedule D, as applicable. Once all items are complete, please return.   Once the completed documents are received, MHHP’s Credentialing Department will send the provider(s) a credentialing application. The agreement will be fully executed by MHHP and a copy sent to you once the provider is approved by the MHHP Credentialing Committee. The effective date will be assigned by MHHP upon approval of the MHHP Credentialing Committee.   We look forward to welcoming you into our network in the near future.   Best Regards,  Camilla Paige', NULL, NULL, '2021-10-15 16:09:04', '2021-10-15 16:09:04'),
(47960, 11056, 31639, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Good morning!  Hope you had a great and safe weekend. Please provide the latest updates regarding the agreement and credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-10-22 16:31:07', '2021-10-22 16:31:07'),
(47961, 11056, 31639, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate   Good afternoon. Credentialing takes 30-45 days. Once I receive the credentialing approvals, I will send the agreement to my leadership team for full execution.', NULL, NULL, '2021-11-11 09:23:32', '2021-11-11 09:23:32'),
(47962, 11056, 31639, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  jcalderon@symplr.com  Sub : RE: 3st & Final Request/ Memorial Hermann Health plan/ Nasa Urgent Care Inc   Hi Ahmed,     The Professional Liability that you forward previously is coverage for the provider only we are still pending the following documents:     Facility Professional Liability Insurance   Facility General Liability Insurance Business Licenses or Certificate of Occupancy Accreditation Certificate CLIA (If applicable) If you are not the person that handles the above documentation can you please direct me to who is.     Thank you,   Johanna Calderon                           Credentialing Specialist  Work: +1 (516) 593-1380 Ext. 287  Fax: 516-620-3054  Email: jcalderon@symplr.com symplr.com', NULL, NULL, '2021-11-15 15:28:52', '2021-11-15 15:28:52'),
(47963, 11056, 31640, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 14:13:47', '2021-06-25 14:13:47'),
(47964, 11056, 31640, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to :  MHHPContracting@memorialhermann.org   Sub : New Provider Enrollment Request - NASA Health Clinic - Memorial Hermann  Greetings,  Hope you are doing well. As per your guideline,  I have filled out the form for participation & enrollment .Please see the attachment.  If any additional information or document needed regarding the enrollment process please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 14:16:44', '2021-06-25 14:16:44'),
(47965, 1006, 31640, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: New Provider Enrollment Request - NASA Health Clinic - Memorial Hermann  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and provider. Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-15 16:57:31', '2021-07-15 16:57:31');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(47966, 1006, 31640, NULL, '2021-08-02 00:00:00.000', 'In Process', 'We received the following query from MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"We are in receipt of Segun Adeoye, MD’s request to become a participating provider with Memorial Hermann Health Plans and need additional information to proceed with your request.  Please provide the following information:  List of services provided ·         Do you provide Virtual Health Services? Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee   Your participation request will be presented at the next NAAC meeting following receipt of the additional information.  Best Regards, MHHP Network Contracting  MHH HealthPlan-Ins_SM_4C  Network Contracting Memorial Hermann Health Plan 929 Gessner Road, Suite 1500 Houston, TX 77024 MHHPContracting@memorialhermann.org\"  Responded to the queries. ', NULL, NULL, '2021-07-26 14:20:31', '2021-07-26 14:20:31'),
(47967, 1006, 31640, NULL, '2021-08-05 00:00:00.000', 'In Process', 'We received the following response from MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"Hi Brad. This request for participation came over as Segun Adeoye, MD at Nasa Health Clinic. Does this Urgent Care bill as an Urgent Care or do the individual practitioners bill individually? Please advise.  Thank you. Camilla\"  Replied: \"Hello Camilla,   I apologize, Nasa Health Clinic is not an urgent care, and the claims are billed with rendering providers NPI and the TIN. Please let me know if you have any other questions.  Thank you. \"', NULL, NULL, '2021-07-29 13:55:02', '2021-07-29 13:55:02'),
(47968, 11056, 31640, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Memorial Hermann Health Plan Request to Participate  Good morning Camilla!  Hope you are doing well. I want to get the enrollment status updates regarding the below mentioned provider and group :   Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you need any documents or information please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 14:53:54', '2021-08-02 14:53:54'),
(47969, 11056, 31640, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: Memorial Hermann Health Plan Request to Participate  Thank you. Could you please update the services provided below?', NULL, NULL, '2021-08-17 10:00:05', '2021-08-17 10:00:05'),
(47970, 11056, 31640, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Good morning!  Hope all is well. Nasa Health Clinic is a walking clinic not an urgent care. Nasa Urgent care is an urgent care. Both are different Clinics with different NPI and Tax I.D.   Feel free to reach out to me If you have further queries related to this. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-25 16:29:00', '2021-08-25 16:29:00'),
(47971, 11056, 31640, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Hi Ahmed. I need these additional questions (listed below) updated for Nasa Health Clinic. As stated below, I will need them by the end of the day today to go to our committee on Friday. If it’s later than that, they will have to wait until next month. Please let me know if you have any questions.     Please provide the following information:  List of services provided Do you provide Virtual Health Services? Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee    Your participation request will be presented at the next NAAC meeting following receipt of the additional information.     Thank you.     Camilla', NULL, NULL, '2021-09-07 17:06:41', '2021-09-07 17:06:41'),
(47972, 11056, 31640, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Hey Camilla!  Hope you are doing well. Here is the information you requested for Nasa Health Clinic.  Practice Details: Practice Name : Nasa Health Clinic Practice TIN # : 47-2682655 Practice NPI # : 1740661453 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406   ·  List of services provided Walk in Clinic   · Do you provide Virtual Health Services? Yes, telehealth services are provided.  ·Current service area and/or list of locations 985 NASA Parkway, Houston, TX 77058-3039 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  ·List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) Name: Segun Adeoye NPI# 1629418025  ·What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years 0~99+ years  ·Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. N/A  ·Link to website N/A  ·Current W-9 Attached  ·Current quality and outcomes data N/A  ·Any additional information you would like presented to the Network Access and Adequacy Committee N/A', NULL, NULL, '2021-09-15 16:53:11', '2021-09-15 16:53:11'),
(47973, 11056, 31640, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate   Hello,  Memorial Hermann Health Plan (MHHP) has accepted your request to participate in our health plan. Please find attached the Provider Agreement. Please have the agreement signed. Please complete the attached Schedule C Tables 1 and 2 and Schedule D, as applicable. Once all items are complete, please return.  Once the completed documents are received, MHHP’s Credentialing Department will send the provider(s) a credentialing application. The agreement will be fully executed by MHHP and a copy sent to you once the provider is approved by the MHHP Credentialing Committee. The effective date will be assigned by MHHP upon approval of the MHHP Credentialing Committee.   We look forward to welcoming you into our network in the near future.  Best Regards, Camilla Paige', NULL, NULL, '2021-09-27 13:12:47', '2021-09-27 13:12:47'),
(47974, 11056, 31640, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Good afternoon!  Hope all is well. Here are the filled and signed provider agreement,Schedule C Tables 1 and 2 and Schedule D. Please see the attachment.  Practice Details: Practice Name : Nasa Urgent Care Inc Practice TIN # : 81-3237149 Practice NPI # : 1821542432 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  If you further need any additional information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 12:22:46', '2021-10-08 12:22:46'),
(47975, 11056, 31640, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Hello,   Memorial Hermann Health Plan (MHHP) has accepted your request to participate in our health plan. Please find attached the Provider Agreement. Please have the agreement signed. Please complete the attached Schedule C Tables 1 and 2 and Schedule D, as applicable. Once all items are complete, please return.   Once the completed documents are received, MHHP’s Credentialing Department will send the provider(s) a credentialing application. The agreement will be fully executed by MHHP and a copy sent to you once the provider is approved by the MHHP Credentialing Committee. The effective date will be assigned by MHHP upon approval of the MHHP Credentialing Committee.   We look forward to welcoming you into our network in the near future.   Best Regards,  Camilla Paige', NULL, NULL, '2021-10-15 16:08:48', '2021-10-15 16:08:48'),
(47976, 11056, 31640, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate  Good morning!  Hope you had a great and safe weekend. Please provide the latest updates regarding the agreement and credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-10-22 16:28:13', '2021-10-22 16:28:13'),
(47977, 11056, 31640, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Re: [EXTERNAL] Re: Memorial Hermann Health Plan Request to Participate   Good afternoon. Credentialing takes 30-45 days. Once I receive the credentialing approvals, I will send the agreement to my leadership team for full execution.', NULL, NULL, '2021-11-11 09:23:26', '2021-11-11 09:23:26'),
(47978, 11056, 31640, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  jcalderon@symplr.com  Sub : RE: 3st & Final Request/ Memorial Hermann Health plan/ Nasa Urgent Care Inc   Hi Ahmed,     The Professional Liability that you forward previously is coverage for the provider only we are still pending the following documents:     Facility Professional Liability Insurance   Facility General Liability Insurance Business Licenses or Certificate of Occupancy Accreditation Certificate CLIA (If applicable) If you are not the person that handles the above documentation can you please direct me to who is.     Thank you,   Johanna Calderon                           Credentialing Specialist  Work: +1 (516) 593-1380 Ext. 287  Fax: 516-620-3054  Email: jcalderon@symplr.com symplr.com', NULL, NULL, '2021-11-15 15:28:57', '2021-11-15 15:28:57'),
(47979, 11056, 31641, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 16:35:44', '2021-06-25 16:35:44'),
(47980, 11056, 31641, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to : Enterprise.Credentialing@memorialhermann.org  Sub : New Provider Enrollment Request - NASA Urgent Care - Memorial Hermann  Good Evening,   I hope you\'re doing well, I wanted to enroll the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider : Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 16:37:13', '2021-06-25 16:37:13'),
(47981, 1006, 31641, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ Enterprise.Credentialing@memorialhermann.org:  Sub: New Provider Enrollment Request - NASA Urgent Care - Memorial Hermann  \"Hello,   I hope you\'re doing well, I\'m still waiting on an update regarding our request. Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-15 16:53:28', '2021-07-15 16:53:28'),
(47982, 1006, 31641, NULL, '2021-08-02 00:00:00.000', 'In Process', 'We received the following query from MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"We are in receipt of Segun Adeoye, MD’s request to become a participating provider with Memorial Hermann Health Plans and need additional information to proceed with your request.  Please provide the following information:  List of services provided ·         Do you provide Virtual Health Services? Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee   Your participation request will be presented at the next NAAC meeting following receipt of the additional information.  Best Regards, MHHP Network Contracting  MHH HealthPlan-Ins_SM_4C  Network Contracting Memorial Hermann Health Plan 929 Gessner Road, Suite 1500 Houston, TX 77024 MHHPContracting@memorialhermann.org\"  Responded to the queries. ', NULL, NULL, '2021-07-26 14:20:27', '2021-07-26 14:20:27'),
(47983, 11056, 31641, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good Afternoon,   I hope you\'re doing well. I wanted to know the enrollment status of the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider : Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 14:09:05', '2021-08-02 14:09:05'),
(47984, 11056, 31641, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning. We need answers to the additional questions that were sent on July 30, 2021 before we can move forward. Please see attached email.   Thank you.    Camilla', NULL, NULL, '2021-08-17 13:33:57', '2021-08-17 13:33:57'),
(47985, 11056, 31641, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning. My apologies. I have received the additional information. The Urgent Care will be presented to our Network Access and Adequacy Committee this month. Once I receive a response from them, I will let you know.     Thank you.     Camilla', NULL, NULL, '2021-08-25 16:22:54', '2021-08-25 16:22:54'),
(47986, 11056, 31641, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Hey Camilla!  Hope you are doing well. Here is the information you requested for Nasa Health Clinic.  Practice Details: Practice Name : Nasa Health Clinic Practice TIN # : 47-2682655 Practice NPI # : 1740661453 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406   ·  List of services provided Walk in Clinic  · Do you provide Virtual Health Services? Yes, telehealth services are provided.  ·Current service area and/or list of locations 985 NASA Parkway, Houston, TX 77058-3039 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  ·List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) Name: Segun Adeoye NPI# 1629418025  ·What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years 0~99+ years  ·Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. N/A  ·Link to website N/A  ·Current W-9 Attached  ·Current quality and outcomes data N/A  ·Any additional information you would like presented to the Network Access and Adequacy Committee N/A', NULL, NULL, '2021-09-07 16:58:10', '2021-09-07 16:58:10'),
(47987, 11056, 31641, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning. I have received the executed agreement for NASA Urgent Care and that information has been forwarded to our credentialing team. However, I have not received the executed agreement for NASA Health Clinic. Please let me know that status of receiving that agreement.', NULL, NULL, '2021-09-15 17:00:00', '2021-09-15 17:00:00'),
(47988, 11056, 31641, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to :MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann   Good afternoon!  Hope this email finds you well. We have already submitted that to you. If you haven\'t received it yet, Please let us know. Please provide that agreement back to us,so we will fill out that again and submit it to you.  Thank you! Have a great day!', NULL, NULL, '2021-09-27 13:06:44', '2021-09-27 13:06:44'),
(47989, 11056, 31641, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good Evening!  Hope this email finds you well. Here are the filled and signed provider agreement,Schedule C Tables 1 and 2 and Schedule D. Please see the attachment.  Practice Details: Practice Name : Nasa Health Clinic Practice TIN # : 47-2682655 Practice NPI # : 1740661453 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  If you further need any additional information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 12:17:05', '2021-10-08 12:17:05'),
(47990, 11056, 31641, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to: MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann   Good morning!  Hope all is well. Here it is. Please find the attached and completed agreement for Nasa Health Clinic.  Please do not hesitate to reach out if you have any questions or concerns. Please keep me updated with the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-10-15 16:02:07', '2021-10-15 16:02:07'),
(47991, 11056, 31641, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning!  Hope you had a great and safe weekend. Please provide the latest updates regarding the agreement and credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025   If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-10-22 16:24:01', '2021-10-22 16:24:01'),
(47992, 11056, 31641, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from:  MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann   Good afternoon. Credentialing takes 30-45 days. Once I receive the credentialing approvals, I will send the agreement to my leadership team for full execution.', NULL, NULL, '2021-11-11 09:25:48', '2021-11-11 09:25:48'),
(47993, 11056, 31641, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  jcalderon@symplr.com  Sub : RE: 3st & Final Request/ Memorial Hermann Health plan/ Nasa Urgent Care Inc   Hi Ahmed,     The Professional Liability that you forward previously is coverage for the provider only we are still pending the following documents:     Facility Professional Liability Insurance   Facility General Liability Insurance Business Licenses or Certificate of Occupancy Accreditation Certificate CLIA (If applicable) If you are not the person that handles the above documentation can you please direct me to who is.     Thank you,   Johanna Calderon                           Credentialing Specialist  Work: +1 (516) 593-1380 Ext. 287  Fax: 516-620-3054  Email: jcalderon@symplr.com symplr.com', NULL, NULL, '2021-11-15 15:29:05', '2021-11-15 15:29:05'),
(47994, 11056, 31642, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 16:35:52', '2021-06-25 16:35:52'),
(47995, 11056, 31642, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to : Enterprise.Credentialing@memorialhermann.org  Sub : New Provider Enrollment Request - NASA Urgent Care - Memorial Hermann  Good Evening,   I hope you\'re doing well, I wanted to enroll the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider : Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 16:37:23', '2021-06-25 16:37:23'),
(47996, 1006, 31642, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ Enterprise.Credentialing@memorialhermann.org:  Sub: New Provider Enrollment Request - NASA Urgent Care - Memorial Hermann  \"Hello,   I hope you\'re doing well, I\'m still waiting on an update regarding our request. Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-15 16:53:24', '2021-07-15 16:53:24'),
(47997, 1006, 31642, NULL, '2021-08-02 00:00:00.000', 'In Process', 'We received the following query from MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"We are in receipt of Segun Adeoye, MD’s request to become a participating provider with Memorial Hermann Health Plans and need additional information to proceed with your request.  Please provide the following information:  List of services provided ·         Do you provide Virtual Health Services? Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee   Your participation request will be presented at the next NAAC meeting following receipt of the additional information.  Best Regards, MHHP Network Contracting  MHH HealthPlan-Ins_SM_4C  Network Contracting Memorial Hermann Health Plan 929 Gessner Road, Suite 1500 Houston, TX 77024 MHHPContracting@memorialhermann.org\"  Responded to the queries. ', NULL, NULL, '2021-07-26 14:20:23', '2021-07-26 14:20:23'),
(47998, 11056, 31642, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good Afternoon,   I hope you\'re doing well. I wanted to know the enrollment status of the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider : Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 14:08:56', '2021-08-02 14:08:56'),
(47999, 11056, 31642, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning. We need answers to the additional questions that were sent on July 30, 2021 before we can move forward. Please see attached email.   Thank you.    Camilla', NULL, NULL, '2021-08-17 13:33:49', '2021-08-17 13:33:49'),
(48000, 11056, 31642, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning. We need answers to the additional questions that were sent on July 30, 2021 before we can move forward. Please see attached email.   Thank you.    Camilla', NULL, NULL, '2021-08-17 13:37:24', '2021-08-17 13:37:24'),
(48001, 11056, 31642, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning. My apologies. I have received the additional information. The Urgent Care will be presented to our Network Access and Adequacy Committee this month. Once I receive a response from them, I will let you know.     Thank you.     Camilla', NULL, NULL, '2021-08-25 16:22:48', '2021-08-25 16:22:48'),
(48002, 11056, 31642, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Hey Camilla!  Hope you are doing well. Here is the information you requested for Nasa Health Clinic.  Practice Details: Practice Name : Nasa Health Clinic Practice TIN # : 47-2682655 Practice NPI # : 1740661453 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406   ·  List of services provided Walk in Clinic  · Do you provide Virtual Health Services? Yes, telehealth services are provided.  ·Current service area and/or list of locations 985 NASA Parkway, Houston, TX 77058-3039 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  ·List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) Name: Segun Adeoye NPI# 1629418025  ·What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years 0~99+ years  ·Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. N/A  ·Link to website N/A  ·Current W-9 Attached  ·Current quality and outcomes data N/A  ·Any additional information you would like presented to the Network Access and Adequacy Committee N/A', NULL, NULL, '2021-09-07 16:58:05', '2021-09-07 16:58:05'),
(48003, 11056, 31642, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning. I have received the executed agreement for NASA Urgent Care and that information has been forwarded to our credentialing team. However, I have not received the executed agreement for NASA Health Clinic. Please let me know that status of receiving that agreement.', NULL, NULL, '2021-09-15 16:59:54', '2021-09-15 16:59:54'),
(48004, 11056, 31642, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to :MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann   Good afternoon!  Hope this email finds you well. We have already submitted that to you. If you haven\'t received it yet, Please let us know. Please provide that agreement back to us,so we will fill out that again and submit it to you.  Thank you! Have a great day!', NULL, NULL, '2021-09-27 13:06:37', '2021-09-27 13:06:37'),
(48005, 11056, 31642, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good Evening!  Hope this email finds you well. Here are the filled and signed provider agreement,Schedule C Tables 1 and 2 and Schedule D. Please see the attachment.  Practice Details: Practice Name : Nasa Health Clinic Practice TIN # : 47-2682655 Practice NPI # : 1740661453 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  If you further need any additional information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 12:16:58', '2021-10-08 12:16:58'),
(48006, 11056, 31642, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to: MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann   Good morning!  Hope all is well. Here it is. Please find the attached and completed agreement for Nasa Health Clinic.  Please do not hesitate to reach out if you have any questions or concerns. Please keep me updated with the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-10-15 16:02:01', '2021-10-15 16:02:01'),
(48007, 11056, 31642, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning!  Hope you had a great and safe weekend. Please provide the latest updates regarding the agreement and credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025   If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-10-22 16:23:55', '2021-10-22 16:23:55'),
(48008, 11056, 31642, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from:  MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann   Good afternoon. Credentialing takes 30-45 days. Once I receive the credentialing approvals, I will send the agreement to my leadership team for full execution.', NULL, NULL, '2021-11-11 09:25:40', '2021-11-11 09:25:40'),
(48009, 11056, 31642, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  jcalderon@symplr.com  Sub : RE: 3st & Final Request/ Memorial Hermann Health plan/ Nasa Urgent Care Inc   Hi Ahmed,     The Professional Liability that you forward previously is coverage for the provider only we are still pending the following documents:     Facility Professional Liability Insurance   Facility General Liability Insurance Business Licenses or Certificate of Occupancy Accreditation Certificate CLIA (If applicable) If you are not the person that handles the above documentation can you please direct me to who is.     Thank you,   Johanna Calderon                           Credentialing Specialist  Work: +1 (516) 593-1380 Ext. 287  Fax: 516-620-3054  Email: jcalderon@symplr.com symplr.com', NULL, NULL, '2021-11-15 15:29:10', '2021-11-15 15:29:10'),
(48010, 11056, 31643, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 16:36:06', '2021-06-25 16:36:06'),
(48011, 11056, 31643, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to : Enterprise.Credentialing@memorialhermann.org  Sub : New Provider Enrollment Request - NASA Urgent Care - Memorial Hermann  Good Evening,   I hope you\'re doing well, I wanted to enroll the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider : Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 16:36:57', '2021-06-25 16:36:57'),
(48012, 1006, 31643, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ Enterprise.Credentialing@memorialhermann.org:  Sub: New Provider Enrollment Request - NASA Urgent Care - Memorial Hermann  \"Hello,   I hope you\'re doing well, I\'m still waiting on an update regarding our request. Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-15 16:53:18', '2021-07-15 16:53:18'),
(48013, 1006, 31643, NULL, '2021-08-02 00:00:00.000', 'In Process', 'We received the following query from MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"We are in receipt of Segun Adeoye, MD’s request to become a participating provider with Memorial Hermann Health Plans and need additional information to proceed with your request.  Please provide the following information:  List of services provided ·         Do you provide Virtual Health Services? Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee   Your participation request will be presented at the next NAAC meeting following receipt of the additional information.  Best Regards, MHHP Network Contracting  MHH HealthPlan-Ins_SM_4C  Network Contracting Memorial Hermann Health Plan 929 Gessner Road, Suite 1500 Houston, TX 77024 MHHPContracting@memorialhermann.org\"  Responded to the queries. ', NULL, NULL, '2021-07-26 14:20:11', '2021-07-26 14:20:11'),
(48014, 11056, 31643, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good Afternoon,   I hope you\'re doing well. I wanted to know the enrollment status of the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider : Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 14:08:31', '2021-08-02 14:08:31'),
(48015, 11056, 31643, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning. We need answers to the additional questions that were sent on July 30, 2021 before we can move forward. Please see attached email.   Thank you.    Camilla', NULL, NULL, '2021-08-17 13:32:23', '2021-08-17 13:32:23'),
(48016, 11056, 31643, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning. My apologies. I have received the additional information. The Urgent Care will be presented to our Network Access and Adequacy Committee this month. Once I receive a response from them, I will let you know.     Thank you.     Camilla', NULL, NULL, '2021-08-25 16:22:35', '2021-08-25 16:22:35'),
(48017, 11056, 31643, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Hey Camilla!  Hope you are doing well. Here is the information you requested for Nasa Health Clinic.  Practice Details: Practice Name : Nasa Health Clinic Practice TIN # : 47-2682655 Practice NPI # : 1740661453 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406   ·  List of services provided Walk in Clinic  · Do you provide Virtual Health Services? Yes, telehealth services are provided.  ·Current service area and/or list of locations 985 NASA Parkway, Houston, TX 77058-3039 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  ·List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) Name: Segun Adeoye NPI# 1629418025  ·What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years 0~99+ years  ·Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. N/A  ·Link to website N/A  ·Current W-9 Attached  ·Current quality and outcomes data N/A  ·Any additional information you would like presented to the Network Access and Adequacy Committee N/A ', NULL, NULL, '2021-09-07 16:57:12', '2021-09-07 16:57:12'),
(48018, 11056, 31643, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning. I have received the executed agreement for NASA Urgent Care and that information has been forwarded to our credentialing team. However, I have not received the executed agreement for NASA Health Clinic. Please let me know that status of receiving that agreement.', NULL, NULL, '2021-09-15 16:59:18', '2021-09-15 16:59:18'),
(48019, 11056, 31643, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to :MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann   Good afternoon!  Hope this email finds you well. We have already submitted that to you. If you haven\'t received it yet, Please let us know. Please provide that agreement back to us,so we will fill out that again and submit it to you.  Thank you! Have a great day! ', NULL, NULL, '2021-09-27 13:06:22', '2021-09-27 13:06:22'),
(48020, 11056, 31643, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good Evening!  Hope this email finds you well. Here are the filled and signed provider agreement,Schedule C Tables 1 and 2 and Schedule D. Please see the attachment.  Practice Details: Practice Name : Nasa Health Clinic Practice TIN # : 47-2682655 Practice NPI # : 1740661453 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  If you further need any additional information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 12:16:08', '2021-10-08 12:16:08'),
(48021, 11056, 31643, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to: MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann   Good morning!  Hope all is well. Here it is. Please find the attached and completed agreement for Nasa Health Clinic.  Please do not hesitate to reach out if you have any questions or concerns. Please keep me updated with the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-10-15 16:01:53', '2021-10-15 16:01:53'),
(48022, 11056, 31643, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning!  Hope you had a great and safe weekend. Please provide the latest updates regarding the agreement and credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025   If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-10-22 16:21:50', '2021-10-22 16:21:50'),
(48023, 11056, 31643, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from:  MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann   Good afternoon. Credentialing takes 30-45 days. Once I receive the credentialing approvals, I will send the agreement to my leadership team for full execution.', NULL, NULL, '2021-11-11 09:25:21', '2021-11-11 09:25:21'),
(48024, 11056, 31643, NULL, '2021-11-26 00:00:00.000', 'On Hold', 'Email received from:  jcalderon@symplr.com  Sub : RE: 3st & Final Request/ Memorial Hermann Health plan/ Nasa Urgent Care Inc   Hi Ahmed,     The Professional Liability that you forward previously is coverage for the provider only we are still pending the following documents:     Facility Professional Liability Insurance   Facility General Liability Insurance Business Licenses or Certificate of Occupancy Accreditation Certificate CLIA (If applicable) If you are not the person that handles the above documentation can you please direct me to who is.     Thank you,   Johanna Calderon                           Credentialing Specialist  Work: +1 (516) 593-1380 Ext. 287  Fax: 516-620-3054  Email: jcalderon@symplr.com symplr.com', NULL, NULL, '2021-11-19 11:22:24', '2021-11-19 11:22:24'),
(48025, 11056, 31644, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 16:40:23', '2021-06-25 16:40:23'),
(48026, 11056, 31644, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment Request - NASA Urgent Care - Cigna Health spring  Good Evening,  Please find the attached enrollment application for our ancillary group, please let me know if anything else is needed to proceed with this request.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 16:41:57', '2021-06-25 16:41:57'),
(48027, 1006, 31644, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email to same email:  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the above-mentioned facility.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-14 17:31:34', '2021-07-14 17:31:34'),
(48028, 11056, 31644, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Cigna Healthspring  Good Afternoon!  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned facility  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-30 16:36:53', '2021-07-30 16:36:53'),
(48029, 11056, 31644, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Cigna Healthspring  May you send me the LOI for Nasa Health Clinic, Nasa Urgent Clinic and BHUCC by today so I may forward them to our committee for our next meeting.   Thank you,   Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-17 09:41:47', '2021-08-17 09:41:47'),
(48030, 11056, 31644, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com  Sub  : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Hey Jennifer!  For sure. Here is the LOI of the facility. Please see the attachment.  If you need any information or documents further, feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:00:16', '2021-08-26 16:00:16'),
(48031, 11056, 31644, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Hi Ahmad,   Thank you for sending this over. In order to be credentialed we will need our letter of interest to be filled out. Once completed for all 3 facilities, may you send them back to me.   Jennifer Perez  Filled and submitted.', NULL, NULL, '2021-09-15 10:37:58', '2021-09-15 10:37:58'),
(48032, 11056, 31644, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Hi Ahmed,  I saw you replied to another email I sent, may you fill out the letter of interest using the following form and send back to me at your earliest convenience.   Thank you   Jennifer Perez Network Operations Senior Analyst | Cigna-Medicare 2800 North Loop West, Suite 400 | Houston, Texas 77092  New LOI has been filled and submitted.', NULL, NULL, '2021-09-28 16:05:36', '2021-09-28 16:05:36'),
(48033, 11056, 31644, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good morning!  Hope all is well. Here is the letter of interest for the below mentioned practice and provider. Please see the attachment.  Practice Details: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI# 1629418025  If further documents or information is needed please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 13:38:11', '2021-10-08 13:38:11'),
(48034, 11056, 31644, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : Rica C  Status: Segun Adeoye is in network Cigna-healthspring and credentialed But the Tax ID and Facility name is not appearing on the screen.  Ref code : 767288758', NULL, NULL, '2021-10-18 14:30:31', '2021-10-18 14:30:31'),
(48035, 11056, 31644, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Rep : Len J  Status:  The provider is still out of network. Linked to the Tax ID of Nasa Health Clinic but the Nasa Urgent Care is not showing up on their system.  Emailed at: txmacontracting@cigna.com as she guided for the follow-up & query.  Ref code: 768092704', NULL, NULL, '2021-10-25 16:43:59', '2021-10-25 16:43:59'),
(48036, 11056, 31644, NULL, '2021-11-18 00:00:00.000', 'In Process', '	 Email sent to: pdm@healthspring.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc.  Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 12:53:32', '2021-11-11 12:53:32'),
(48037, 11056, 31644, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: pdm@healthspring.com & txmacontracting@cigna.com & JENNIFER.PEREZ@cigna.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704   Eagerly, waiting to get back from you soon.  Thank you!', NULL, NULL, '2021-11-19 11:29:43', '2021-11-19 11:29:43');
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
(48038, 11056, 31644, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email received from:  cresta.smith@careallies.com  Sub:  Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Are these for Renaissance or Cigna Medicare direct?     Thanks,  Cresta  Replied:  Good afternoon!  Hope all is well with you. This is for Cigna Healthspring.  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-03 16:42:54', '2021-12-03 16:42:54'),
(48039, 11056, 31644, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to:  cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704  Eagerly, waiting to get back from you soon. If you guys are not interested in responding back to us or do not want to credential our provider, Please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-12-14 17:59:41', '2021-12-14 17:59:41'),
(48040, 11056, 31644, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc. Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 17:22:38', '2021-12-22 17:22:38'),
(48041, 19067, 31644, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Cigna Healthspring ||   Good Morning!   Hope you\'re doing well.  I would like to know the enrollment status of the following Provider & Group.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Kindly respond in a timely manner!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 10:56:36', '2021-12-30 10:56:36'),
(48042, 19067, 31644, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Cigna Healthspring ||   Hello!  Hope this email finds you well.  This is my Second reminder on the previous request.  Kindly get in touch as soon as you have time.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 19:04:16', '2022-01-09 19:04:16'),
(48043, 11056, 31645, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 16:41:05', '2021-06-25 16:41:05'),
(48044, 11056, 31645, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment Request - NASA Urgent Care - Cigna Health spring  Good Evening,  Please find the attached enrollment application for our ancillary group, please let me know if anything else is needed to proceed with this request.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 16:41:47', '2021-06-25 16:41:47'),
(48045, 1006, 31645, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email to same email:  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the above-mentioned facility.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-14 17:31:30', '2021-07-14 17:31:30'),
(48046, 11056, 31645, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Cigna Healthspring  Good Afternoon!  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned facility  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-30 16:36:34', '2021-07-30 16:36:34'),
(48047, 11056, 31645, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Cigna Healthspring  May you send me the LOI for Nasa Health Clinic, Nasa Urgent Clinic and BHUCC by today so I may forward them to our committee for our next meeting.   Thank you,   Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-17 09:41:39', '2021-08-17 09:41:39'),
(48048, 11056, 31645, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com  Sub  : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Hey Jennifer!  For sure. Here is the LOI of the facility. Please see the attachment.  If you need any information or documents further, feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:00:24', '2021-08-26 16:00:24'),
(48049, 11056, 31645, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Hi Ahmad,   Thank you for sending this over. In order to be credentialed we will need our letter of interest to be filled out. Once completed for all 3 facilities, may you send them back to me.   Jennifer Perez  Filled and submitted.', NULL, NULL, '2021-09-15 10:38:04', '2021-09-15 10:38:04'),
(48050, 11056, 31645, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Hi Ahmed,  I saw you replied to another email I sent, may you fill out the letter of interest using the following form and send back to me at your earliest convenience.   Thank you   Jennifer Perez Network Operations Senior Analyst | Cigna-Medicare 2800 North Loop West, Suite 400 | Houston, Texas 77092  New LOI has been filled and submitted.', NULL, NULL, '2021-09-28 16:05:22', '2021-09-28 16:05:22'),
(48051, 11056, 31645, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good morning!  Hope all is well. Here is the letter of interest for the below mentioned practice and provider. Please see the attachment.  Practice Details: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI# 1629418025  If further documents or information is needed please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 13:38:32', '2021-10-08 13:38:32'),
(48052, 11056, 31645, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : Rica C  Status: Segun Adeoye is in network Cigna-healthspring and credentialed But the Tax ID and Facility name is not appearing on the screen.  Ref code : 767288758', NULL, NULL, '2021-10-18 14:30:25', '2021-10-18 14:30:25'),
(48053, 11056, 31645, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Rep : Len J  Status:  The provider is still out of network. Linked to the Tax ID of Nasa Health Clinic but the Nasa Urgent Care is not showing up on their system.  Emailed at: txmacontracting@cigna.com as she guided for the follow-up & query.  Ref code: 768092704', NULL, NULL, '2021-10-25 16:44:47', '2021-10-25 16:44:47'),
(48054, 11056, 31645, NULL, '2021-11-18 00:00:00.000', 'In Process', '	 Email sent to: pdm@healthspring.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc.  Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 12:53:23', '2021-11-11 12:53:23'),
(48055, 11056, 31645, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: pdm@healthspring.com & txmacontracting@cigna.com & JENNIFER.PEREZ@cigna.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704   Eagerly, waiting to get back from you soon.  Thank you!', NULL, NULL, '2021-11-19 11:29:39', '2021-11-19 11:29:39'),
(48056, 11056, 31645, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email received from:  cresta.smith@careallies.com  Sub:  Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Are these for Renaissance or Cigna Medicare direct?     Thanks,  Cresta  Replied:  Good afternoon!  Hope all is well with you. This is for Cigna Healthspring.  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-03 16:42:48', '2021-12-03 16:42:48'),
(48057, 11056, 31645, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to:  cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704  Eagerly, waiting to get back from you soon. If you guys are not interested in responding back to us or do not want to credential our provider, Please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-12-14 17:59:36', '2021-12-14 17:59:36'),
(48058, 11056, 31645, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc. Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 17:22:43', '2021-12-22 17:22:43'),
(48059, 19067, 31645, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Cigna Healthspring ||   Good Morning!   Hope you\'re doing well.  I would like to know the enrollment status of the following Provider & Group.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Kindly respond in a timely manner!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 10:56:31', '2021-12-30 10:56:31'),
(48060, 19067, 31645, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Cigna Healthspring ||   Hello!  Hope this email finds you well.  This is my Second reminder on the previous request.  Kindly get in touch as soon as you have time.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 19:04:06', '2022-01-09 19:04:06'),
(48061, 11056, 31646, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 16:50:45', '2021-06-25 16:50:45'),
(48062, 11056, 31646, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Health spring  Good Evening,   I hope you\'re doing well, I wanted to enroll the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider:    Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 17:00:55', '2021-06-25 17:00:55'),
(48063, 1006, 31646, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment request for this group and the provider mentioned.  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-07-14 17:34:15', '2021-07-14 17:34:15'),
(48064, 11056, 31646, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good Evening,   I hope you\'re doing well, I wanted to enroll the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider:    Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you! Have a great day!', NULL, NULL, '2021-07-22 16:53:10', '2021-07-22 16:53:10'),
(48065, 11056, 31646, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good Evening,   I hope you\'re doing well. I wanted to inquire about the enrollment status of the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day! ', NULL, NULL, '2021-07-30 16:44:56', '2021-07-30 16:44:56'),
(48066, 11056, 31646, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Cigna Healthspring  May you send me the LOI for Nasa Health Clinic, Nasa Urgent Clinic and BHUCC by today so I may forward them to our committee for our next meeting.   Thank you,   Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-17 09:41:03', '2021-08-17 09:41:03'),
(48067, 11056, 31646, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com &  JENNIFER.PEREZ@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good morning!  Hope all is well. Here is the letter of interest for the below mentioned practice and provider. Please see the attachment.  Practice Details: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI# 1629418025  If further documents or information is needed please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 14:57:34', '2021-08-26 14:57:34'),
(48068, 11056, 31646, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding my applications for both of the facilities Nasa Urgent Care Inc. & Nasa Health Clinic for the provider,Segun Adeoye, which were submitted to you in the month of August. Kindly, update me soon.  If you have any questions or concerns or need any additional information or documents please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-09-15 10:47:17', '2021-09-15 10:47:17'),
(48069, 11056, 31646, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 16:02:16', '2021-09-28 16:02:16'),
(48070, 11056, 31646, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent  to :txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!  Hope all is well with you. It has been a long time since I got a response from you guys. I am still waiting to get an update on the credentialing applications for Nasa Health Clinic & Nasa Urgent Care.  Have my applications been credentialed yet or not?  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-10-08 13:51:07', '2021-10-08 13:51:07'),
(48071, 11056, 31646, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : Rica C  Status: Segun Adeoye is in network Cigna-healthspring and credentialed But the Tax ID and Facility name is not appearing on the screen.  Ref code : 767288758', NULL, NULL, '2021-10-18 14:30:18', '2021-10-18 14:30:18'),
(48072, 11056, 31646, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Rep : Len J  Status:  The provider is still out of network. Linked to the Tax ID of Nasa Health Clinic but the Nasa Urgent Care is not showing up on their system.  Emailed at: txmacontracting@cigna.com as she guided for the follow-up & query.  Ref code: 768092704', NULL, NULL, '2021-10-25 16:44:06', '2021-10-25 16:44:06'),
(48073, 11056, 31646, NULL, '2021-11-18 00:00:00.000', 'In Process', '	 Email sent to: pdm@healthspring.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc.  Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 12:53:18', '2021-11-11 12:53:18'),
(48074, 11056, 31646, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: pdm@healthspring.com & txmacontracting@cigna.com & JENNIFER.PEREZ@cigna.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704   Eagerly, waiting to get back from you soon.  Thank you!', NULL, NULL, '2021-11-19 11:29:31', '2021-11-19 11:29:31'),
(48075, 11056, 31646, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email received from:  cresta.smith@careallies.com  Sub:  Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Are these for Renaissance or Cigna Medicare direct?     Thanks,  Cresta  Replied:  Good afternoon!  Hope all is well with you. This is for Cigna Healthspring.  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-03 16:42:42', '2021-12-03 16:42:42'),
(48076, 11056, 31646, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to:  cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704  Eagerly, waiting to get back from you soon. If you guys are not interested in responding back to us or do not want to credential our provider, Please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-12-14 17:59:31', '2021-12-14 17:59:31'),
(48077, 11056, 31646, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc. Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 17:22:48', '2021-12-22 17:22:48'),
(48078, 19067, 31646, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Cigna Healthspring ||   Good Morning!   Hope you\'re doing well.  I would like to know the enrollment status of the following Provider & Group.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Kindly respond in a timely manner!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 10:47:13', '2021-12-30 10:47:13'),
(48079, 19067, 31646, NULL, '2022-01-15 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Re: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Cigna Healthspring ||    Hello!  Hope this email finds you well.  This is my second reminder on the previously mentioned request.  Kindly get in touch as soon as possible.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-07 23:26:19', '2022-01-07 23:26:19'),
(48080, 11056, 31647, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 16:50:50', '2021-06-25 16:50:50'),
(48081, 11056, 31647, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Health spring  Good Evening,   I hope you\'re doing well, I wanted to enroll the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider:    Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 17:00:57', '2021-06-25 17:00:57'),
(48082, 1006, 31647, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment request for this group and the provider mentioned.  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-07-14 17:34:06', '2021-07-14 17:34:06'),
(48083, 11056, 31647, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good Evening,   I hope you\'re doing well, I wanted to enroll the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider:    Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you! Have a great day!', NULL, NULL, '2021-07-22 16:53:25', '2021-07-22 16:53:25'),
(48084, 11056, 31647, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good Evening,   I hope you\'re doing well. I wanted to inquire about the enrollment status of the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-30 16:45:14', '2021-07-30 16:45:14'),
(48085, 11056, 31647, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Cigna Healthspring  May you send me the LOI for Nasa Health Clinic, Nasa Urgent Clinic and BHUCC by today so I may forward them to our committee for our next meeting.   Thank you,   Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-17 09:40:56', '2021-08-17 09:40:56'),
(48086, 11056, 31647, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com &  JENNIFER.PEREZ@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good morning!  Hope all is well. Here is the letter of interest for the below mentioned practice and provider. Please see the attachment.  Practice Details: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI# 1629418025  If further documents or information is needed please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 14:57:24', '2021-08-26 14:57:24'),
(48087, 11056, 31647, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding my applications for both of the facilities Nasa Urgent Care Inc. & Nasa Health Clinic for the provider,Segun Adeoye, which were submitted to you in the month of August. Kindly, update me soon.  If you have any questions or concerns or need any additional information or documents please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-09-15 10:47:10', '2021-09-15 10:47:10'),
(48088, 11056, 31647, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 16:02:07', '2021-09-28 16:02:07'),
(48089, 11056, 31647, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent  to :txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!  Hope all is well with you. It has been a long time since I got a response from you guys. I am still waiting to get an update on the credentialing applications for Nasa Health Clinic & Nasa Urgent Care.  Have my applications been credentialed yet or not?  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-10-08 13:51:28', '2021-10-08 13:51:28'),
(48090, 11056, 31647, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : Rica C  Status: Segun Adeoye is in network Cigna-healthspring and credentialed But the Tax ID and Facility name is not appearing on the screen.  Ref code : 767288758', NULL, NULL, '2021-10-18 14:30:11', '2021-10-18 14:30:11'),
(48091, 11056, 31647, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Rep : Len J  Status:  The provider is still out of network. Linked to the Tax ID of Nasa Health Clinic but the Nasa Urgent Care is not showing up on their system.  Emailed at: txmacontracting@cigna.com as she guided for the follow-up & query.  Ref code: 768092704', NULL, NULL, '2021-10-25 16:44:12', '2021-10-25 16:44:12'),
(48092, 11056, 31647, NULL, '2021-11-18 00:00:00.000', 'In Process', '	 Email sent to: pdm@healthspring.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc.  Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 12:53:12', '2021-11-11 12:53:12'),
(48093, 11056, 31647, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: pdm@healthspring.com & txmacontracting@cigna.com & JENNIFER.PEREZ@cigna.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704   Eagerly, waiting to get back from you soon.  Thank you!', NULL, NULL, '2021-11-19 11:29:25', '2021-11-19 11:29:25'),
(48094, 11056, 31647, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email received from:  cresta.smith@careallies.com  Sub:  Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Are these for Renaissance or Cigna Medicare direct?     Thanks,  Cresta  Replied:  Good afternoon!  Hope all is well with you. This is for Cigna Healthspring.  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-03 16:42:37', '2021-12-03 16:42:37'),
(48095, 11056, 31647, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to:  cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704  Eagerly, waiting to get back from you soon. If you guys are not interested in responding back to us or do not want to credential our provider, Please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-12-14 17:59:26', '2021-12-14 17:59:26'),
(48096, 11056, 31647, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc. Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 17:22:53', '2021-12-22 17:22:53'),
(48097, 19067, 31647, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Cigna Healthspring ||   Good Morning!   Hope you\'re doing well.  I would like to know the enrollment status of the following Provider & Group.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Kindly respond in a timely manner!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 10:47:00', '2021-12-30 10:47:00'),
(48098, 19067, 31647, NULL, '2022-01-15 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Re: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Cigna Healthspring ||    Hello!  Hope this email finds you well.  This is my second reminder on the previously mentioned request.  Kindly get in touch as soon as possible.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-07 23:26:12', '2022-01-07 23:26:12'),
(48099, 11056, 31648, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 16:50:57', '2021-06-25 16:50:57'),
(48100, 11056, 31648, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Health spring  Good Evening,   I hope you\'re doing well, I wanted to enroll the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider:    Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 17:00:48', '2021-06-25 17:00:48'),
(48101, 1006, 31648, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment request for this group and the provider mentioned.  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-07-14 17:34:03', '2021-07-14 17:34:03'),
(48102, 11056, 31648, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good Evening,   I hope you\'re doing well, I wanted to enroll the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider:    Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you! Have a great day!', NULL, NULL, '2021-07-22 16:53:32', '2021-07-22 16:53:32'),
(48103, 11056, 31648, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good Evening,   I hope you\'re doing well. I wanted to inquire about the enrollment status of the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-30 16:45:36', '2021-07-30 16:45:36'),
(48104, 11056, 31648, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Cigna Healthspring  May you send me the LOI for Nasa Health Clinic, Nasa Urgent Clinic and BHUCC by today so I may forward them to our committee for our next meeting.   Thank you,   Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-17 09:40:39', '2021-08-17 09:40:39'),
(48105, 11056, 31648, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com &  JENNIFER.PEREZ@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good morning!  Hope all is well. Here is the letter of interest for the below mentioned practice and provider. Please see the attachment.  Practice Details: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI# 1629418025  If further documents or information is needed please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 14:57:17', '2021-08-26 14:57:17'),
(48106, 11056, 31648, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding my applications for both of the facilities Nasa Urgent Care Inc. & Nasa Health Clinic for the provider,Segun Adeoye, which were submitted to you in the month of August. Kindly, update me soon.  If you have any questions or concerns or need any additional information or documents please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-09-15 10:47:03', '2021-09-15 10:47:03'),
(48107, 11056, 31648, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 16:02:01', '2021-09-28 16:02:01'),
(48108, 11056, 31648, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent  to :txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!  Hope all is well with you. It has been a long time since I got a response from you guys. I am still waiting to get an update on the credentialing applications for Nasa Health Clinic & Nasa Urgent Care.  Have my applications been credentialed yet or not?  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-10-08 13:51:38', '2021-10-08 13:51:38'),
(48109, 11056, 31648, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : Rica C  Status: Segun Adeoye is in network Cigna-healthspring and credentialed But the Tax ID and Facility name is not appearing on the screen.  Ref code : 767288758', NULL, NULL, '2021-10-18 14:30:05', '2021-10-18 14:30:05'),
(48110, 11056, 31648, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Rep : Len J  Status:  The provider is still out of network. Linked to the Tax ID of Nasa Health Clinic but the Nasa Urgent Care is not showing up on their system.  Emailed at: txmacontracting@cigna.com as she guided for the follow-up & query.  Ref code: 768092704', NULL, NULL, '2021-10-25 16:44:18', '2021-10-25 16:44:18'),
(48111, 11056, 31648, NULL, '2021-11-18 00:00:00.000', 'In Process', '	 Email sent to: pdm@healthspring.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc.  Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 12:53:07', '2021-11-11 12:53:07'),
(48112, 11056, 31648, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: pdm@healthspring.com & txmacontracting@cigna.com & JENNIFER.PEREZ@cigna.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704   Eagerly, waiting to get back from you soon.  Thank you!', NULL, NULL, '2021-11-19 11:29:21', '2021-11-19 11:29:21'),
(48113, 11056, 31648, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email received from:  cresta.smith@careallies.com  Sub:  Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Are these for Renaissance or Cigna Medicare direct?     Thanks,  Cresta  Replied:  Good afternoon!  Hope all is well with you. This is for Cigna Healthspring.  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-03 16:42:32', '2021-12-03 16:42:32'),
(48114, 11056, 31648, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to:  cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704  Eagerly, waiting to get back from you soon. If you guys are not interested in responding back to us or do not want to credential our provider, Please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-12-14 17:59:22', '2021-12-14 17:59:22'),
(48115, 11056, 31648, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc. Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 17:22:58', '2021-12-22 17:22:58'),
(48116, 19067, 31648, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Cigna Healthspring ||   Good Morning!   Hope you\'re doing well.  I would like to know the enrollment status of the following Provider & Group.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Kindly respond in a timely manner!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 10:46:50', '2021-12-30 10:46:50'),
(48117, 19067, 31648, NULL, '2022-01-15 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Re: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Cigna Healthspring ||    Hello!  Hope this email finds you well.  This is my second reminder on the previously mentioned request.  Kindly get in touch as soon as possible.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-07 23:26:06', '2022-01-07 23:26:06'),
(48118, 11056, 31649, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-25 16:51:00', '2021-06-25 16:51:00'),
(48119, 11056, 31649, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Health spring  Good Evening,   I hope you\'re doing well, I wanted to enroll the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider:    Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 17:00:23', '2021-06-25 17:00:23');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(48120, 1006, 31649, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment request for this group and the provider mentioned.  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-07-14 17:33:58', '2021-07-14 17:33:58'),
(48121, 11056, 31649, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good Evening,   I hope you\'re doing well, I wanted to enroll the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider:    Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you! Have a great day!', NULL, NULL, '2021-07-22 16:53:45', '2021-07-22 16:53:45'),
(48122, 11056, 31649, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good Evening,   I hope you\'re doing well. I wanted to inquire about the enrollment status of the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-30 16:45:24', '2021-07-30 16:45:24'),
(48123, 11056, 31649, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Cigna Healthspring  May you send me the LOI for Nasa Health Clinic, Nasa Urgent Clinic and BHUCC by today so I may forward them to our committee for our next meeting.   Thank you,   Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-17 09:35:59', '2021-08-17 09:35:59'),
(48124, 11056, 31649, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Cigna Healthspring  May you send me the LOI for Nasa Health Clinic, Nasa Urgent Clinic and BHUCC by today so I may forward them to our committee for our next meeting.   Thank you,   Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-17 09:37:03', '2021-08-17 09:37:03'),
(48125, 11056, 31649, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : 	txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Cigna Healthspring  May you send me the LOI for Nasa Health Clinic, Nasa Urgent Clinic and BHUCC by today so I may forward them to our committee for our next meeting.   Thank you,   Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-17 09:37:59', '2021-08-17 09:37:59'),
(48126, 11056, 31649, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com &  JENNIFER.PEREZ@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good morning!  Hope all is well. Here is the letter of interest for the below mentioned practice and provider. Please see the attachment.  Practice Details: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI# 1629418025  If further documents or information is needed please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 14:56:57', '2021-08-26 14:56:57'),
(48127, 11056, 31649, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding my applications for both of the facilities Nasa Urgent Care Inc. & Nasa Health Clinic for the provider,Segun Adeoye, which were submitted to you in the month of August. Kindly, update me soon.  If you have any questions or concerns or need any additional information or documents please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-09-15 10:46:46', '2021-09-15 10:46:46'),
(48128, 11056, 31649, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-09-28 16:01:49', '2021-09-28 16:01:49'),
(48129, 11056, 31649, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent  to :txgqproviderrelations@healthspring.com  Sub : Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!  Hope all is well with you. It has been a long time since I got a response from you guys. I am still waiting to get an update on the credentialing applications for Nasa Health Clinic & Nasa Urgent Care.  Have my applications been credentialed yet or not?  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-10-08 13:51:48', '2021-10-08 13:51:48'),
(48130, 11056, 31649, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : Rica C  Status: Segun Adeoye is in network Cigna-healthspring and credentialed But the Tax ID and Facility name is not appearing on the screen.  Ref code : 767288758', NULL, NULL, '2021-10-18 14:29:41', '2021-10-18 14:29:41'),
(48131, 11056, 31649, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Rep : Len J  Status:  The provider is still out of network. Linked to the Tax ID of Nasa Health Clinic but the Nasa Urgent Care is not showing up on their system.  Emailed at: txmacontracting@cigna.com as she guided for the follow-up & query.  Ref code: 768092704', NULL, NULL, '2021-10-25 16:44:24', '2021-10-25 16:44:24'),
(48132, 11056, 31649, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: pdm@healthspring.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc.  Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 12:52:03', '2021-11-11 12:52:03'),
(48133, 11056, 31649, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: pdm@healthspring.com & txmacontracting@cigna.com & JENNIFER.PEREZ@cigna.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704   Eagerly, waiting to get back from you soon.  Thank you!', NULL, NULL, '2021-11-19 11:29:07', '2021-11-19 11:29:07'),
(48134, 11056, 31649, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email received from:  cresta.smith@careallies.com  Sub:  Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring  Are these for Renaissance or Cigna Medicare direct?     Thanks,  Cresta  Replied:  Good afternoon!  Hope all is well with you. This is for Cigna Healthspring.  Please get back to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-03 16:42:05', '2021-12-03 16:42:05'),
(48135, 11056, 31649, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to:  cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!   Hope this email finds you well. It has been along that our emails haven\'t been responded to and ignored by your side. Please don\'t let us get disheartened and lose our patience. Kindly, respond to our query regarding the enrollment of the provider, Segun Adeoye with the practices, NASA health Clinic & NASA Urgent Care Inc. as soon as possible.  We also have called Cigna Health spring for the follow-up and the ref code is:  768092704  Eagerly, waiting to get back from you soon. If you guys are not interested in responding back to us or do not want to credential our provider, Please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-12-14 17:59:07', '2021-12-14 17:59:07'),
(48136, 11056, 31649, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: cresta.smith@careallies.com  Sub: Enrollment & Location Status Query - NASA Health Clinic- Cigna Healthspring   Good afternoon!  Hope all is well with you. Please let us know the latest updates on our applications for both practices, NASA health Clinic & NASA Urgent Care Inc. Kindly assist us soon regarding our query.  Eagerly, waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-22 17:23:02', '2021-12-22 17:23:02'),
(48137, 19067, 31649, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Cigna Healthspring ||   Good Morning!   Hope you\'re doing well.  I would like to know the enrollment status of the following Provider & Group.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Kindly respond in a timely manner!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 10:46:39', '2021-12-30 10:46:39'),
(48138, 19067, 31649, NULL, '2022-01-15 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com, txgqproviderrelations@healthspring.com, JENNIFER.PEREZ@cigna.com, pdm@healthspring.com, cresta.smith@careallies.com  Subject: Re: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Cigna Healthspring ||    Hello!  Hope this email finds you well.  This is my second reminder on the previously mentioned request.  Kindly get in touch as soon as possible.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-07 23:25:58', '2022-01-07 23:25:58'),
(48139, 1006, 31650, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-28 09:45:03', '2021-06-28 09:45:03'),
(48140, 1006, 31650, NULL, '2021-07-05 00:00:00.000', 'Approved', 'We received the following confirmation email from Healthsmart MDI PR Support mdiprsupport@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - HealthSmart  \"Hi,  Provider \'\' ADEOYE, SEGUN P \'\' is Effective \'\' 11/01/2018 \'\'.  Our system has been updated as requested.  * The locations below have been added.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :81494)  Thanks. HealthSmart Provider Relations.\"', NULL, NULL, '2021-06-28 09:45:27', '2021-06-28 09:45:27'),
(48141, 1006, 31651, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-28 09:45:08', '2021-06-28 09:45:08'),
(48142, 1006, 31651, NULL, '2021-07-05 00:00:00.000', 'Approved', 'We received the following confirmation email from Healthsmart MDI PR Support mdiprsupport@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - HealthSmart  \"Hi,  Provider \'\' ADEOYE, SEGUN P \'\' is Effective \'\' 11/01/2018 \'\'.  Our system has been updated as requested.  * The locations below have been added.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :81494)  Thanks. HealthSmart Provider Relations.\"', NULL, NULL, '2021-06-28 09:45:33', '2021-06-28 09:45:33'),
(48143, 1006, 31652, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-28 13:30:45', '2021-06-28 13:30:45'),
(48144, 1006, 31652, NULL, '2021-07-05 00:00:00.000', 'Initiated', 'Sent a new f/u email @ credentialing@anci-care.com & ACS VIP Providers VIPproviders@anci-care.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Anci-Care   \"Hello,   I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-06-28 13:31:03', '2021-06-28 13:31:03'),
(48145, 11056, 31652, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : VIPproviders@anci-care.com   &   credentialing@anci-care.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Anci-Care  Greetings,  I hope you\'re doing well. We wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them. If not then guide me the procedure for enrollment soon.  Practice Details: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:28:13', '2021-07-19 16:28:13'),
(48146, 11056, 31652, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Brad,     Hi.     Please see attached for NASA Urgent Care Inc.     Email to my attention.   patti.davidson@healthsmart.com        Thank you,     Patti Davidson | Manager, Network Development  HealthSmart | Network Solutions  Office: 972 388 3091 | Fax: 214 574 1121  patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-08-02 11:23:28', '2021-08-02 11:23:28'),
(48147, 11056, 31652, NULL, '2021-08-28 00:00:00.000', 'In Process', 'Waiting for the Segun\'s Malpractice for the forms to be submitted', NULL, NULL, '2021-08-20 17:09:37', '2021-08-20 17:09:37'),
(48148, 11056, 31652, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Waiting for the Segun\'s Malpractice for the forms to be submitted. Contacted alot but haven\'t responded back yet', NULL, NULL, '2021-08-25 16:16:41', '2021-08-25 16:16:41'),
(48149, 11056, 31652, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com & Jennifer.Maligaya@healthsmart.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Good morning!  Hope this email finds you well. Sorry for the delay. Please accept my apology. Here are the forms you requested for the Ancillary contracting of Nasa Urgent Care Inc. Please find the attachment.  If further any additional information or documents are needed feel free to reach out to me. Waiting for your response.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-22 14:43:31', '2021-09-22 14:43:31'),
(48150, 11056, 31652, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Thank you!  This has been sent for processing and credentialing approval.  Once approved you will receive a welcome letter and the signed agreement from our credentialing department.   Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-10-08 08:39:21', '2021-10-08 08:39:21'),
(48151, 11056, 31652, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the following facility and provider\'s credentialing process with Anci Care.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  Feel free to reach out to me if you have any questions or concerns.  Thank you! Have a blessed weekend!', NULL, NULL, '2021-10-15 16:54:36', '2021-10-15 16:54:36'),
(48152, 11056, 31652, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  This is in process with Credentialing for approval.     Thank you,   Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-10-22 17:06:05', '2021-10-22 17:06:05'),
(48153, 11056, 31652, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Good evening!  Hope this email finds you well. Any latest updates on the credentialing process. Is this approved by the credential department?  If you have any queries or concerns feel free to reach out to me.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 10:28:51', '2021-11-11 10:28:51'),
(48154, 11056, 31652, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  Leslie.Perez@healthsmart.com  Sub : NASA HealthClinic - Anci-Care   Hello,     The approval for this facility will be on hold until I receive the information requested to complete processing.     Once you receive a copy please send me a copy.   emailed to Mr. Segun on 21, Sept,2021:  Good morning Sir!  Hope you are doing great and had a wonderful week yet.  We have not received the documents below that are necessary to complete the credentialing process yet.  DOCUMENTS IN DEMAND: 1. Business License  2. Accreditation letter.  3. CLIA  ( for both Nasa Urgent Care & Nasa Health Clinic )  Eagerly, waiting for the documents.  Take Care of yourself!  Thank you! Have a wonderful weekend!   He hasn\'t provided the documents yet.', NULL, NULL, '2021-11-15 15:11:57', '2021-11-15 15:11:57'),
(48155, 1006, 31653, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-28 13:30:47', '2021-06-28 13:30:47'),
(48156, 1006, 31653, NULL, '2021-07-05 00:00:00.000', 'Initiated', 'Sent a new f/u email @ credentialing@anci-care.com & ACS VIP Providers VIPproviders@anci-care.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Anci-Care   \"Hello,   I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-06-28 13:30:59', '2021-06-28 13:30:59'),
(48157, 11056, 31653, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : VIPproviders@anci-care.com   &   credentialing@anci-care.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Anci-Care  Greetings,  I hope you\'re doing well. We wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them. If not then guide me the procedure for enrollment soon.  Practice Details: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:28:20', '2021-07-19 16:28:20'),
(48158, 11056, 31653, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Brad,     Hi.     Please see attached for NASA Urgent Care Inc.     Email to my attention.   patti.davidson@healthsmart.com        Thank you,     Patti Davidson | Manager, Network Development  HealthSmart | Network Solutions  Office: 972 388 3091 | Fax: 214 574 1121  patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-08-02 11:22:51', '2021-08-02 11:22:51'),
(48159, 11056, 31653, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Brad,     Hi.     Please see attached for NASA Urgent Care Inc.     Email to my attention.   patti.davidson@healthsmart.com        Thank you,     Patti Davidson | Manager, Network Development  HealthSmart | Network Solutions  Office: 972 388 3091 | Fax: 214 574 1121  patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-08-02 11:22:52', '2021-08-02 11:22:52'),
(48160, 11056, 31653, NULL, '2021-08-28 00:00:00.000', 'In Process', 'Waiting for the Segun\'s Malpractice for the forms to be submitted', NULL, NULL, '2021-08-20 17:10:00', '2021-08-20 17:10:00'),
(48161, 11056, 31653, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Waiting for the Segun\'s Malpractice for the forms to be submitted. Contacted alot but haven\'t responded back yet.', NULL, NULL, '2021-08-25 16:16:35', '2021-08-25 16:16:35'),
(48162, 11056, 31653, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com & Jennifer.Maligaya@healthsmart.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Good morning!  Hope this email finds you well. Sorry for the delay. Please accept my apology. Here are the forms you requested for the Ancillary contracting of Nasa Urgent Care Inc. Please find the attachment.  If further any additional information or documents are needed feel free to reach out to me. Waiting for your response.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-22 14:42:11', '2021-09-22 14:42:11'),
(48163, 11056, 31653, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com & Jennifer.Maligaya@healthsmart.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Good morning!  Hope this email finds you well. Sorry for the delay. Please accept my apology. Here are the forms you requested for the Ancillary contracting of Nasa Urgent Care Inc. Please find the attachment.  If further any additional information or documents are needed feel free to reach out to me. Waiting for your response.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-22 14:42:12', '2021-09-22 14:42:12'),
(48164, 11056, 31653, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Thank you!  This has been sent for processing and credentialing approval.  Once approved you will receive a welcome letter and the signed agreement from our credentialing department.   Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-10-08 08:38:08', '2021-10-08 08:38:08'),
(48165, 11056, 31653, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the following facility and provider\'s credentialing process with Anci Care.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  Feel free to reach out to me if you have any questions or concerns.  Thank you! Have a blessed weekend!', NULL, NULL, '2021-10-15 16:54:20', '2021-10-15 16:54:20'),
(48166, 11056, 31653, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  This is in process with Credentialing for approval.     Thank you,   Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-10-22 17:05:47', '2021-10-22 17:05:47'),
(48167, 11056, 31653, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Good evening!  Hope this email finds you well. Any latest updates on the credentialing process. Is this approved by the credential department?  If you have any queries or concerns feel free to reach out to me.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 10:28:34', '2021-11-11 10:28:34'),
(48168, 11056, 31653, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  Leslie.Perez@healthsmart.com  Sub : NASA HealthClinic - Anci-Care   Hello,     The approval for this facility will be on hold until I receive the information requested to complete processing.     Once you receive a copy please send me a copy.   emailed to Mr. Segun on 21, Sept,2021:  Good morning Sir!  Hope you are doing great and had a wonderful week yet.  We have not received the documents below that are necessary to complete the credentialing process yet.  DOCUMENTS IN DEMAND: 1. Business License  2. Accreditation letter.  3. CLIA  ( for both Nasa Urgent Care & Nasa Health Clinic )  Eagerly, waiting for the documents.  Take Care of yourself!  Thank you! Have a wonderful weekend!   He hasn\'t provided the documents yet.', NULL, NULL, '2021-11-15 15:12:02', '2021-11-15 15:12:02'),
(48169, 1006, 31654, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-28 13:38:19', '2021-06-28 13:38:19'),
(48170, 1006, 31654, NULL, '2021-07-05 00:00:00.000', 'Initiated', 'Sent f/u email at corrected email @ credentialing@anci-care.com & VIPproviders@anci-care.com:  Sub; Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  \"Hello,    I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Anci-Care and if the mentioned addresses are also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-06-28 13:38:41', '2021-06-28 13:38:41'),
(48171, 11056, 31654, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : credentialing@anci-care.com   &   VIPproviders@anci-care.com  Sub :  Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  Greetings,  I hope you\'re doing well. We wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them. If not then guide me the procedure for enrollment soon.  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:22:28', '2021-07-19 16:22:28'),
(48172, 11056, 31654, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to :   credentialing@anci-care.com,    ACS VIP Providers  VIPproviders@anci-care.com,  &  Jennifer MaligayaACS  jmaligaya@anci-care.com   Sub : Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  Greetings,  I hope you\'re doing well. We wanted to verify if the following group and provider were enrolled with Anci Care and if the mentioned addresses are also correctly listed under them. If not then guide me the procedure for enrollment soon.  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 09:02:14', '2021-08-03 09:02:14'),
(48173, 11056, 31654, NULL, '2021-08-28 00:00:00.000', 'In Process', 'Waiting for the Segun\'s Malpractice for the forms to be submitted', NULL, NULL, '2021-08-20 17:10:08', '2021-08-20 17:10:08'),
(48174, 11056, 31654, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Waiting for the Segun\'s Malpractice for the forms to be submitted. Contacted alot but haven\'t responded back yet', NULL, NULL, '2021-08-25 16:15:54', '2021-08-25 16:15:54'),
(48175, 11056, 31654, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  Hi.  The Agreement Packet for Nasa Urgent Care was sent to Brad.  I have not received it back signed for processing.  Nasa Health Clinic – primary healthcare clinic – not Urgent Care.  ACS only contracts with ancillary providers such as Urgent Care or Walk in Clinic not primary healthcare.  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thank you, Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-09-22 14:52:19', '2021-09-22 14:52:19'),
(48176, 11056, 31654, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : NASA HealthClinic - Anci-Care  Hi.  Please see attached.  Email to my attention:  patti.davidson@healthsmart.com  Thank you,  Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-10-08 08:31:21', '2021-10-08 08:31:21'),
(48177, 11056, 31654, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : 	Patti DavidsonACS pdavidson@anci-care.com & patti.davidson@healthsmart.com  Sub  : NASA HealthClinic - Anci-Care  Good morning Patti!  Hope this email finds you well. Here are the documents you requested for the following Practice enrollment and contracting with Anci-Care. If any corrections are needed please let me know.   Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Name	NPI Segun Adeoye	1629418025   If you need any further information or documents feel free to reach out to me. Please see the attachments. Thank you! Have a blessed day!', NULL, NULL, '2021-10-15 16:52:09', '2021-10-15 16:52:09'),
(48178, 11056, 31654, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : NASA HealthClinic - Anci-Care  Ahmed,  Hi.   Please complete the ACS Application questions:   PROVIDER APPLICATION CONFIDENTIAL INFORMATION  Resend to me and copy:  Leslie.perez@healthsmart.com For Credentialing processing.', NULL, NULL, '2021-10-25 16:06:50', '2021-10-25 16:06:50'),
(48179, 11056, 31654, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Leslie.perez@healthsmart.com  Sub: NASA HealthClinic - Anci-Care  Good morning Leslie!  Hope this email finds you well. Please find the attached PROVIDER APPLICATION form for the credentialing process of Nasa Health Clinic. If any corrections or documents are required please let me know.   Thank you! Have a great day! ', NULL, NULL, '2021-11-11 10:31:22', '2021-11-11 10:31:22'),
(48180, 11056, 31654, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  Leslie.Perez@healthsmart.com  Sub : NASA HealthClinic - Anci-Care   Hello,     The approval for this facility will be on hold until I receive the information requested to complete processing.     Once you receive a copy please send me a copy.   emailed to Mr. Segun on 21, Sept,2021:  Good morning Sir!  Hope you are doing great and had a wonderful week yet.  We have not received the documents below that are necessary to complete the credentialing process yet.  DOCUMENTS IN DEMAND: 1. Business License  2. Accreditation letter.  3. CLIA  ( for both Nasa Urgent Care & Nasa Health Clinic )  Eagerly, waiting for the documents.  Take Care of yourself!  Thank you! Have a wonderful weekend!   He hasn\'t provided the documents yet.', NULL, NULL, '2021-11-15 15:12:24', '2021-11-15 15:12:24'),
(48181, 1006, 31655, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-28 13:38:22', '2021-06-28 13:38:22'),
(48182, 1006, 31655, NULL, '2021-07-05 00:00:00.000', 'Initiated', 'Sent f/u email at corrected email @ credentialing@anci-care.com & VIPproviders@anci-care.com:  Sub; Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  \"Hello,    I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Anci-Care and if the mentioned addresses are also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-06-28 13:38:38', '2021-06-28 13:38:38'),
(48183, 11056, 31655, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : credentialing@anci-care.com   &   VIPproviders@anci-care.com  Sub :  Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  Greetings,  I hope you\'re doing well. We wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them. If not then guide me the procedure for enrollment soon.  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:22:36', '2021-07-19 16:22:36'),
(48184, 11056, 31655, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to :   credentialing@anci-care.com,    ACS VIP Providers  VIPproviders@anci-care.com,  &  Jennifer MaligayaACS  jmaligaya@anci-care.com   Sub : Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  Greetings,  I hope you\'re doing well. We wanted to verify if the following group and provider were enrolled with Anci Care and if the mentioned addresses are also correctly listed under them. If not then guide me the procedure for enrollment soon.  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!Greetings,  I hope you\'re doing well. We wanted to verify if the following group and provider were enrolled with Anci Care and if the mentioned addresses are also correctly listed under them. If not then guide me the procedure for enrollment soon.  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 09:01:40', '2021-08-03 09:01:40'),
(48185, 11056, 31655, NULL, '2021-08-28 00:00:00.000', 'In Process', 'Waiting for the Segun\'s Malpractice for the forms to be submitted', NULL, NULL, '2021-08-20 17:10:15', '2021-08-20 17:10:15'),
(48186, 11056, 31655, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Waiting for the Segun\'s Malpractice for the forms to be submitted. Contacted alot but haven\'t responded back yet', NULL, NULL, '2021-08-25 16:13:49', '2021-08-25 16:13:49'),
(48187, 11056, 31655, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - Anci-Care  Hi.  The Agreement Packet for Nasa Urgent Care was sent to Brad.  I have not received it back signed for processing.  Nasa Health Clinic – primary healthcare clinic – not Urgent Care.  ACS only contracts with ancillary providers such as Urgent Care or Walk in Clinic not primary healthcare.  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thank you, Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-09-22 14:51:57', '2021-09-22 14:51:57'),
(48188, 11056, 31655, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : NASA HealthClinic - Anci-Care  Hi.  Please see attached.  Email to my attention:  patti.davidson@healthsmart.com  Thank you,  Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-10-08 08:31:15', '2021-10-08 08:31:15'),
(48189, 11056, 31655, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : 	Patti DavidsonACS pdavidson@anci-care.com & patti.davidson@healthsmart.com  Sub  : NASA HealthClinic - Anci-Care  Good morning Patti!  Hope this email finds you well. Here are the documents you requested for the following Practice enrollment and contracting with Anci-Care. If any corrections are needed please let me know.   Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Name	NPI Segun Adeoye	1629418025   If you need any further information or documents feel free to reach out to me. Please see the attachments. Thank you! Have a blessed day!', NULL, NULL, '2021-10-15 16:51:41', '2021-10-15 16:51:41'),
(48190, 11056, 31655, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : 	Patti DavidsonACS pdavidson@anci-care.com & patti.davidson@healthsmart.com  Sub  : NASA HealthClinic - Anci-Care  Good morning Patti!  Hope this email finds you well. Here are the documents you requested for the following Practice enrollment and contracting with Anci-Care. If any corrections are needed please let me know.   Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Name	NPI Segun Adeoye	1629418025   If you need any further information or documents feel free to reach out to me. Please see the attachments. Thank you! Have a blessed day!', NULL, NULL, '2021-10-15 16:51:42', '2021-10-15 16:51:42'),
(48191, 11056, 31655, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : NASA HealthClinic - Anci-Care  Ahmed,  Hi.   Please complete the ACS Application questions:   PROVIDER APPLICATION CONFIDENTIAL INFORMATION  Resend to me and copy:  Leslie.perez@healthsmart.com For Credentialing processing.', NULL, NULL, '2021-10-25 16:06:35', '2021-10-25 16:06:35'),
(48192, 11056, 31655, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Leslie.perez@healthsmart.com  Sub: NASA HealthClinic - Anci-Care  Good morning Leslie!  Hope this email finds you well. Please find the attached PROVIDER APPLICATION form for the credentialing process of Nasa Health Clinic. If any corrections or documents are required please let me know.   Thank you! Have a great day! ', NULL, NULL, '2021-11-11 10:31:00', '2021-11-11 10:31:00'),
(48193, 11056, 31655, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  Leslie.Perez@healthsmart.com  Sub : NASA HealthClinic - Anci-Care   Hello,     The approval for this facility will be on hold until I receive the information requested to complete processing.     Once you receive a copy please send me a copy.   emailed to Mr. Segun on 21, Sept,2021:  Good morning Sir!  Hope you are doing great and had a wonderful week yet.  We have not received the documents below that are necessary to complete the credentialing process yet.  DOCUMENTS IN DEMAND: 1. Business License  2. Accreditation letter.  3. CLIA  ( for both Nasa Urgent Care & Nasa Health Clinic )  Eagerly, waiting for the documents.  Take Care of yourself!  Thank you! Have a wonderful weekend!   He hasn\'t provided the documents yet.', NULL, NULL, '2021-11-15 15:12:31', '2021-11-15 15:12:31'),
(48194, 1005, 31656, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-30 12:02:20', '2021-06-30 12:02:20'),
(48195, 1005, 31656, NULL, '2021-07-07 00:00:00.000', 'Initiated', 'Check the main (Group) Task for details.', NULL, NULL, '2021-06-30 12:06:00', '2021-06-30 12:06:00'),
(48196, 1006, 31656, NULL, '2021-07-09 00:00:00.000', 'In Process', 'The request is in-process in the main group task for reference.', NULL, NULL, '2021-07-02 13:54:50', '2021-07-02 13:54:50'),
(48197, 1006, 31656, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ Teresa White Teresa.White@fridayhealthplans.com:  Sub: Enrollment Request - RSM - Friday Health Plans  \"Hello Teresa,  I hope you\'re doing well, I just wanted to check in on the status of this request.   Thank you.\"', NULL, NULL, '2021-07-27 17:10:21', '2021-07-27 17:10:21'),
(48198, 1006, 31656, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Sent f/u email @ Teresa White Teresa.White@fridayhealthplans.com:  Sub: Enrollment Request - RSM - Friday Health Plans  \"Hello Teresa,   We are still waiting on an update regarding the enrollment status for our group and providers. Please get back to me as soon as possible or please let me know who I should contact regarding this.  Thank you .\"', NULL, NULL, '2021-08-10 17:06:42', '2021-08-10 17:06:42'),
(48199, 1006, 31656, NULL, '2021-08-31 00:00:00.000', 'In Process', 'We received a letter from Friday Healthplans requesting DEA of Dr. Ram, sent them the following email @ providers@fridayhealthplans.com:  Sub: Ramegowda Belakere - Right Step Medical Center  \"Hello,   Please find the updated copy of the DEA for Dr. Ramegowda. Please do let me know if anything else is required to proceed.  Thank you. \"', NULL, NULL, '2021-08-24 16:15:35', '2021-08-24 16:15:35'),
(48200, 11056, 31656, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Good Afternoon!  Hope this email finds you well. Please inform us with the latest enrollment  status of the following provider and practice soon.  Practice Details :  Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  If you need any additional information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-09-02 15:24:53', '2021-09-02 15:24:53'),
(48201, 11056, 31656, NULL, '2021-09-11 00:00:00.000', 'Approved', 'I have verified the effective date by rep. Kale w. She confirmed the date. Eff date for provider :  08/27/2021  Please see the attachment.', NULL, NULL, '2021-09-03 17:03:18', '2021-09-03 17:03:18'),
(48202, 1005, 31657, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-30 12:02:20', '2021-06-30 12:02:20'),
(48203, 1005, 31657, NULL, '2021-07-07 00:00:00.000', 'Initiated', 'Check the main (Group) Task for details.', NULL, NULL, '2021-06-30 12:05:54', '2021-06-30 12:05:54'),
(48204, 1006, 31657, NULL, '2021-07-09 00:00:00.000', 'In Process', 'The request is in-process in the main group task for reference.', NULL, NULL, '2021-07-02 13:54:47', '2021-07-02 13:54:47'),
(48205, 1006, 31657, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ Teresa White Teresa.White@fridayhealthplans.com:  Sub: Enrollment Request - RSM - Friday Health Plans  \"Hello Teresa,  I hope you\'re doing well, I just wanted to check in on the status of this request.   Thank you.\"', NULL, NULL, '2021-07-27 17:10:17', '2021-07-27 17:10:17'),
(48206, 1006, 31657, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Sent f/u email @ Teresa White Teresa.White@fridayhealthplans.com:  Sub: Enrollment Request - RSM - Friday Health Plans  \"Hello Teresa,   We are still waiting on an update regarding the enrollment status for our group and providers. Please get back to me as soon as possible or please let me know who I should contact regarding this.  Thank you .\"', NULL, NULL, '2021-08-10 17:06:39', '2021-08-10 17:06:39'),
(48207, 1006, 31657, NULL, '2021-08-31 00:00:00.000', 'In Process', 'We received a letter from Friday Healthplans requesting DEA of Dr. Ram, sent them the following email @ providers@fridayhealthplans.com:  Sub: Ramegowda Belakere - Right Step Medical Center  \"Hello,   Please find the updated copy of the DEA for Dr. Ramegowda. Please do let me know if anything else is required to proceed.  Thank you. \"', NULL, NULL, '2021-08-24 16:15:32', '2021-08-24 16:15:32');
