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
(52946, 20067, 44683, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: HGBProviderRosters@humana.com  Sub: Automatic reply: Provider Roster || Edna Michi || VMUC || Tricare  Thank you for your roster submission!  Roster updates will be processed within 30 days of receipt and status responses that include loaded data and effective dates will be delivered upon completion.  Please note roster updates must include at minimum the following data elements in order for updates to be processed:  Name, NPI or SSN, Gender, Address, Specialty, Location or Practice Name, Phone Number, and Fax Number. Incomplete records will not be processed and will not be viewable on the online provider directory.  The use of Humana Military’s standard roster template is highly encouraged and will result in more efficient processing times.  The use of other formats requires significant manual processing and slower load times.     Humana Military Team', NULL, NULL, '2022-03-10 15:35:16', '2022-03-10 15:35:16'),
(52947, 10057, 44684, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:26:44', '2021-11-01 13:26:44'),
(52948, 10057, 44684, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Tricare. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:42:35', '2021-11-01 13:42:35'),
(52949, 10057, 44684, NULL, '2021-12-08 00:00:00.000', 'Initiated', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Hello,  Could you please update me with the process to enroll the following providers under the TIN and locations.  Kindly get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-01 16:29:05', '2021-12-01 16:29:05'),
(52950, 10057, 44684, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : trenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon, sir.  An email was sent to you on 11/1/21 advising what is needed to credentialing the providers:  I would need the above information sent to me by email on each provider so I can submit to my credentialing team to process.   Thank you, Jacque Trenz', NULL, NULL, '2021-12-08 11:12:33', '2021-12-08 11:12:33'),
(52951, 10057, 44684, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Hello Jacque,  Thank you for reaching out. Please find the attached documents for your reference. Let me know once you get any update.  Regards,', NULL, NULL, '2021-12-14 13:35:01', '2021-12-14 13:35:01'),
(52952, 10057, 44684, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Dear Sir:  The attachments do not have a credentialing application.  The attachments include a “certification” application.  We cannot use a certification application to credential a provider.  Please see the correct form attached above.  You can use either the Texas Standardized Credentialing Application (TSCA) or the Humana Military credentialing application.   Just complete one, NOT both.  The TSCA can also be found on the Texas Dept of Insurance website also.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-21 13:34:01', '2021-12-21 13:34:01'),
(52953, 10057, 44684, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Thank you for reaching out. Please find the attached forms as requested.  Let me know the update.  Thanks & Regards,', NULL, NULL, '2021-12-29 15:57:25', '2021-12-29 15:57:25'),
(52954, 20067, 44684, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Garcia Homero	1730564857 Wert Jeniece	1659919702 Juan Hernandez	1225617558   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:09:04', '2022-01-05 17:09:04'),
(52955, 20067, 44684, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad ', NULL, NULL, '2022-01-18 14:08:57', '2022-01-18 14:08:57'),
(52956, 20067, 44684, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad', NULL, NULL, '2022-01-31 11:07:30', '2022-01-31 11:07:30'),
(52957, 20067, 44684, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good afternoon,     TRICARE does not send Welcome Kits or Letters.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE', NULL, NULL, '2022-02-16 17:29:42', '2022-02-16 17:29:42'),
(52958, 20067, 44684, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Evening!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-listed providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Nubia Benavides	1801371935	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Nubia Benavides	1801371935	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Nubia Benavides	1801371935	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Edna Michi	1992293906	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Edna Michi	1992293906	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Edna Michi	1992293906	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Juan Hernandez	1225617558	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Juan Hernandez	1225617558	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Juan Hernandez	1225617558	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Jeniece Wert	1659919702	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Jeniece Wert	1659919702	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Thank you,', NULL, NULL, '2022-03-02 17:05:46', '2022-03-02 17:05:46'),
(52959, 20067, 44684, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Secure Email received from: jtrenz@humana.com   Sub: RE: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon –     1)  Nubia Benavides  -   There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please use the attached form to submit a name update/correction.  Be sure to check the box at the top which states “Update Solo Practitioner Name”.  This needs to be corrected before credentialing can be completed. Please fax completed form to 608-221-7535.     2) Edna Michi – Please complete the 2nd attachment (Provider Roster).  On the first spreadsheet tab, include all information of the three locations.  On the second tab for Professional Info, please complete with all information on the professional provider. This will add the provider to the 3 locations.  Once complete, please email this form to HGBProviderRosters@humana.com.     3)  Juan Hernandez – There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please follow the same instructions for the form as with #1, Nubia Benavides.     4)  Jeniece Wert – Provider profile is complete.   101 E Expressway 83, Ste 170, McAllen Texas – Effective date 1/31/2022  800 E Alton Gloor, Brownsville TX – Effective date 1/31/2022.     Thank you,  Jacque Trenz', NULL, NULL, '2022-03-10 15:14:05', '2022-03-10 15:14:05'),
(52960, 20067, 44684, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Sub: Provider Roster || Edna Michi || VMUC || Tricare  Good Afternoon!  Attached is the roster for Edna Michi.  Thank you', NULL, NULL, '2022-03-10 15:25:43', '2022-03-10 15:25:43'),
(52961, 20067, 44684, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: HGBProviderRosters@humana.com  Sub: Automatic reply: Provider Roster || Edna Michi || VMUC || Tricare  Thank you for your roster submission!  Roster updates will be processed within 30 days of receipt and status responses that include loaded data and effective dates will be delivered upon completion.  Please note roster updates must include at minimum the following data elements in order for updates to be processed:  Name, NPI or SSN, Gender, Address, Specialty, Location or Practice Name, Phone Number, and Fax Number. Incomplete records will not be processed and will not be viewable on the online provider directory.  The use of Humana Military’s standard roster template is highly encouraged and will result in more efficient processing times.  The use of other formats requires significant manual processing and slower load times.     Humana Military Team', NULL, NULL, '2022-03-10 15:35:10', '2022-03-10 15:35:10'),
(52962, 10057, 44685, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:26:57', '2021-11-01 13:26:57'),
(52963, 10057, 44685, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Tricare. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:43:36', '2021-11-01 13:43:36'),
(52964, 10057, 44685, NULL, '2021-12-08 00:00:00.000', 'Initiated', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Hello,  Could you please update me with the process to enroll the following providers under the TIN and locations.  Kindly get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-01 16:28:59', '2021-12-01 16:28:59'),
(52965, 10057, 44685, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : trenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon, sir.  An email was sent to you on 11/1/21 advising what is needed to credentialing the providers:  I would need the above information sent to me by email on each provider so I can submit to my credentialing team to process.   Thank you, Jacque Trenz', NULL, NULL, '2021-12-08 11:12:28', '2021-12-08 11:12:28'),
(52966, 10057, 44685, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Hello Jacque,  Thank you for reaching out. Please find the attached documents for your reference. Let me know once you get any update.  Regards,', NULL, NULL, '2021-12-14 13:34:55', '2021-12-14 13:34:55'),
(52967, 10057, 44685, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Dear Sir:  The attachments do not have a credentialing application.  The attachments include a “certification” application.  We cannot use a certification application to credential a provider.  Please see the correct form attached above.  You can use either the Texas Standardized Credentialing Application (TSCA) or the Humana Military credentialing application.   Just complete one, NOT both.  The TSCA can also be found on the Texas Dept of Insurance website also.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-21 13:33:53', '2021-12-21 13:33:53'),
(52968, 10057, 44685, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Thank you for reaching out. Please find the attached forms as requested.  Let me know the update.  Thanks & Regards,', NULL, NULL, '2021-12-29 15:57:14', '2021-12-29 15:57:14'),
(52969, 20067, 44685, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Garcia Homero	1730564857 Wert Jeniece	1659919702 Juan Hernandez	1225617558   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:08:49', '2022-01-05 17:08:49'),
(52970, 20067, 44685, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad ', NULL, NULL, '2022-01-18 14:08:50', '2022-01-18 14:08:50'),
(52971, 20067, 44685, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad', NULL, NULL, '2022-01-31 11:07:24', '2022-01-31 11:07:24'),
(52972, 20067, 44685, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good afternoon,     TRICARE does not send Welcome Kits or Letters.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE', NULL, NULL, '2022-02-16 17:29:36', '2022-02-16 17:29:36'),
(52973, 20067, 44685, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Evening!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-listed providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Nubia Benavides	1801371935	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Nubia Benavides	1801371935	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Nubia Benavides	1801371935	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Edna Michi	1992293906	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Edna Michi	1992293906	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Edna Michi	1992293906	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Juan Hernandez	1225617558	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Juan Hernandez	1225617558	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Juan Hernandez	1225617558	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Jeniece Wert	1659919702	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Jeniece Wert	1659919702	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Thank you,', NULL, NULL, '2022-03-02 17:05:39', '2022-03-02 17:05:39'),
(52974, 20067, 44685, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Secure Email received from: jtrenz@humana.com   Sub: RE: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon –     1)  Nubia Benavides  -   There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please use the attached form to submit a name update/correction.  Be sure to check the box at the top which states “Update Solo Practitioner Name”.  This needs to be corrected before credentialing can be completed. Please fax completed form to 608-221-7535.     2) Edna Michi – Please complete the 2nd attachment (Provider Roster).  On the first spreadsheet tab, include all information of the three locations.  On the second tab for Professional Info, please complete with all information on the professional provider. This will add the provider to the 3 locations.  Once complete, please email this form to HGBProviderRosters@humana.com.     3)  Juan Hernandez – There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please follow the same instructions for the form as with #1, Nubia Benavides.     4)  Jeniece Wert – Provider profile is complete.   101 E Expressway 83, Ste 170, McAllen Texas – Effective date 1/31/2022  800 E Alton Gloor, Brownsville TX – Effective date 1/31/2022.     Thank you,  Jacque Trenz', NULL, NULL, '2022-03-10 15:13:58', '2022-03-10 15:13:58'),
(52975, 20067, 44685, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Fax the provider update info at 608-221-7535  See the attachment', NULL, NULL, '2022-03-10 15:27:57', '2022-03-10 15:27:57'),
(52976, 10057, 44686, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:27:08', '2021-11-01 13:27:08'),
(52977, 10057, 44686, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Tricare. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:43:30', '2021-11-01 13:43:30'),
(52978, 10057, 44686, NULL, '2021-12-08 00:00:00.000', 'Initiated', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Hello,  Could you please update me with the process to enroll the following providers under the TIN and locations.  Kindly get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-01 16:28:53', '2021-12-01 16:28:53'),
(52979, 10057, 44686, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : trenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon, sir.  An email was sent to you on 11/1/21 advising what is needed to credentialing the providers:  I would need the above information sent to me by email on each provider so I can submit to my credentialing team to process.   Thank you, Jacque Trenz', NULL, NULL, '2021-12-08 11:12:23', '2021-12-08 11:12:23'),
(52980, 10057, 44686, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Hello Jacque,  Thank you for reaching out. Please find the attached documents for your reference. Let me know once you get any update.  Regards,', NULL, NULL, '2021-12-14 13:34:50', '2021-12-14 13:34:50'),
(52981, 10057, 44686, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Dear Sir:  The attachments do not have a credentialing application.  The attachments include a “certification” application.  We cannot use a certification application to credential a provider.  Please see the correct form attached above.  You can use either the Texas Standardized Credentialing Application (TSCA) or the Humana Military credentialing application.   Just complete one, NOT both.  The TSCA can also be found on the Texas Dept of Insurance website also.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-21 13:33:45', '2021-12-21 13:33:45'),
(52982, 10057, 44686, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Thank you for reaching out. Please find the attached forms as requested.  Let me know the update.  Thanks & Regards,', NULL, NULL, '2021-12-29 15:57:05', '2021-12-29 15:57:05'),
(52983, 20067, 44686, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Garcia Homero	1730564857 Wert Jeniece	1659919702 Juan Hernandez	1225617558   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:08:20', '2022-01-05 17:08:20'),
(52984, 20067, 44686, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad ', NULL, NULL, '2022-01-18 14:08:42', '2022-01-18 14:08:42'),
(52985, 20067, 44686, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad', NULL, NULL, '2022-01-31 11:07:18', '2022-01-31 11:07:18'),
(52986, 20067, 44686, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good afternoon,     TRICARE does not send Welcome Kits or Letters.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE', NULL, NULL, '2022-02-16 17:29:30', '2022-02-16 17:29:30'),
(52987, 20067, 44686, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Evening!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-listed providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Nubia Benavides	1801371935	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Nubia Benavides	1801371935	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Nubia Benavides	1801371935	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Edna Michi	1992293906	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Edna Michi	1992293906	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Edna Michi	1992293906	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Juan Hernandez	1225617558	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Juan Hernandez	1225617558	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Juan Hernandez	1225617558	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Jeniece Wert	1659919702	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Jeniece Wert	1659919702	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Thank you,', NULL, NULL, '2022-03-02 17:05:32', '2022-03-02 17:05:32'),
(52988, 20067, 44686, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Secure Email received from: jtrenz@humana.com   Sub: RE: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon –     1)  Nubia Benavides  -   There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please use the attached form to submit a name update/correction.  Be sure to check the box at the top which states “Update Solo Practitioner Name”.  This needs to be corrected before credentialing can be completed. Please fax completed form to 608-221-7535.     2) Edna Michi – Please complete the 2nd attachment (Provider Roster).  On the first spreadsheet tab, include all information of the three locations.  On the second tab for Professional Info, please complete with all information on the professional provider. This will add the provider to the 3 locations.  Once complete, please email this form to HGBProviderRosters@humana.com.     3)  Juan Hernandez – There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please follow the same instructions for the form as with #1, Nubia Benavides.     4)  Jeniece Wert – Provider profile is complete.   101 E Expressway 83, Ste 170, McAllen Texas – Effective date 1/31/2022  800 E Alton Gloor, Brownsville TX – Effective date 1/31/2022.     Thank you,  Jacque Trenz', NULL, NULL, '2022-03-10 15:13:50', '2022-03-10 15:13:50'),
(52989, 20067, 44686, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Fax the provider update info at 608-221-7535  See the attachment', NULL, NULL, '2022-03-10 15:27:43', '2022-03-10 15:27:43'),
(52990, 10057, 44687, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:27:19', '2021-11-01 13:27:19'),
(52991, 10057, 44687, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Tricare. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:43:23', '2021-11-01 13:43:23'),
(52992, 10057, 44687, NULL, '2021-12-08 00:00:00.000', 'Initiated', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Hello,  Could you please update me with the process to enroll the following providers under the TIN and locations.  Kindly get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-01 16:28:46', '2021-12-01 16:28:46'),
(52993, 10057, 44687, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : trenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon, sir.  An email was sent to you on 11/1/21 advising what is needed to credentialing the providers:  I would need the above information sent to me by email on each provider so I can submit to my credentialing team to process.   Thank you, Jacque Trenz', NULL, NULL, '2021-12-08 11:12:16', '2021-12-08 11:12:16'),
(52994, 10057, 44687, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Hello Jacque,  Thank you for reaching out. Please find the attached documents for your reference. Let me know once you get any update.  Regards,', NULL, NULL, '2021-12-14 13:34:35', '2021-12-14 13:34:35'),
(52995, 10057, 44687, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Dear Sir:  The attachments do not have a credentialing application.  The attachments include a “certification” application.  We cannot use a certification application to credential a provider.  Please see the correct form attached above.  You can use either the Texas Standardized Credentialing Application (TSCA) or the Humana Military credentialing application.   Just complete one, NOT both.  The TSCA can also be found on the Texas Dept of Insurance website also.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-21 13:33:34', '2021-12-21 13:33:34'),
(52996, 10057, 44687, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Thank you for reaching out. Please find the attached forms as requested.  Let me know the update.  Thanks & Regards,', NULL, NULL, '2021-12-29 15:56:56', '2021-12-29 15:56:56'),
(52997, 20067, 44687, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Garcia Homero	1730564857 Wert Jeniece	1659919702 Juan Hernandez	1225617558   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:07:51', '2022-01-05 17:07:51'),
(52998, 20067, 44687, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad ', NULL, NULL, '2022-01-18 14:08:31', '2022-01-18 14:08:31'),
(52999, 20067, 44687, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad', NULL, NULL, '2022-01-31 11:07:11', '2022-01-31 11:07:11'),
(53000, 20067, 44687, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good afternoon,     TRICARE does not send Welcome Kits or Letters.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE', NULL, NULL, '2022-02-16 17:29:22', '2022-02-16 17:29:22'),
(53001, 20067, 44687, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Evening!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-listed providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Nubia Benavides	1801371935	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Nubia Benavides	1801371935	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Nubia Benavides	1801371935	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Edna Michi	1992293906	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Edna Michi	1992293906	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Edna Michi	1992293906	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Juan Hernandez	1225617558	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Juan Hernandez	1225617558	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Juan Hernandez	1225617558	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Jeniece Wert	1659919702	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Jeniece Wert	1659919702	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Thank you,', NULL, NULL, '2022-03-02 17:05:23', '2022-03-02 17:05:23'),
(53002, 20067, 44687, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Secure Email received from: jtrenz@humana.com   Sub: RE: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon –     1)  Nubia Benavides  -   There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please use the attached form to submit a name update/correction.  Be sure to check the box at the top which states “Update Solo Practitioner Name”.  This needs to be corrected before credentialing can be completed. Please fax completed form to 608-221-7535.     2) Edna Michi – Please complete the 2nd attachment (Provider Roster).  On the first spreadsheet tab, include all information of the three locations.  On the second tab for Professional Info, please complete with all information on the professional provider. This will add the provider to the 3 locations.  Once complete, please email this form to HGBProviderRosters@humana.com.     3)  Juan Hernandez – There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please follow the same instructions for the form as with #1, Nubia Benavides.     4)  Jeniece Wert – Provider profile is complete.   101 E Expressway 83, Ste 170, McAllen Texas – Effective date 1/31/2022  800 E Alton Gloor, Brownsville TX – Effective date 1/31/2022.     Thank you,  Jacque Trenz', NULL, NULL, '2022-03-10 15:13:41', '2022-03-10 15:13:41'),
(53003, 20067, 44687, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Fax the provider update info at 608-221-7535  See the attachment', NULL, NULL, '2022-03-10 15:27:31', '2022-03-10 15:27:31'),
(53004, 10057, 44688, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:44:13', '2021-11-01 13:44:13'),
(53005, 10057, 44688, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with TriWest. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:51:18', '2021-11-01 13:51:18'),
(53006, 10057, 44688, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Good Morning,  Could you please help me out to get the latest update on the below mentioned enrollment request.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-16 10:41:28', '2021-11-16 10:41:28'),
(53007, 10057, 44688, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Good Morning,  Could you please help me out to get the latest update on the below mentioned enrollment request.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-30 16:00:20', '2021-11-30 16:00:20'),
(53008, 10057, 44688, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Received From : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Hello,  All of the locations show active.  As long as these providers bill under your TIN and NPI, then they will be covered.  Thank you,  Mr. Shannon Berger, Provider E-mail Support Specialist | TriWest Healthcare Alliance', NULL, NULL, '2021-12-07 14:22:52', '2021-12-07 14:22:52'),
(53009, 10057, 44688, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Thank you for your kind response. If you can provide me the effective date for the group Valley Med Urgent Care PLLC.  I would greatly appreciate it. Have a great day!  Regards,', NULL, NULL, '2021-12-16 13:27:36', '2021-12-16 13:27:36'),
(53010, 10057, 44688, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.', NULL, NULL, '2021-12-22 13:55:31', '2021-12-22 13:55:31'),
(53011, 10057, 44689, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:44:24', '2021-11-01 13:44:24'),
(53012, 10057, 44689, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with TriWest. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:51:12', '2021-11-01 13:51:12'),
(53013, 10057, 44689, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Good Morning,  Could you please help me out to get the latest update on the below mentioned enrollment request.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-16 10:41:22', '2021-11-16 10:41:22'),
(53014, 10057, 44689, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Good Morning,  Could you please help me out to get the latest update on the below mentioned enrollment request.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-30 16:00:14', '2021-11-30 16:00:14'),
(53015, 10057, 44689, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Received From : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Hello,  All of the locations show active.  As long as these providers bill under your TIN and NPI, then they will be covered.  Thank you,  Mr. Shannon Berger, Provider E-mail Support Specialist | TriWest Healthcare Alliance', NULL, NULL, '2021-12-07 14:22:39', '2021-12-07 14:22:39'),
(53016, 10057, 44689, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Thank you for your kind response. If you can provide me the effective date for the group Valley Med Urgent Care PLLC.  I would greatly appreciate it. Have a great day!  Regards,', NULL, NULL, '2021-12-16 13:27:30', '2021-12-16 13:27:30'),
(53017, 10057, 44689, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.', NULL, NULL, '2021-12-22 13:55:24', '2021-12-22 13:55:24'),
(53018, 10057, 44690, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:44:35', '2021-11-01 13:44:35'),
(53019, 10057, 44690, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with TriWest. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:51:06', '2021-11-01 13:51:06'),
(53020, 10057, 44690, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Good Morning,  Could you please help me out to get the latest update on the below mentioned enrollment request.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-16 10:41:17', '2021-11-16 10:41:17'),
(53021, 10057, 44690, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Good Morning,  Could you please help me out to get the latest update on the below mentioned enrollment request.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-30 16:00:08', '2021-11-30 16:00:08'),
(53022, 10057, 44690, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Received From : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Hello,  All of the locations show active.  As long as these providers bill under your TIN and NPI, then they will be covered.  Thank you,  Mr. Shannon Berger, Provider E-mail Support Specialist | TriWest Healthcare Alliance', NULL, NULL, '2021-12-07 14:22:31', '2021-12-07 14:22:31');
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
(53023, 10057, 44690, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Thank you for your kind response. If you can provide me the effective date for the group Valley Med Urgent Care PLLC.  I would greatly appreciate it. Have a great day!  Regards,', NULL, NULL, '2021-12-16 13:27:25', '2021-12-16 13:27:25'),
(53024, 10057, 44690, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.', NULL, NULL, '2021-12-22 13:55:17', '2021-12-22 13:55:17'),
(53025, 10057, 44691, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:44:47', '2021-11-01 13:44:47'),
(53026, 10057, 44691, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with TriWest. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:50:59', '2021-11-01 13:50:59'),
(53027, 10057, 44691, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Good Morning,  Could you please help me out to get the latest update on the below mentioned enrollment request.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-16 10:41:10', '2021-11-16 10:41:10'),
(53028, 10057, 44691, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Good Morning,  Could you please help me out to get the latest update on the below mentioned enrollment request.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-30 16:00:01', '2021-11-30 16:00:01'),
(53029, 10057, 44691, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Received From : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Hello,  All of the locations show active.  As long as these providers bill under your TIN and NPI, then they will be covered.  Thank you,  Mr. Shannon Berger, Provider E-mail Support Specialist | TriWest Healthcare Alliance', NULL, NULL, '2021-12-07 14:22:22', '2021-12-07 14:22:22'),
(53030, 10057, 44691, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Thank you for your kind response. If you can provide me the effective date for the group Valley Med Urgent Care PLLC.  I would greatly appreciate it. Have a great day!  Regards,', NULL, NULL, '2021-12-16 13:27:20', '2021-12-16 13:27:20'),
(53031, 10057, 44691, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.', NULL, NULL, '2021-12-22 13:55:10', '2021-12-22 13:55:10'),
(53032, 10057, 44692, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:45:00', '2021-11-01 13:45:00'),
(53033, 10057, 44692, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with TriWest. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:50:51', '2021-11-01 13:50:51'),
(53034, 10057, 44692, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Good Morning,  Could you please help me out to get the latest update on the below mentioned enrollment request.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-16 10:41:05', '2021-11-16 10:41:05'),
(53035, 10057, 44692, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Good Morning,  Could you please help me out to get the latest update on the below mentioned enrollment request.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-30 15:59:55', '2021-11-30 15:59:55'),
(53036, 10057, 44692, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Received From : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Hello,  All of the locations show active.  As long as these providers bill under your TIN and NPI, then they will be covered.  Thank you,  Mr. Shannon Berger, Provider E-mail Support Specialist | TriWest Healthcare Alliance', NULL, NULL, '2021-12-07 14:22:13', '2021-12-07 14:22:13'),
(53037, 10057, 44692, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Thank you for your kind response. If you can provide me the effective date for the group Valley Med Urgent Care PLLC.  I would greatly appreciate it. Have a great day!  Regards,', NULL, NULL, '2021-12-16 13:27:14', '2021-12-16 13:27:14'),
(53038, 10057, 44692, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.', NULL, NULL, '2021-12-22 13:54:39', '2021-12-22 13:54:39'),
(53039, 10057, 44693, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:45:10', '2021-11-01 13:45:10'),
(53040, 10057, 44693, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with TriWest. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:50:44', '2021-11-01 13:50:44'),
(53041, 10057, 44693, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Good Morning,  Could you please help me out to get the latest update on the below mentioned enrollment request.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-16 10:40:59', '2021-11-16 10:40:59'),
(53042, 10057, 44693, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Good Morning,  Could you please help me out to get the latest update on the below mentioned enrollment request.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-30 15:59:49', '2021-11-30 15:59:49'),
(53043, 10057, 44693, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Received From : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Hello,  All of the locations show active.  As long as these providers bill under your TIN and NPI, then they will be covered.  Thank you,  Mr. Shannon Berger, Provider E-mail Support Specialist | TriWest Healthcare Alliance', NULL, NULL, '2021-12-07 14:22:04', '2021-12-07 14:22:04'),
(53044, 10057, 44693, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : providerservices@triwest.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || TriWest ||  Thank you for your kind response. If you can provide me the effective date for the group Valley Med Urgent Care PLLC.  I would greatly appreciate it. Have a great day!  Regards,', NULL, NULL, '2021-12-16 13:27:06', '2021-12-16 13:27:06'),
(53045, 10057, 44693, NULL, '2021-12-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.', NULL, NULL, '2021-12-22 13:54:27', '2021-12-22 13:54:27'),
(53046, 10057, 44694, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:51:59', '2021-11-01 13:51:59'),
(53047, 10057, 44694, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : patti.davidson@healthsmart.com, Leslie.Perez@healthsmart.com & credentialing@anci-care.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Anci-Care. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:58:31', '2021-11-01 13:58:31'),
(53048, 10057, 44694, NULL, '2021-11-09 00:00:00.000', 'In Process', '', NULL, NULL, '2021-11-02 09:02:15', '2021-11-02 09:02:15'),
(53049, 10057, 44694, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Call for the status : ref code 2058176  Representative requested to wait at least 3 weeks.', NULL, NULL, '2021-11-02 09:04:38', '2021-11-02 09:04:38'),
(53050, 10057, 44694, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : shane.radford@healthsmart.com & patti.davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Greetings!  Can I get the effective date for the group since its Ancillary Contract.  Please get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:14:14', '2021-11-30 11:14:14'),
(53051, 10057, 44694, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : Shane.Radford@healthsmart.com Patti.Davidson@healthsmart.com &   Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good morning Steve.  I am following up to your below request, the effective date for the group is 3/15/2018.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121', NULL, NULL, '2021-12-06 16:23:57', '2021-12-06 16:23:57'),
(53052, 10057, 44694, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : shane.radford@healthsmart.com & patti.davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Thank you for your response. Can you confirm for me that Anci-care and Health Smart are the same insurance?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-14 09:45:14', '2021-12-14 09:45:14'),
(53053, 10057, 44694, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : Shane.Radford@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good morning Steve.   Anci-care and Health Smart are two separate contracts.   Anci-Care is now owned by Healthsmart but they do have separate contracts for each.  Hope that information helps, please let me know if you should need any additional information.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121', NULL, NULL, '2021-12-20 17:49:10', '2021-12-20 17:49:10'),
(53054, 10057, 44694, NULL, '2022-01-05 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-12-29 15:43:17', '2021-12-29 15:43:17'),
(53055, 10057, 44695, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:52:16', '2021-11-01 13:52:16'),
(53056, 10057, 44695, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : patti.davidson@healthsmart.com, Leslie.Perez@healthsmart.com & credentialing@anci-care.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Anci-Care. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:58:24', '2021-11-01 13:58:24'),
(53057, 10057, 44695, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : Patti.Davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Same Consultant Group.  Parent Provider ID # 437745  All sites loaded.  Would you please let him know?  Thanks,  *******************************************************************  Email Received From : Shane.Radford@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Steve,  Good afternoon, I am responding to the below request.  All of the sites in question have been loaded.  Please feel free to contact me if you should need any additional information.  Thank you, Shane Radford| Provider Relations HealthSmart | Network Solutions', NULL, NULL, '2021-11-02 09:02:11', '2021-11-02 09:02:11'),
(53058, 10057, 44695, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Call for the status : ref code 2058176  Representative requested to wait at least 3 weeks.', NULL, NULL, '2021-11-02 09:04:33', '2021-11-02 09:04:33'),
(53059, 10057, 44695, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : shane.radford@healthsmart.com & patti.davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Greetings!  Can I get the effective date for the group since its Ancillary Contract.  Please get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:14:09', '2021-11-30 11:14:09'),
(53060, 10057, 44695, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : Shane.Radford@healthsmart.com Patti.Davidson@healthsmart.com &   Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good morning Steve.  I am following up to your below request, the effective date for the group is 3/15/2018.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121', NULL, NULL, '2021-12-06 16:23:48', '2021-12-06 16:23:48'),
(53061, 10057, 44695, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : shane.radford@healthsmart.com & patti.davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Thank you for your response. Can you confirm for me that Anci-care and Health Smart are the same insurance?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-14 09:45:08', '2021-12-14 09:45:08'),
(53062, 10057, 44695, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : Shane.Radford@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good morning Steve.   Anci-care and Health Smart are two separate contracts.   Anci-Care is now owned by Healthsmart but they do have separate contracts for each.  Hope that information helps, please let me know if you should need any additional information.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121', NULL, NULL, '2021-12-20 17:49:03', '2021-12-20 17:49:03'),
(53063, 10057, 44695, NULL, '2022-01-05 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-12-29 15:43:09', '2021-12-29 15:43:09'),
(53064, 10057, 44696, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:52:27', '2021-11-01 13:52:27'),
(53065, 10057, 44696, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : patti.davidson@healthsmart.com, Leslie.Perez@healthsmart.com & credentialing@anci-care.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Anci-Care. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:58:09', '2021-11-01 13:58:09'),
(53066, 10057, 44696, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : Patti.Davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Same Consultant Group.  Parent Provider ID # 437745  All sites loaded.  Would you please let him know?  Thanks,  *******************************************************************  Email Received From : Shane.Radford@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Steve,  Good afternoon, I am responding to the below request.  All of the sites in question have been loaded.  Please feel free to contact me if you should need any additional information.  Thank you, Shane Radford| Provider Relations HealthSmart | Network Solutions', NULL, NULL, '2021-11-02 09:02:05', '2021-11-02 09:02:05'),
(53067, 10057, 44696, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Call for the status : ref code 2058176  Representative requested to wait at least 3 weeks.', NULL, NULL, '2021-11-02 09:04:27', '2021-11-02 09:04:27'),
(53068, 10057, 44696, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : shane.radford@healthsmart.com & patti.davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Greetings!  Can I get the effective date for the group since its Ancillary Contract.  Please get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:14:03', '2021-11-30 11:14:03'),
(53069, 10057, 44696, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : Shane.Radford@healthsmart.com Patti.Davidson@healthsmart.com &   Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good morning Steve.  I am following up to your below request, the effective date for the group is 3/15/2018.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121', NULL, NULL, '2021-12-06 16:23:39', '2021-12-06 16:23:39'),
(53070, 10057, 44696, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : shane.radford@healthsmart.com & patti.davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Thank you for your response. Can you confirm for me that Anci-care and Health Smart are the same insurance?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-14 09:45:03', '2021-12-14 09:45:03'),
(53071, 10057, 44696, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : Shane.Radford@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good morning Steve.   Anci-care and Health Smart are two separate contracts.   Anci-Care is now owned by Healthsmart but they do have separate contracts for each.  Hope that information helps, please let me know if you should need any additional information.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121', NULL, NULL, '2021-12-20 17:48:55', '2021-12-20 17:48:55'),
(53072, 10057, 44696, NULL, '2022-01-05 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-12-29 15:43:01', '2021-12-29 15:43:01'),
(53073, 10057, 44697, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:52:51', '2021-11-01 13:52:51'),
(53074, 10057, 44697, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : patti.davidson@healthsmart.com, Leslie.Perez@healthsmart.com & credentialing@anci-care.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Anci-Care. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:58:03', '2021-11-01 13:58:03'),
(53075, 10057, 44697, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : Patti.Davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Same Consultant Group.  Parent Provider ID # 437745  All sites loaded.  Would you please let him know?  Thanks,  *******************************************************************  Email Received From : Shane.Radford@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Steve,  Good afternoon, I am responding to the below request.  All of the sites in question have been loaded.  Please feel free to contact me if you should need any additional information.  Thank you, Shane Radford| Provider Relations HealthSmart | Network Solutions', NULL, NULL, '2021-11-02 09:02:00', '2021-11-02 09:02:00'),
(53076, 10057, 44697, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Call for the status : ref code 2058176  Representative requested to wait at least 3 weeks.', NULL, NULL, '2021-11-02 09:04:21', '2021-11-02 09:04:21'),
(53077, 10057, 44697, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : shane.radford@healthsmart.com & patti.davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Greetings!  Can I get the effective date for the group since its Ancillary Contract.  Please get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:13:58', '2021-11-30 11:13:58'),
(53078, 10057, 44697, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : Shane.Radford@healthsmart.com Patti.Davidson@healthsmart.com &   Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good morning Steve.  I am following up to your below request, the effective date for the group is 3/15/2018.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121', NULL, NULL, '2021-12-06 16:23:30', '2021-12-06 16:23:30'),
(53079, 10057, 44697, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : shane.radford@healthsmart.com & patti.davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Thank you for your response. Can you confirm for me that Anci-care and Health Smart are the same insurance?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-14 09:44:57', '2021-12-14 09:44:57'),
(53080, 10057, 44697, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : Shane.Radford@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good morning Steve.   Anci-care and Health Smart are two separate contracts.   Anci-Care is now owned by Healthsmart but they do have separate contracts for each.  Hope that information helps, please let me know if you should need any additional information.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121', NULL, NULL, '2021-12-20 17:48:47', '2021-12-20 17:48:47'),
(53081, 10057, 44697, NULL, '2022-01-05 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-12-29 15:42:53', '2021-12-29 15:42:53'),
(53082, 10057, 44698, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:53:02', '2021-11-01 13:53:02'),
(53083, 10057, 44698, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : patti.davidson@healthsmart.com, Leslie.Perez@healthsmart.com & credentialing@anci-care.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Anci-Care. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:57:57', '2021-11-01 13:57:57'),
(53084, 10057, 44698, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : Patti.Davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Same Consultant Group.  Parent Provider ID # 437745  All sites loaded.  Would you please let him know?  Thanks,  *******************************************************************  Email Received From : Shane.Radford@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Steve,  Good afternoon, I am responding to the below request.  All of the sites in question have been loaded.  Please feel free to contact me if you should need any additional information.  Thank you, Shane Radford| Provider Relations HealthSmart | Network Solutions', NULL, NULL, '2021-11-02 09:01:53', '2021-11-02 09:01:53'),
(53085, 10057, 44698, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Call for the status : ref code 2058176  Representative requested to wait at least 3 weeks.', NULL, NULL, '2021-11-02 09:04:15', '2021-11-02 09:04:15'),
(53086, 10057, 44698, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : shane.radford@healthsmart.com & patti.davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Greetings!  Can I get the effective date for the group since its Ancillary Contract.  Please get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:13:53', '2021-11-30 11:13:53'),
(53087, 10057, 44698, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : Shane.Radford@healthsmart.com Patti.Davidson@healthsmart.com &   Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good morning Steve.  I am following up to your below request, the effective date for the group is 3/15/2018.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121', NULL, NULL, '2021-12-06 16:23:20', '2021-12-06 16:23:20'),
(53088, 10057, 44698, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : shane.radford@healthsmart.com & patti.davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Thank you for your response. Can you confirm for me that Anci-care and Health Smart are the same insurance?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-14 09:44:52', '2021-12-14 09:44:52'),
(53089, 10057, 44698, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : Shane.Radford@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good morning Steve.   Anci-care and Health Smart are two separate contracts.   Anci-Care is now owned by Healthsmart but they do have separate contracts for each.  Hope that information helps, please let me know if you should need any additional information.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121', NULL, NULL, '2021-12-20 17:48:40', '2021-12-20 17:48:40'),
(53090, 10057, 44698, NULL, '2022-01-05 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-12-29 15:42:45', '2021-12-29 15:42:45'),
(53091, 10057, 44699, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:53:12', '2021-11-01 13:53:12'),
(53092, 10057, 44699, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : patti.davidson@healthsmart.com, Leslie.Perez@healthsmart.com & credentialing@anci-care.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Anci-Care. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 13:57:51', '2021-11-01 13:57:51'),
(53093, 10057, 44699, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : Patti.Davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Same Consultant Group.  Parent Provider ID # 437745  All sites loaded.  Would you please let him know?  Thanks,  *******************************************************************  Email Received From : Shane.Radford@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Steve,  Good afternoon, I am responding to the below request.  All of the sites in question have been loaded.  Please feel free to contact me if you should need any additional information.  Thank you, Shane Radford| Provider Relations HealthSmart | Network Solutions', NULL, NULL, '2021-11-02 09:01:47', '2021-11-02 09:01:47'),
(53094, 10057, 44699, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Call for the status : ref code 2058176  Representative requested to wait at least 3 weeks.', NULL, NULL, '2021-11-02 09:04:10', '2021-11-02 09:04:10'),
(53095, 10057, 44699, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : shane.radford@healthsmart.com & patti.davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Greetings!  Can I get the effective date for the group since its Ancillary Contract.  Please get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-30 11:13:45', '2021-11-30 11:13:45'),
(53096, 10057, 44699, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : Shane.Radford@healthsmart.com Patti.Davidson@healthsmart.com &   Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good morning Steve.  I am following up to your below request, the effective date for the group is 3/15/2018.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121', NULL, NULL, '2021-12-06 16:23:11', '2021-12-06 16:23:11'),
(53097, 10057, 44699, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : shane.radford@healthsmart.com & patti.davidson@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Thank you for your response. Can you confirm for me that Anci-care and Health Smart are the same insurance?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-14 09:44:47', '2021-12-14 09:44:47'),
(53098, 10057, 44699, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : Shane.Radford@healthsmart.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Anci-Care ||  Good morning Steve.   Anci-care and Health Smart are two separate contracts.   Anci-Care is now owned by Healthsmart but they do have separate contracts for each.  Hope that information helps, please let me know if you should need any additional information.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121', NULL, NULL, '2021-12-20 17:48:32', '2021-12-20 17:48:32'),
(53099, 10057, 44699, NULL, '2022-01-05 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-12-29 15:42:02', '2021-12-29 15:42:02'),
(53100, 10057, 44700, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:59:47', '2021-11-01 13:59:47'),
(53101, 10057, 44700, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : SWHPRECRED@bswhealth.org & SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Scott & White ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Scott & White. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:05:37', '2021-11-01 14:05:37'),
(53102, 10057, 44700, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : SWHPPROVSERVICES@bswhealth.org SWHPRECRED@bswhealth.org, SWHPPROVSERVICES@bswhealth.org, SWHPREGION4@bswhealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Scott & White ||  Good Afternoon Steve,  It appears we have an active SWHP Facility contract for this Urgent Care location however we do not have any providers enrolled.  You may need a new Group agreement to include providers.  I have included the Provider Relations Region 4 email on my response.  They should be able to assist you further.  Thank you and have a great day. Brenda P  Provider Services', NULL, NULL, '2021-11-02 08:32:58', '2021-11-02 08:32:58'),
(53103, 10057, 44700, NULL, '2021-11-16 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, '2021-11-09 13:27:38', '2021-11-09 13:27:38'),
(53104, 10057, 44701, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 13:59:58', '2021-11-01 13:59:58'),
(53105, 10057, 44701, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : SWHPRECRED@bswhealth.org & SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Scott & White ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Scott & White. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:05:30', '2021-11-01 14:05:30'),
(53106, 10057, 44701, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : SWHPPROVSERVICES@bswhealth.org SWHPRECRED@bswhealth.org, SWHPPROVSERVICES@bswhealth.org, SWHPREGION4@bswhealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Scott & White ||  Good Afternoon Steve,  It appears we have an active SWHP Facility contract for this Urgent Care location however we do not have any providers enrolled.  You may need a new Group agreement to include providers.  I have included the Provider Relations Region 4 email on my response.  They should be able to assist you further.  Thank you and have a great day. Brenda P  Provider Services', NULL, NULL, '2021-11-02 08:32:51', '2021-11-02 08:32:51'),
(53107, 10057, 44701, NULL, '2021-11-16 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, '2021-11-09 13:27:31', '2021-11-09 13:27:31'),
(53108, 10057, 44702, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:00:09', '2021-11-01 14:00:09'),
(53109, 10057, 44702, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : SWHPRECRED@bswhealth.org & SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Scott & White ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Scott & White. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:05:24', '2021-11-01 14:05:24'),
(53110, 10057, 44702, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : SWHPPROVSERVICES@bswhealth.org SWHPRECRED@bswhealth.org, SWHPPROVSERVICES@bswhealth.org, SWHPREGION4@bswhealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Scott & White ||  Good Afternoon Steve,  It appears we have an active SWHP Facility contract for this Urgent Care location however we do not have any providers enrolled.  You may need a new Group agreement to include providers.  I have included the Provider Relations Region 4 email on my response.  They should be able to assist you further.  Thank you and have a great day. Brenda P  Provider Services', NULL, NULL, '2021-11-02 08:32:44', '2021-11-02 08:32:44'),
(53111, 10057, 44702, NULL, '2021-11-16 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, '2021-11-09 13:27:24', '2021-11-09 13:27:24'),
(53112, 10057, 44703, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:00:59', '2021-11-01 14:00:59'),
(53113, 10057, 44703, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : SWHPRECRED@bswhealth.org & SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Scott & White ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Scott & White. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:05:17', '2021-11-01 14:05:17'),
(53114, 10057, 44703, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : SWHPPROVSERVICES@bswhealth.org SWHPRECRED@bswhealth.org, SWHPPROVSERVICES@bswhealth.org, SWHPREGION4@bswhealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Scott & White ||  Good Afternoon Steve,  It appears we have an active SWHP Facility contract for this Urgent Care location however we do not have any providers enrolled.  You may need a new Group agreement to include providers.  I have included the Provider Relations Region 4 email on my response.  They should be able to assist you further.  Thank you and have a great day. Brenda P  Provider Services', NULL, NULL, '2021-11-02 08:32:38', '2021-11-02 08:32:38'),
(53115, 10057, 44703, NULL, '2021-11-16 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, '2021-11-09 13:27:17', '2021-11-09 13:27:17'),
(53116, 10057, 44704, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:01:09', '2021-11-01 14:01:09'),
(53117, 10057, 44704, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : SWHPRECRED@bswhealth.org & SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Scott & White ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Scott & White. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:05:11', '2021-11-01 14:05:11'),
(53118, 10057, 44704, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : SWHPPROVSERVICES@bswhealth.org SWHPRECRED@bswhealth.org, SWHPPROVSERVICES@bswhealth.org, SWHPREGION4@bswhealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Scott & White ||  Good Afternoon Steve,  It appears we have an active SWHP Facility contract for this Urgent Care location however we do not have any providers enrolled.  You may need a new Group agreement to include providers.  I have included the Provider Relations Region 4 email on my response.  They should be able to assist you further.  Thank you and have a great day. Brenda P  Provider Services', NULL, NULL, '2021-11-02 08:32:31', '2021-11-02 08:32:31'),
(53119, 10057, 44704, NULL, '2021-11-16 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, '2021-11-09 13:27:09', '2021-11-09 13:27:09'),
(53120, 10057, 44705, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:01:19', '2021-11-01 14:01:19'),
(53121, 10057, 44705, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : SWHPRECRED@bswhealth.org & SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Scott & White ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Scott & White. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:05:03', '2021-11-01 14:05:03'),
(53122, 10057, 44705, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : SWHPPROVSERVICES@bswhealth.org SWHPRECRED@bswhealth.org, SWHPPROVSERVICES@bswhealth.org, SWHPREGION4@bswhealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Scott & White ||  Good Afternoon Steve,  It appears we have an active SWHP Facility contract for this Urgent Care location however we do not have any providers enrolled.  You may need a new Group agreement to include providers.  I have included the Provider Relations Region 4 email on my response.  They should be able to assist you further.  Thank you and have a great day. Brenda P  Provider Services', NULL, NULL, '2021-11-02 08:32:26', '2021-11-02 08:32:26'),
(53123, 10057, 44705, NULL, '2021-11-16 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, '2021-11-09 13:26:39', '2021-11-09 13:26:39'),
(53124, 10057, 44706, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:06:29', '2021-11-01 14:06:29'),
(53125, 10057, 44706, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : Kavalos@ghn-mci.com & mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Galaxy Health. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:11:22', '2021-11-01 14:11:22'),
(53126, 10057, 44706, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : kavalos@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Hello Steve;  There is no need to add a provider this is a facility agreement all provider will be covered billing under facility TIN  Thanks; Karen A', NULL, NULL, '2021-11-02 08:39:26', '2021-11-02 08:39:26');
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
(53127, 10057, 44706, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Received From : mmedina@ghn-mci.com & dmarley@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Hi Steve,  I have forward your email to Daniel Marley he is the facility rep. if you have any terms, changes or adds they will go to Daniel. Thanks  Malanie Medina Network Support Coordinator Galaxy Health Network Ph: 817-633-5822 or 800-975-3322 Fx: 817-633-5729', NULL, NULL, '2021-11-10 10:55:00', '2021-11-10 10:55:00'),
(53128, 10057, 44706, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Good Afternoon,  Could you please help me out to get the latest updates on the below mentioned request.  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:32:25', '2021-11-30 13:32:25'),
(53129, 10057, 44706, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  The update is a facility update and any questions are to be sent to Daniel. Thanks', NULL, NULL, '2021-12-06 17:53:17', '2021-12-06 17:53:17'),
(53130, 10057, 44706, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task.  Group Effective Date: 03/07/2017', NULL, NULL, '2021-12-16 11:43:09', '2021-12-16 11:43:09'),
(53131, 10057, 44707, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:06:39', '2021-11-01 14:06:39'),
(53132, 10057, 44707, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : Kavalos@ghn-mci.com & mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Galaxy Health. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:11:13', '2021-11-01 14:11:13'),
(53133, 10057, 44707, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : kavalos@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Hello Steve;  There is no need to add a provider this is a facility agreement all provider will be covered billing under facility TIN  Thanks; Karen A', NULL, NULL, '2021-11-02 08:39:17', '2021-11-02 08:39:17'),
(53134, 10057, 44707, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Received From : mmedina@ghn-mci.com & dmarley@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Hi Steve,  I have forward your email to Daniel Marley he is the facility rep. if you have any terms, changes or adds they will go to Daniel. Thanks  Malanie Medina Network Support Coordinator Galaxy Health Network Ph: 817-633-5822 or 800-975-3322 Fx: 817-633-5729', NULL, NULL, '2021-11-10 10:54:55', '2021-11-10 10:54:55'),
(53135, 10057, 44707, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Good Afternoon,  Could you please help me out to get the latest updates on the below mentioned request.  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:32:20', '2021-11-30 13:32:20'),
(53136, 10057, 44707, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  The update is a facility update and any questions are to be sent to Daniel. Thanks', NULL, NULL, '2021-12-06 17:53:08', '2021-12-06 17:53:08'),
(53137, 10057, 44707, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task.  Group Effective Date: 03/07/2017', NULL, NULL, '2021-12-16 11:43:01', '2021-12-16 11:43:01'),
(53138, 10057, 44708, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:06:49', '2021-11-01 14:06:49'),
(53139, 10057, 44708, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : Kavalos@ghn-mci.com & mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Galaxy Health. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:11:07', '2021-11-01 14:11:07'),
(53140, 10057, 44708, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : kavalos@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Hello Steve;  There is no need to add a provider this is a facility agreement all provider will be covered billing under facility TIN  Thanks; Karen A', NULL, NULL, '2021-11-02 08:39:55', '2021-11-02 08:39:55'),
(53141, 10057, 44708, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Received From : mmedina@ghn-mci.com & dmarley@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Hi Steve,  I have forward your email to Daniel Marley he is the facility rep. if you have any terms, changes or adds they will go to Daniel. Thanks  Malanie Medina Network Support Coordinator Galaxy Health Network Ph: 817-633-5822 or 800-975-3322 Fx: 817-633-5729', NULL, NULL, '2021-11-10 10:54:47', '2021-11-10 10:54:47'),
(53142, 10057, 44708, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Good Afternoon,  Could you please help me out to get the latest updates on the below mentioned request.  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:32:14', '2021-11-30 13:32:14'),
(53143, 10057, 44708, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  The update is a facility update and any questions are to be sent to Daniel. Thanks', NULL, NULL, '2021-12-06 17:52:59', '2021-12-06 17:52:59'),
(53144, 10057, 44708, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task.  Group Effective Date: 03/07/2017', NULL, NULL, '2021-12-16 11:42:54', '2021-12-16 11:42:54'),
(53145, 10057, 44709, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:07:02', '2021-11-01 14:07:02'),
(53146, 10057, 44709, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : Kavalos@ghn-mci.com & mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Galaxy Health. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:11:01', '2021-11-01 14:11:01'),
(53147, 10057, 44709, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : kavalos@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Hello Steve;  There is no need to add a provider this is a facility agreement all provider will be covered billing under facility TIN  Thanks; Karen A', NULL, NULL, '2021-11-02 08:39:12', '2021-11-02 08:39:12'),
(53148, 10057, 44709, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Received From : mmedina@ghn-mci.com & dmarley@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Hi Steve,  I have forward your email to Daniel Marley he is the facility rep. if you have any terms, changes or adds they will go to Daniel. Thanks  Malanie Medina Network Support Coordinator Galaxy Health Network Ph: 817-633-5822 or 800-975-3322 Fx: 817-633-5729', NULL, NULL, '2021-11-10 10:55:37', '2021-11-10 10:55:37'),
(53149, 10057, 44709, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Good Afternoon,  Could you please help me out to get the latest updates on the below mentioned request.  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:32:08', '2021-11-30 13:32:08'),
(53150, 10057, 44709, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  The update is a facility update and any questions are to be sent to Daniel. Thanks', NULL, NULL, '2021-12-06 17:52:49', '2021-12-06 17:52:49'),
(53151, 10057, 44709, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task.  Group Effective Date: 03/07/2017', NULL, NULL, '2021-12-16 11:42:41', '2021-12-16 11:42:41'),
(53152, 10057, 44710, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:07:13', '2021-11-01 14:07:13'),
(53153, 10057, 44710, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : Kavalos@ghn-mci.com & mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Galaxy Health. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:10:53', '2021-11-01 14:10:53'),
(53154, 10057, 44710, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : kavalos@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Hello Steve;  There is no need to add a provider this is a facility agreement all provider will be covered billing under facility TIN  Thanks; Karen A', NULL, NULL, '2021-11-02 08:39:06', '2021-11-02 08:39:06'),
(53155, 10057, 44710, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Received From : mmedina@ghn-mci.com & dmarley@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Hi Steve,  I have forward your email to Daniel Marley he is the facility rep. if you have any terms, changes or adds they will go to Daniel. Thanks  Malanie Medina Network Support Coordinator Galaxy Health Network Ph: 817-633-5822 or 800-975-3322 Fx: 817-633-5729', NULL, NULL, '2021-11-10 10:55:31', '2021-11-10 10:55:31'),
(53156, 10057, 44710, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Good Afternoon,  Could you please help me out to get the latest updates on the below mentioned request.  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:32:02', '2021-11-30 13:32:02'),
(53157, 10057, 44710, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  The update is a facility update and any questions are to be sent to Daniel. Thanks', NULL, NULL, '2021-12-06 17:52:41', '2021-12-06 17:52:41'),
(53158, 10057, 44710, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task.  Group Effective Date: 03/07/2017', NULL, NULL, '2021-12-16 11:42:35', '2021-12-16 11:42:35'),
(53159, 10057, 44711, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:07:22', '2021-11-01 14:07:22'),
(53160, 10057, 44711, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : Kavalos@ghn-mci.com & mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Galaxy Health. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:10:46', '2021-11-01 14:10:46'),
(53161, 10057, 44711, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Received From : kavalos@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Hello Steve;  There is no need to add a provider this is a facility agreement all provider will be covered billing under facility TIN  Thanks; Karen A', NULL, NULL, '2021-11-02 08:39:00', '2021-11-02 08:39:00'),
(53162, 10057, 44711, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Received From : mmedina@ghn-mci.com & dmarley@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Hi Steve,  I have forward your email to Daniel Marley he is the facility rep. if you have any terms, changes or adds they will go to Daniel. Thanks  Malanie Medina Network Support Coordinator Galaxy Health Network Ph: 817-633-5822 or 800-975-3322 Fx: 817-633-5729', NULL, NULL, '2021-11-10 10:55:25', '2021-11-10 10:55:25'),
(53163, 10057, 44711, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  Good Afternoon,  Could you please help me out to get the latest updates on the below mentioned request.  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 13:31:56', '2021-11-30 13:31:56'),
(53164, 10057, 44711, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : mmedina@ghn-mci.com  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Galaxy Health ||  The update is a facility update and any questions are to be sent to Daniel. Thanks', NULL, NULL, '2021-12-06 17:52:32', '2021-12-06 17:52:32'),
(53165, 10057, 44711, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   Please find contract in group task.  Group Effective Date: 03/07/2017', NULL, NULL, '2021-12-16 11:42:22', '2021-12-16 11:42:22'),
(53166, 10057, 44712, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:18:49', '2021-11-01 14:18:49'),
(53167, 10057, 44712, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : christus.hp.credentialing@christushealth.org & vicki.guerra@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Health Plan ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Health Plan. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:26:45', '2021-11-01 14:26:45'),
(53168, 10057, 44712, NULL, '2021-11-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227  www.christushealthplan.org', NULL, NULL, '2021-11-03 09:11:32', '2021-11-03 09:11:32'),
(53169, 10057, 44713, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:19:00', '2021-11-01 14:19:00'),
(53170, 10057, 44713, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : christus.hp.credentialing@christushealth.org & vicki.guerra@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Health Plan ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Health Plan. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:26:39', '2021-11-01 14:26:39'),
(53171, 10057, 44713, NULL, '2021-11-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227  www.christushealthplan.org', NULL, NULL, '2021-11-03 09:11:26', '2021-11-03 09:11:26'),
(53172, 10057, 44714, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:19:13', '2021-11-01 14:19:13'),
(53173, 10057, 44714, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : christus.hp.credentialing@christushealth.org & vicki.guerra@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Health Plan ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Health Plan. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:26:32', '2021-11-01 14:26:32'),
(53174, 10057, 44714, NULL, '2021-11-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227  www.christushealthplan.org', NULL, NULL, '2021-11-03 09:11:18', '2021-11-03 09:11:18'),
(53175, 10057, 44715, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:19:24', '2021-11-01 14:19:24'),
(53176, 10057, 44715, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : christus.hp.credentialing@christushealth.org & vicki.guerra@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Health Plan ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Health Plan. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:26:26', '2021-11-01 14:26:26'),
(53177, 10057, 44715, NULL, '2021-11-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227  www.christushealthplan.org', NULL, NULL, '2021-11-03 09:11:12', '2021-11-03 09:11:12'),
(53178, 10057, 44716, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:19:37', '2021-11-01 14:19:37'),
(53179, 10057, 44716, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : christus.hp.credentialing@christushealth.org & vicki.guerra@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Health Plan ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Health Plan. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:26:20', '2021-11-01 14:26:20'),
(53180, 10057, 44716, NULL, '2021-11-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227  www.christushealthplan.org', NULL, NULL, '2021-11-03 09:11:01', '2021-11-03 09:11:01'),
(53181, 10057, 44717, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:19:47', '2021-11-01 14:19:47'),
(53182, 10057, 44717, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : christus.hp.credentialing@christushealth.org & vicki.guerra@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Health Plan ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Health Plan. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:26:12', '2021-11-01 14:26:12'),
(53183, 10057, 44717, NULL, '2021-11-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227  www.christushealthplan.org', NULL, NULL, '2021-11-03 09:10:48', '2021-11-03 09:10:48'),
(53184, 10057, 44718, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:33:36', '2021-11-01 14:33:36'),
(53185, 10057, 44718, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : hunter.barrett@christushealth.org &  CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Spohn. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:42:08', '2021-11-01 14:42:08'),
(53186, 10057, 44718, NULL, '2021-11-18 00:00:00.000', 'Initiated', 'Email Sent To : hunter.barrett@christushealth.org, CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Good Evening,  I want to know the status of my request. Can someone give me an update on that.  Earlier responses will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-11 16:09:38', '2021-11-11 16:09:38'),
(53187, 10057, 44718, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : hunter.barrett@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Please reach out to Michal Simms, as she is the contact for Nueces area.  Simms, Michal michal.simms@christushealth.org  Thanks,  Hunter Barrett Network Contracting  CHRISTUS Health Plan', NULL, NULL, '2021-11-30 11:42:10', '2021-11-30 11:42:10'),
(53188, 10057, 44718, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : michal.simms@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Hello,  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Spohn. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name NPI Michi, Edna D 1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:18:08', '2021-12-06 17:18:08'),
(53189, 10057, 44718, NULL, '2021-12-14 00:00:00.000', 'Not Eligible', 'Email Received From : michal.simms@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Hello Steve,  Please see the attached letter and let me know if you have questions.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region', NULL, NULL, '2021-12-07 17:12:18', '2021-12-07 17:12:18'),
(53190, 10057, 44719, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:33:53', '2021-11-01 14:33:53'),
(53191, 10057, 44719, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : hunter.barrett@christushealth.org &  CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Spohn. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:42:02', '2021-11-01 14:42:02'),
(53192, 10057, 44719, NULL, '2021-11-18 00:00:00.000', 'Initiated', 'Email Sent To : hunter.barrett@christushealth.org, CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Good Evening,  I want to know the status of my request. Can someone give me an update on that.  Earlier responses will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-11 16:09:31', '2021-11-11 16:09:31'),
(53193, 10057, 44719, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : hunter.barrett@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Please reach out to Michal Simms, as she is the contact for Nueces area.  Simms, Michal michal.simms@christushealth.org  Thanks,  Hunter Barrett Network Contracting  CHRISTUS Health Plan', NULL, NULL, '2021-11-30 11:42:05', '2021-11-30 11:42:05'),
(53194, 10057, 44719, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : michal.simms@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Hello,  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Spohn. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name NPI Michi, Edna D 1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:18:00', '2021-12-06 17:18:00'),
(53195, 10057, 44719, NULL, '2021-12-14 00:00:00.000', 'Not Eligible', 'Email Received From : michal.simms@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Hello Steve,  Please see the attached letter and let me know if you have questions.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region', NULL, NULL, '2021-12-07 17:12:00', '2021-12-07 17:12:00'),
(53196, 10057, 44720, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:34:08', '2021-11-01 14:34:08'),
(53197, 10057, 44720, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : hunter.barrett@christushealth.org &  CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Spohn. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:41:57', '2021-11-01 14:41:57'),
(53198, 10057, 44720, NULL, '2021-11-18 00:00:00.000', 'Initiated', 'Email Sent To : hunter.barrett@christushealth.org, CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Good Evening,  I want to know the status of my request. Can someone give me an update on that.  Earlier responses will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-11 16:09:26', '2021-11-11 16:09:26'),
(53199, 10057, 44720, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : hunter.barrett@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Please reach out to Michal Simms, as she is the contact for Nueces area.  Simms, Michal michal.simms@christushealth.org  Thanks,  Hunter Barrett Network Contracting  CHRISTUS Health Plan', NULL, NULL, '2021-11-30 11:42:00', '2021-11-30 11:42:00'),
(53200, 10057, 44720, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : michal.simms@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Hello,  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Spohn. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name NPI Michi, Edna D 1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:17:52', '2021-12-06 17:17:52'),
(53201, 10057, 44720, NULL, '2021-12-14 00:00:00.000', 'Not Eligible', 'Email Received From : michal.simms@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Hello Steve,  Please see the attached letter and let me know if you have questions.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region', NULL, NULL, '2021-12-07 17:11:29', '2021-12-07 17:11:29'),
(53202, 10057, 44721, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:34:21', '2021-11-01 14:34:21'),
(53203, 10057, 44721, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : hunter.barrett@christushealth.org &  CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Spohn. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:41:51', '2021-11-01 14:41:51'),
(53204, 10057, 44721, NULL, '2021-11-18 00:00:00.000', 'Initiated', 'Email Sent To : hunter.barrett@christushealth.org, CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Good Evening,  I want to know the status of my request. Can someone give me an update on that.  Earlier responses will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-11 16:09:19', '2021-11-11 16:09:19'),
(53205, 10057, 44721, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : hunter.barrett@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Please reach out to Michal Simms, as she is the contact for Nueces area.  Simms, Michal michal.simms@christushealth.org  Thanks,  Hunter Barrett Network Contracting  CHRISTUS Health Plan', NULL, NULL, '2021-11-30 11:41:54', '2021-11-30 11:41:54'),
(53206, 10057, 44721, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : michal.simms@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Hello,  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Spohn. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name NPI Michi, Edna D 1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:17:45', '2021-12-06 17:17:45'),
(53207, 10057, 44721, NULL, '2021-12-14 00:00:00.000', 'Not Eligible', 'Email Received From : michal.simms@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Hello Steve,  Please see the attached letter and let me know if you have questions.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region', NULL, NULL, '2021-12-07 17:11:06', '2021-12-07 17:11:06'),
(53208, 10057, 44722, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:34:32', '2021-11-01 14:34:32'),
(53209, 10057, 44722, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : hunter.barrett@christushealth.org &  CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Spohn. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:41:45', '2021-11-01 14:41:45'),
(53210, 10057, 44722, NULL, '2021-11-18 00:00:00.000', 'Initiated', 'Email Sent To : hunter.barrett@christushealth.org, CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Good Evening,  I want to know the status of my request. Can someone give me an update on that.  Earlier responses will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-11 16:09:13', '2021-11-11 16:09:13'),
(53211, 10057, 44722, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : hunter.barrett@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Please reach out to Michal Simms, as she is the contact for Nueces area.  Simms, Michal michal.simms@christushealth.org  Thanks,  Hunter Barrett Network Contracting  CHRISTUS Health Plan', NULL, NULL, '2021-11-30 11:41:49', '2021-11-30 11:41:49'),
(53212, 10057, 44722, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : michal.simms@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Hello,  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Spohn. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name NPI Michi, Edna D 1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:17:32', '2021-12-06 17:17:32'),
(53213, 10057, 44722, NULL, '2021-12-14 00:00:00.000', 'Not Eligible', 'Email Received From : michal.simms@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Hello Steve,  Please see the attached letter and let me know if you have questions.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region', NULL, NULL, '2021-12-07 17:10:46', '2021-12-07 17:10:46'),
(53214, 10057, 44723, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:34:44', '2021-11-01 14:34:44'),
(53215, 10057, 44723, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email Sent To : hunter.barrett@christushealth.org &  CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Good Afternoon!  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Spohn. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Michi, Edna D	1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-01 14:41:38', '2021-11-01 14:41:38'),
(53216, 10057, 44723, NULL, '2021-11-18 00:00:00.000', 'Initiated', 'Email Sent To : hunter.barrett@christushealth.org, CHRISTUS.HP.Credentialing@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Good Evening,  I want to know the status of my request. Can someone give me an update on that.  Earlier responses will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-11 16:09:05', '2021-11-11 16:09:05'),
(53217, 10057, 44723, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : hunter.barrett@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Please reach out to Michal Simms, as she is the contact for Nueces area.  Simms, Michal michal.simms@christushealth.org  Thanks,  Hunter Barrett Network Contracting  CHRISTUS Health Plan', NULL, NULL, '2021-11-30 11:41:44', '2021-11-30 11:41:44'),
(53218, 10057, 44723, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : michal.simms@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Hello,  Hope this email finds you well. Please assist me with the enrollment procedure for the below-mentioned providers with Christus Spohn. Also guide me on how to proceed with the credentialing process for the provider with three 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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name NPI Michi, Edna D 1992293906 Benavides, Nubia Olivama	1801371935  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:17:23', '2021-12-06 17:17:23'),
(53219, 10057, 44723, NULL, '2021-12-14 00:00:00.000', 'Not Eligible', 'Email Received From : michal.simms@christushealth.org  Sub : Enrollment Query || Valley Med Urgent Care PLLC || Provider || Christus Spohn ||  Hello Steve,  Please see the attached letter and let me know if you have questions.  Thanks, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region', NULL, NULL, '2021-12-07 17:10:10', '2021-12-07 17:10:10'),
(53220, 11056, 44724, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-01 14:36:09', '2021-11-01 14:36:09'),
(53221, 11056, 44724, NULL, '2021-11-08 00:00:00.000', 'Initiated', 'Email sent to : 	credentialing@anci-care.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Anci-Care  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Health Smart. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-01 14:43:21', '2021-11-01 14:43:21');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(53222, 11056, 44724, NULL, '2021-11-15 00:00:00.000', 'Initiated', 'Email sent to : 	credentialing@anci-care.com  Sub : Enrollment Query - Statcare Minor Emergency Clinic - Anci-Care  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Anci-Care. Please guide me on how to proceed with the credentialing process for the provider with all the locations.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Elsa Pearce	1083784102  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-08 16:31:56', '2021-11-08 16:31:56'),
(53223, 11056, 44724, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from:  Shane.Radford@healthsmart.com  Sub:  Demographic Updates Needed - StatCare Minor Emergency Clinic - Anci Care   Good morning,  I am following up to the below request in reference to the requested address update.     The below address has been updated in our database and I am attaching the link for our website.  You can use this link to see all of your location information we have on file.   https://www.anci-care.com/contact.html  Please forward any future updates or request for information to vipproviders@anci-care.com  Please feel free to reach out if you should need any additional information.  Another Email:  Good morning,  Yes you can start billing under the TIN 460575924.   When we load a new location it uses the same effective date as the primary location so the effective date for this location is 7/23/2020.  Thank you,  Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Fax: 214 574 1121   Please see the attachment.   Ancillary contract provider\'s credentialing is not required.', NULL, NULL, '2021-11-17 10:13:50', '2021-11-17 10:13:50'),
(53224, 11056, 44724, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from: Shane.Radford@healthsmart.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic - Anci-Care  Good afternoon,  I wanted to follow up and make sure you have gotten an answer on the Credentialing process for the providers locations.  According to our records your contract effective date and credentialing was done on July 23, 2020 and the Recredentialing is not due again until July 1, 2023.   I have attached the Recredentialing documents for your reference.  Please feel free to reach out to me if you should need any additional information.     Thank you,        Shane Radford| Provider Relations HealthSmart | Network Solutions Office: 214 574 2664 | Office: 214 574 1121  222 W Las Colinas Blvd | Suite 550 N | Irving, Tx 75039 Email: shane.radford@healthsmart.com', NULL, NULL, '2021-11-17 10:15:50', '2021-11-17 10:15:50'),
(53225, 11056, 44725, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-03 08:31:42', '2021-11-03 08:31:42'),
(53226, 11056, 44725, NULL, '2021-11-12 00:00:00.000', 'Initiated', 'Enrollment Application Status   Application Status : Submitted	 PEP Ticket Number: 18226147', NULL, NULL, '2021-11-05 16:47:23', '2021-11-05 16:47:23'),
(53227, 11056, 44725, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'Enrollment Application Status   Application Status PEP Ticket Number In Progress		18226147 ', NULL, NULL, '2021-11-12 14:02:20', '2021-11-12 14:02:20'),
(53228, 11056, 44725, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Ticket no. : 42741689000 Rep: Patricia S  The issue has been resolved.  Enrollment Application Status  Application Status: In Progress PEP Ticket Number: 18226147', NULL, NULL, '2021-11-22 13:13:45', '2021-11-22 13:13:45'),
(53229, 11056, 44725, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status:  In Progress PEP Ticket Number:  18226147', NULL, NULL, '2021-11-29 17:16:49', '2021-11-29 17:16:49'),
(53230, 11056, 44725, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Rep: Glenda  Status: Locations have been listed we will be able to see the other locations   Revalidation date: 11/22/2026  Interaction no. : 42868475000', NULL, NULL, '2021-12-14 13:47:01', '2021-12-14 13:47:01'),
(53231, 11056, 44725, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Alexis  Ref code: 42900508000  Status: Have to wait for the conversion.', NULL, NULL, '2021-12-20 16:01:12', '2021-12-20 16:01:12'),
(53232, 19067, 44725, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pemsemailservice@tmhp.com  Subject: Enrollment Status || RHC || Elsa Pearce || MEDICAID ||   Hello!   Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:47:15', '2021-12-29 14:47:15'),
(53233, 19067, 44725, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: HospicePolicy@hhsc.state.tx  Subject: Fwd: Enrollment Status || RHC || Elsa Pearce || MEDICAID ||   Hello!   Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad. ', NULL, NULL, '2021-12-29 14:55:25', '2021-12-29 14:55:25'),
(53234, 19067, 44725, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pemssupport@tmhp.com  Subject: Fwd: Enrollment Status || RHC || Elsa Pearce || MEDICAID ||  Hello!   Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 15:58:19', '2021-12-29 15:58:19'),
(53235, 1019, 44725, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:26:58', '2022-02-02 10:26:58'),
(53236, 11056, 44726, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-04 13:37:51', '2021-11-04 13:37:51'),
(53237, 11056, 44726, NULL, '2021-11-15 00:00:00.000', 'Initiated', 'Enrollment Application Status   Application Status:       Submitted PEP Ticket Number:     18230383', NULL, NULL, '2021-11-08 17:38:07', '2021-11-08 17:38:07'),
(53238, 11056, 44726, NULL, '2021-11-22 00:00:00.000', 'Initiated', 'Enrollment Application Status   Application Status     In Progress	 PEP Ticket Number   18230383   Correctly initiated again. The issues have been resolved.', NULL, NULL, '2021-11-15 12:23:41', '2021-11-15 12:23:41'),
(53239, 11056, 44726, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status:  In Progress PEP Ticket Number:  18230383', NULL, NULL, '2021-11-29 16:58:19', '2021-11-29 16:58:19'),
(53240, 11056, 44726, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Rep: Glenda    Status: Waiting for the State Confirmation and approval   Interaction no. : 42868475000', NULL, NULL, '2021-12-14 13:44:22', '2021-12-14 13:44:22'),
(53241, 11056, 44726, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Alexis  Status: They will call us regarding the issue. the request has been placed for escalation and related to deficiency as well.  Ref code: 42900508000', NULL, NULL, '2021-12-20 16:00:19', '2021-12-20 16:00:19'),
(53242, 19067, 44726, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pemssupport@tmhp.com  Subject: Enrollment Status || CBUC & GWMC || Leticia Aleman-Listenbee || MEDICAID ||  Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following provider with Medicaid.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 16:39:02', '2021-12-29 16:39:02'),
(53243, 19067, 44726, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Fax received from: 512-514-4214  See attachment.', NULL, NULL, '2022-01-06 15:34:01', '2022-01-06 15:34:01'),
(53244, 19067, 44726, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Fax received from: 512-514-4214  See attachment.', NULL, NULL, '2022-01-06 15:35:14', '2022-01-06 15:35:14'),
(53245, 19067, 44726, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Fax sent to 512-514-4214  See Attachment.', NULL, NULL, '2022-01-06 15:53:58', '2022-01-06 15:53:58'),
(53246, 1019, 44726, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Provider has shown up on the PEMS portal, waiting for the welcome letter.', NULL, NULL, '2022-02-02 13:41:07', '2022-02-02 13:41:07'),
(53247, 11056, 44727, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-04 13:43:19', '2021-11-04 13:43:19'),
(53248, 11056, 44727, NULL, '2021-11-11 00:00:00.000', 'Initiated', 'Email received from : customerservice-donotreply@cms.hhs.gov  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102820210003226)   Sent: 10/28/2021 16:03 PM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:  Application Tracking ID: T102820210003226        NPI: 1154999654        Medicare ID: 1V5988, 1V5995        Name: LETICIA A ALEMAN-LISTENBEE          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2021-11-04 13:44:12', '2021-11-04 13:44:12'),
(53249, 11056, 44727, NULL, '2021-11-11 00:00:00.000', 'Approved', 'Email received from: medenroll@novitas-solutions.com  Sub ; Medicare Provider Enrollment Notification LETICIA ALEMAN-LISTENBEE NP  Please see the attached Notification letter.  NOTE:  THIS MESSAGE HAS BEEN SENT FROM AN AUTOMATED E-MAIL BOX FROM THE PROVIDER ENROLLMENT DEPARTMENT.  PLEASE DO NOT SEND ANY REPLY VIA E-MAIL AS THIS MAILBOX IS NOT MONITORED FOR INCOMING E-MAILS.  eff date : 11/01/2021  Please see the attached.', NULL, NULL, '2021-11-04 13:44:46', '2021-11-04 13:44:46'),
(53250, 11056, 44727, NULL, '2021-11-11 00:00:00.000', 'Approved', 'Eff date :  09/01/2021', NULL, NULL, '2021-11-04 13:50:36', '2021-11-04 13:50:36'),
(53251, 11056, 44728, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-04 13:44:46', '2021-11-04 13:44:46'),
(53252, 11056, 44728, NULL, '2021-11-15 00:00:00.000', 'Initiated', 'Enrollment Application Status   Application Status:       Submitted PEP Ticket Number:     18230383 ', NULL, NULL, '2021-11-08 17:37:54', '2021-11-08 17:37:54'),
(53253, 11056, 44728, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Enrollment Application Status   Application Status     In Progress	 PEP Ticket Number   18230383   Correctly initiated again. The issues have been resolved.', NULL, NULL, '2021-11-16 17:40:04', '2021-11-16 17:40:04'),
(53254, 11056, 44728, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status:  In Progress PEP Ticket Number:  18230383 ', NULL, NULL, '2021-11-29 16:54:48', '2021-11-29 16:54:48'),
(53255, 11056, 44728, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Rep: Glenda    Status: Waiting for the State Confirmation and approval   Interaction no. : 42868475000', NULL, NULL, '2021-12-14 13:44:49', '2021-12-14 13:44:49'),
(53256, 11056, 44728, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Alexis  Status: They will call us regarding the issue. the request has been placed for escalation and related to deficiency as well.  Ref code: 42900508000', NULL, NULL, '2021-12-20 16:00:02', '2021-12-20 16:00:02'),
(53257, 19067, 44728, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pemssupport@tmhp.com  Subject: Enrollment Status || CBUC & GWMC || Leticia Aleman-Listenbee || MEDICAID ||  Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following provider with Medicaid.   Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Provider Name	NPI	Location Leticia Aleman-Listenbee	1154999654	301 S HILLSIDE DR STE 4 BEEVILLE, TX 78102-5324 Leticia Aleman-Listenbee	1154999654	504A Houston Street, Live Oak County, George West, TX 78022-3663   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 16:39:20', '2021-12-29 16:39:20'),
(53258, 11056, 44729, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-04 13:56:55', '2021-11-04 13:56:55'),
(53259, 11056, 44729, NULL, '2021-11-11 00:00:00.000', 'Initiated', 'Email receive from:	customerservice-donotreply@cms.hhs.gov  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102720210000801)   Sent: 10/27/2021 10:42 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:  Application Tracking ID: T102720210000801        NPI: 1083784102        Medicare ID: 1B5118, 1V5150, 404573YLUJ, 632692AS8U, 638533AT3H                                    5 earliest of 6 total Medicare IDs are above        Name: ELSA C PEARCE          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2021-11-04 13:59:54', '2021-11-04 13:59:54'),
(53260, 11056, 44729, NULL, '2021-11-11 00:00:00.000', 'Approved', 'Email received from: customerservice-donotreply@cms.hhs.gov  Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T102720210000801)  Date:  11/02/2021 15:30 PM  This message is in response to your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T102720210000801. The application listed below has reached a final status.  Application Tracking ID: T102720210000801   NPI ID: 1083784102   Medicare ID: TXB162756, 404573YLUJ, 638533AT3H, 632692AS8U, 1B5118      5 earliest of 7 total Medicare IDs are above.  Name: ELSA PEARCE  State: TX   Form Type: 855I  Date: 11/02/2021  Status: APPROVED   eff date: 9/1/2021  Please also see the attachment.', NULL, NULL, '2021-11-04 14:02:35', '2021-11-04 14:02:35'),
(53261, 11056, 44730, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-04 13:57:04', '2021-11-04 13:57:04'),
(53262, 11056, 44730, NULL, '2021-11-11 00:00:00.000', 'Initiated', 'Email receive from:	customerservice-donotreply@cms.hhs.gov  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102720210000801)   Sent: 10/27/2021 10:42 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:  Application Tracking ID: T102720210000801        NPI: 1083784102        Medicare ID: 1B5118, 1V5150, 404573YLUJ, 632692AS8U, 638533AT3H                                    5 earliest of 6 total Medicare IDs are above        Name: ELSA C PEARCE          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2021-11-04 13:59:46', '2021-11-04 13:59:46'),
(53263, 11056, 44730, NULL, '2021-11-11 00:00:00.000', 'Approved', 'Email received from: customerservice-donotreply@cms.hhs.gov  Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T102720210000801)  Date:  11/02/2021 15:30 PM  This message is in response to your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T102720210000801. The application listed below has reached a final status.  Application Tracking ID: T102720210000801   NPI ID: 1083784102   Medicare ID: TXB162756, 404573YLUJ, 638533AT3H, 632692AS8U, 1B5118      5 earliest of 7 total Medicare IDs are above.  Name: ELSA PEARCE  State: TX   Form Type: 855I  Date: 11/02/2021  Status: APPROVED   eff date: 9/1/2021  Please also see the attachment.', NULL, NULL, '2021-11-04 14:02:19', '2021-11-04 14:02:19'),
(53264, 11056, 44731, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-04 13:57:16', '2021-11-04 13:57:16'),
(53265, 11056, 44731, NULL, '2021-11-11 00:00:00.000', 'Initiated', 'Email receive from:	customerservice-donotreply@cms.hhs.gov  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T102720210000801)   Sent: 10/27/2021 10:42 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:  Application Tracking ID: T102720210000801        NPI: 1083784102        Medicare ID: 1B5118, 1V5150, 404573YLUJ, 632692AS8U, 638533AT3H                                    5 earliest of 6 total Medicare IDs are above        Name: ELSA C PEARCE          State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.                 MECHANICSBURG,PA,17055-1813', NULL, NULL, '2021-11-04 13:59:38', '2021-11-04 13:59:38'),
(53266, 11056, 44731, NULL, '2021-11-11 00:00:00.000', 'Approved', 'Email received from: customerservice-donotreply@cms.hhs.gov  Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T102720210000801)  Date:  11/02/2021 15:30 PM  This message is in response to your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T102720210000801. The application listed below has reached a final status.  Application Tracking ID: T102720210000801   NPI ID: 1083784102   Medicare ID: TXB162756, 404573YLUJ, 638533AT3H, 632692AS8U, 1B5118      5 earliest of 7 total Medicare IDs are above.  Name: ELSA PEARCE  State: TX   Form Type: 855I  Date: 11/02/2021  Status: APPROVED   eff date: 9/1/2021  Please also see the attachment.', NULL, NULL, '2021-11-04 14:01:45', '2021-11-04 14:01:45'),
(53267, 11056, 44732, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-04 14:01:45', '2021-11-04 14:01:45'),
(53268, 11056, 44732, NULL, '2021-11-12 00:00:00.000', 'Initiated', 'Enrollment Application Status   Application Status : Submitted	 PEP Ticket Number: 18226147', NULL, NULL, '2021-11-05 16:46:58', '2021-11-05 16:46:58'),
(53269, 11056, 44732, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'Enrollment Application Status   Application Status PEP Ticket Number In Progress		18226147 ', NULL, NULL, '2021-11-12 14:01:52', '2021-11-12 14:01:52'),
(53270, 11056, 44732, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Ticket no. : 42741689000 Rep: Patricia S  The issue has been resolved.  Enrollment Application Status  Application Status: In Progress PEP Ticket Number: 18226147', NULL, NULL, '2021-11-22 13:13:52', '2021-11-22 13:13:52'),
(53271, 11056, 44732, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status:  In Progress PEP Ticket Number:  18226147', NULL, NULL, '2021-11-29 17:16:44', '2021-11-29 17:16:44'),
(53272, 11056, 44732, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Rep: Glenda  Status: Locations have been listed we will be able to see the other locations   Revalidation date: 11/22/2026  Interaction no. : 42868475000', NULL, NULL, '2021-12-14 13:46:55', '2021-12-14 13:46:55'),
(53273, 11056, 44732, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Alexis  Ref code: 42900508000  Status: Have to wait for the conversion.', NULL, NULL, '2021-12-20 16:01:02', '2021-12-20 16:01:02'),
(53274, 19067, 44732, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pemsemailservice@tmhp.com  Subject: Enrollment Status || RHC || Elsa Pearce || MEDICAID ||   Hello!   Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:47:11', '2021-12-29 14:47:11'),
(53275, 19067, 44732, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: HospicePolicy@hhsc.state.tx  Subject: Fwd: Enrollment Status || RHC || Elsa Pearce || MEDICAID ||   Hello!   Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad. ', NULL, NULL, '2021-12-29 14:55:19', '2021-12-29 14:55:19'),
(53276, 19067, 44732, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pemssupport@tmhp.com  Subject: Fwd: Enrollment Status || RHC || Elsa Pearce || MEDICAID ||  Hello!   Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 15:58:12', '2021-12-29 15:58:12'),
(53277, 1019, 44732, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:26:50', '2022-02-02 10:26:50'),
(53278, 11056, 44733, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-04 14:02:19', '2021-11-04 14:02:19'),
(53279, 11056, 44733, NULL, '2021-11-12 00:00:00.000', 'Initiated', 'Enrollment Application Status   Application Status : Submitted	 PEP Ticket Number: 18226147', NULL, NULL, '2021-11-05 16:46:37', '2021-11-05 16:46:37'),
(53280, 11056, 44733, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'Enrollment Application Status   Application Status PEP Ticket Number In Progress		18226147 ', NULL, NULL, '2021-11-12 14:01:15', '2021-11-12 14:01:15'),
(53281, 11056, 44733, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Ticket no. : 42741689000 Rep: Patricia S  The issue has been resolved.  Enrollment Application Status  Application Status: In Progress PEP Ticket Number: 18226147', NULL, NULL, '2021-11-22 13:13:57', '2021-11-22 13:13:57'),
(53282, 11056, 44733, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status:  In Progress PEP Ticket Number:  18226147', NULL, NULL, '2021-11-29 17:16:39', '2021-11-29 17:16:39'),
(53283, 11056, 44733, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Rep: Glenda  Status: Locations have been listed we will be able to see the other locations   Revalidation date: 11/22/2026  Interaction no. : 42868475000', NULL, NULL, '2021-12-14 13:46:50', '2021-12-14 13:46:50'),
(53284, 11056, 44733, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Alexis  Ref code: 42900508000  Status: Have to wait for the conversion.', NULL, NULL, '2021-12-20 16:00:56', '2021-12-20 16:00:56'),
(53285, 19067, 44733, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pemsemailservice@tmhp.com  Subject: Enrollment Status || RHC || Elsa Pearce || MEDICAID ||   Hello!   Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:47:06', '2021-12-29 14:47:06'),
(53286, 19067, 44733, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: HospicePolicy@hhsc.state.tx  Subject: Fwd: Enrollment Status || RHC || Elsa Pearce || MEDICAID ||   Hello!   Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad. ', NULL, NULL, '2021-12-29 14:55:13', '2021-12-29 14:55:13'),
(53287, 19067, 44733, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pemssupport@tmhp.com  Subject: Fwd: Enrollment Status || RHC || Elsa Pearce || MEDICAID ||  Hello!   Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 15:58:06', '2021-12-29 15:58:06'),
(53288, 1019, 44733, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:26:44', '2022-02-02 10:26:44'),
(53289, 1019, 44733, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:26:45', '2022-02-02 10:26:45'),
(53290, 11056, 44734, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-04 14:02:35', '2021-11-04 14:02:35'),
(53291, 11056, 44734, NULL, '2021-11-12 00:00:00.000', 'Initiated', 'Enrollment Application Status   Application Status : Submitted	 PEP Ticket Number: 18226147 ', NULL, NULL, '2021-11-05 16:46:03', '2021-11-05 16:46:03'),
(53292, 11056, 44734, NULL, '2021-11-24 00:00:00.000', 'Initiated', 'Enrollment Application Status   Application Status PEP Ticket Number In Progress		18226147', NULL, NULL, '2021-11-17 15:22:46', '2021-11-17 15:22:46'),
(53293, 11056, 44734, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Ticket no. : 42741689000 Rep: Patricia S  The issue has been resolved.  Enrollment Application Status  Application Status: In Progress PEP Ticket Number: 18226147', NULL, NULL, '2021-11-22 13:14:02', '2021-11-22 13:14:02'),
(53294, 11056, 44734, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status:  In Progress PEP Ticket Number:  18226147', NULL, NULL, '2021-11-29 17:16:27', '2021-11-29 17:16:27'),
(53295, 11056, 44734, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Rep: Glenda  Status: Locations have been listed we will be able to see the other locations   Revalidation date: 11/22/2026  Interaction no. : 42868475000', NULL, NULL, '2021-12-14 13:46:41', '2021-12-14 13:46:41'),
(53296, 11056, 44734, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Alexis  Ref code: 42900508000  Status: Have to wait for the conversion.', NULL, NULL, '2021-12-20 16:00:50', '2021-12-20 16:00:50'),
(53297, 19067, 44734, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pemsemailservice@tmhp.com  Subject: Enrollment Status || RHC || Elsa Pearce || MEDICAID ||   Hello!   Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:46:56', '2021-12-29 14:46:56'),
(53298, 19067, 44734, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: HospicePolicy@hhsc.state.tx  Subject: Fwd: Enrollment Status || RHC || Elsa Pearce || MEDICAID ||   Hello!   Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad. ', NULL, NULL, '2021-12-29 14:55:04', '2021-12-29 14:55:04'),
(53299, 19067, 44734, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: pemssupport@tmhp.com  Subject: Fwd: Enrollment Status || RHC || Elsa Pearce || MEDICAID ||  Hello!   Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E CAESAR KINGSVILLE, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive Corpus Christi, TX 78415   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 15:58:02', '2021-12-29 15:58:02'),
(53300, 1019, 44734, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Request open waiting for TMHP to call for PEMS as we are unable to add info Request number 20018604.', NULL, NULL, '2022-02-02 10:26:39', '2022-02-02 10:26:39'),
(53301, 10057, 44735, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-05 12:08:23', '2021-11-05 12:08:23'),
(53302, 10057, 44735, NULL, '2021-11-12 00:00:00.000', 'Initiated', 'Application Status PEP Ticket Number Submitted :18226213  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.  If you have chosen to apply with Medicaid and the CSHCN Services Program at the same time, applications for both programs will be processed concurrently. You may also apply for the CSHCN Services Program once your application to Medicaid has been approved and you have received a Medicaid Texas Provider Identifier (TPI).', NULL, NULL, '2021-11-05 16:49:49', '2021-11-05 16:49:49'),
(53303, 10057, 44735, NULL, '2021-11-22 00:00:00.000', 'Initiated', 'Application Status PEP Ticket Number In Progress	18226213  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.  If you have chosen to apply with Medicaid and the CSHCN Services Program at the same time, applications for both programs will be processed concurrently. You may also apply for the CSHCN Services Program once your application to Medicaid has been approved and you have received a Medicaid Texas Provider Identifier (TPI).', NULL, NULL, '2021-11-15 13:55:39', '2021-11-15 13:55:39'),
(53304, 10057, 44735, NULL, '2021-11-24 00:00:00.000', 'In Process', 'The issue has been resolved, application has been submitted again.  Application Status PEP Ticket Number In Progress 18226213  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.  Please see attachment', NULL, NULL, '2021-11-17 14:20:14', '2021-11-17 14:20:14'),
(53305, 10057, 44735, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status:  In Progress PEP Ticket Number 18226213', NULL, NULL, '2021-12-01 13:07:39', '2021-12-01 13:07:39'),
(53306, 10057, 44735, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Checked Via Portal still in process.  Will call next week for follow-up', NULL, NULL, '2021-12-08 10:44:51', '2021-12-08 10:44:51'),
(53307, 10057, 44735, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Portal in updating process, will check next week.', NULL, NULL, '2021-12-14 11:21:48', '2021-12-14 11:21:48'),
(53308, 10057, 44735, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Call Comments:  Rep: Alexis - Ref code: 42900508000  Status: Need to wait, portal still in process.', NULL, NULL, '2021-12-21 10:48:09', '2021-12-21 10:48:09'),
(53309, 10057, 44735, NULL, '2022-01-04 00:00:00.000', 'In Process', 'I have checked still there is no option to add locations.  Portal still under maintenance process.  Regards, Steve Albert', NULL, NULL, '2021-12-28 13:18:24', '2021-12-28 13:18:24'),
(53310, 20067, 44735, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP  Good Afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the following applications. Application# 18226213 Application# 18247429  Your Early response will be highly appreciated. Thanks & regards, Syed Ahad.', NULL, NULL, '2022-01-20 14:50:40', '2022-01-20 14:50:40'),
(53311, 20067, 44735, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub:  Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP   Good Afternoon!  Hope this email finds you well. Kindly send me the welcome kit for provider Nubia Benavides & Edna Michi.  Thank you,', NULL, NULL, '2022-02-04 13:19:00', '2022-02-04 13:19:00'),
(53312, 20067, 44735, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Provider.relations@tmhp.com  Sub: RE: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP - CRM 2018774100  Thank you for contacting TMHP Provider Relations.  Your inquiry has been assigned to a Provider Relations Representative.  Your ticket number for this request is 2018774100.     The Provider Relations Representative will be contacting you to assist you in this matter.     If you need to contact us about this request, please submit and e-mail to provider.relations@tmhp.com  and reference the ticket number.     If immediate assistance is needed, please contact the TMHP Contact Center at 1-800-925-9126.     Thank you,  Texas Medicaid & Healthcare Partnership (TMHP) Provider Relations Department  Provider.Relations@tmhp.com', NULL, NULL, '2022-02-04 15:20:46', '2022-02-04 15:20:46'),
(53313, 20067, 44735, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub: Re: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP  Good Afternoon!  I would like to add the Secondary and Tertiary locations for the below-mentioned providers.  Attached are the W9 for both locations  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia O Benavides	1801371935 Edna Michi	1992293906	  Thank you, Syed Ahad.', NULL, NULL, '2022-03-04 14:13:00', '2022-03-04 14:13:00'),
(53314, 22077, 44735, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: provider.relations@tmhp.com  Subject: Re: FW: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP File Maintenance Walkthrough Appointment Request - CRM 2019063700  Hi,  In the previous email, we were advised that someone will contact us regarding our request. So far no one has contacted us. I would like to get the updates on the previously mentioned request.  Thanks, Alex', NULL, NULL, '2022-04-08 07:54:35', '2022-04-08 07:54:35'),
(53315, 10057, 44736, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-05 12:09:15', '2021-11-05 12:09:15'),
(53316, 10057, 44736, NULL, '2021-11-12 00:00:00.000', 'Initiated', 'Application Status PEP Ticket Number Submitted :18226213  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.  If you have chosen to apply with Medicaid and the CSHCN Services Program at the same time, applications for both programs will be processed concurrently. You may also apply for the CSHCN Services Program once your application to Medicaid has been approved and you have received a Medicaid Texas Provider Identifier (TPI).', NULL, NULL, '2021-11-05 16:49:37', '2021-11-05 16:49:37'),
(53317, 10057, 44736, NULL, '2021-11-22 00:00:00.000', 'Initiated', 'Application Status PEP Ticket Number In Progress	18226213  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.  If you have chosen to apply with Medicaid and the CSHCN Services Program at the same time, applications for both programs will be processed concurrently. You may also apply for the CSHCN Services Program once your application to Medicaid has been approved and you have received a Medicaid Texas Provider Identifier (TPI).', NULL, NULL, '2021-11-15 13:55:29', '2021-11-15 13:55:29'),
(53318, 10057, 44736, NULL, '2021-11-24 00:00:00.000', 'In Process', 'The issue has been resolved, application has been submitted again.  Application Status PEP Ticket Number In Progress 18226213  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.  Please see attachment', NULL, NULL, '2021-11-17 14:20:03', '2021-11-17 14:20:03'),
(53319, 10057, 44736, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status:  In Progress PEP Ticket Number 18226213', NULL, NULL, '2021-12-01 13:07:32', '2021-12-01 13:07:32'),
(53320, 10057, 44736, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Checked Via Portal still in process.  Will call next week for follow-up', NULL, NULL, '2021-12-08 10:44:45', '2021-12-08 10:44:45'),
(53321, 10057, 44736, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Portal in updating process, will check next week.', NULL, NULL, '2021-12-14 11:21:44', '2021-12-14 11:21:44'),
(53322, 10057, 44736, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Call Comments:  Rep: Alexis - Ref code: 42900508000  Status: Need to wait, portal still in process.', NULL, NULL, '2021-12-21 10:48:04', '2021-12-21 10:48:04'),
(53323, 10057, 44736, NULL, '2022-01-04 00:00:00.000', 'In Process', 'I have checked still there is no option to add locations.  Portal still under maintenance process.  Regards, Steve Albert', NULL, NULL, '2021-12-28 13:18:17', '2021-12-28 13:18:17'),
(53324, 20067, 44736, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP  Good Afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the following applications. Application# 18226213 Application# 18247429  Your Early response will be highly appreciated. Thanks & regards, Syed Ahad.', NULL, NULL, '2022-01-20 14:50:31', '2022-01-20 14:50:31'),
(53325, 20067, 44736, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub:  Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP   Good Afternoon!  Hope this email finds you well. Kindly send me the welcome kit for provider Nubia Benavides & Edna Michi.  Thank you,', NULL, NULL, '2022-02-04 13:18:55', '2022-02-04 13:18:55'),
(53326, 20067, 44736, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Provider.relations@tmhp.com  Sub: RE: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP - CRM 2018774100  Thank you for contacting TMHP Provider Relations.  Your inquiry has been assigned to a Provider Relations Representative.  Your ticket number for this request is 2018774100.     The Provider Relations Representative will be contacting you to assist you in this matter.     If you need to contact us about this request, please submit and e-mail to provider.relations@tmhp.com  and reference the ticket number.     If immediate assistance is needed, please contact the TMHP Contact Center at 1-800-925-9126.     Thank you,  Texas Medicaid & Healthcare Partnership (TMHP) Provider Relations Department  Provider.Relations@tmhp.com', NULL, NULL, '2022-02-04 15:20:41', '2022-02-04 15:20:41'),
(53327, 20067, 44736, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub: Re: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP  Good Afternoon!  I would like to add the Secondary and Tertiary locations for the below-mentioned providers.  Attached are the W9 for both locations  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia O Benavides	1801371935 Edna Michi	1992293906	  Thank you, Syed Ahad.', NULL, NULL, '2022-03-04 14:12:53', '2022-03-04 14:12:53'),
(53328, 22077, 44736, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: provider.relations@tmhp.com  Subject: Re: FW: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP File Maintenance Walkthrough Appointment Request - CRM 2019063700  Hi,  In the previous email, we were advised that someone will contact us regarding our request. So far no one has contacted us. I would like to get the updates on the previously mentioned request.  Thanks, Alex', NULL, NULL, '2022-04-08 07:54:15', '2022-04-08 07:54:15'),
(53329, 10057, 44737, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-05 12:10:19', '2021-11-05 12:10:19'),
(53330, 10057, 44737, NULL, '2021-11-12 00:00:00.000', 'Initiated', 'Application Status PEP Ticket Number Submitted :18226213  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.  If you have chosen to apply with Medicaid and the CSHCN Services Program at the same time, applications for both programs will be processed concurrently. You may also apply for the CSHCN Services Program once your application to Medicaid has been approved and you have received a Medicaid Texas Provider Identifier (TPI).', NULL, NULL, '2021-11-05 16:49:21', '2021-11-05 16:49:21'),
(53331, 10057, 44737, NULL, '2021-11-22 00:00:00.000', 'Initiated', 'Application Status PEP Ticket Number In Progress	18226213  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.  If you have chosen to apply with Medicaid and the CSHCN Services Program at the same time, applications for both programs will be processed concurrently. You may also apply for the CSHCN Services Program once your application to Medicaid has been approved and you have received a Medicaid Texas Provider Identifier (TPI).', NULL, NULL, '2021-11-15 13:55:14', '2021-11-15 13:55:14'),
(53332, 10057, 44737, NULL, '2021-11-24 00:00:00.000', 'In Process', 'The issue has been resolved, application has been submitted again.  Application Status PEP Ticket Number In Progress 18226213  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.  Please see attachment', NULL, NULL, '2021-11-17 14:19:51', '2021-11-17 14:19:51'),
(53333, 10057, 44737, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status:  In Progress PEP Ticket Number 18226213', NULL, NULL, '2021-12-01 13:07:26', '2021-12-01 13:07:26'),
(53334, 10057, 44737, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Checked Via Portal still in process.  Will call next week for follow-up', NULL, NULL, '2021-12-08 10:44:39', '2021-12-08 10:44:39'),
(53335, 10057, 44737, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Portal in updating process, will check next week.', NULL, NULL, '2021-12-14 11:21:39', '2021-12-14 11:21:39'),
(53336, 10057, 44737, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Call Comments:  Rep: Alexis - Ref code: 42900508000  Status: Need to wait, portal still in process.', NULL, NULL, '2021-12-21 10:47:59', '2021-12-21 10:47:59'),
(53337, 10057, 44737, NULL, '2022-01-04 00:00:00.000', 'In Process', 'I have checked still there is no option to add locations.  Portal still under maintenance process.  Regards, Steve Albert', NULL, NULL, '2021-12-28 13:18:12', '2021-12-28 13:18:12'),
(53338, 20067, 44737, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP  Good Afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the following applications. Application# 18226213 Application# 18247429  Your Early response will be highly appreciated. Thanks & regards, Syed Ahad.', NULL, NULL, '2022-01-20 14:50:23', '2022-01-20 14:50:23'),
(53339, 20067, 44737, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub:  Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP   Good Afternoon!  Hope this email finds you well. Kindly send me the welcome kit for provider Nubia Benavides & Edna Michi.  Thank you,', NULL, NULL, '2022-02-04 13:18:49', '2022-02-04 13:18:49');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(53340, 20067, 44737, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Provider.relations@tmhp.com  Sub: RE: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP - CRM 2018774100  Thank you for contacting TMHP Provider Relations.  Your inquiry has been assigned to a Provider Relations Representative.  Your ticket number for this request is 2018774100.     The Provider Relations Representative will be contacting you to assist you in this matter.     If you need to contact us about this request, please submit and e-mail to provider.relations@tmhp.com  and reference the ticket number.     If immediate assistance is needed, please contact the TMHP Contact Center at 1-800-925-9126.     Thank you,  Texas Medicaid & Healthcare Partnership (TMHP) Provider Relations Department  Provider.Relations@tmhp.com', NULL, NULL, '2022-02-04 15:20:35', '2022-02-04 15:20:35'),
(53341, 20067, 44737, NULL, '2022-02-24 00:00:00.000', 'Approved', 'Called TMHP and spoke to Dwin Ref# 43213698000  Term:11/22/2026 Medicaid# 395614603 Enrollment: 09/01/2021 Effective Date:11/23/2021 Ticket# 7620059 Welcome letter requested', NULL, NULL, '2022-02-17 12:13:23', '2022-02-17 12:13:23'),
(53342, 10057, 44738, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-05 12:14:01', '2021-11-05 12:14:01'),
(53343, 10057, 44738, NULL, '2021-11-17 00:00:00.000', 'On Hold', 'SSN Required', NULL, NULL, '2021-11-10 09:42:15', '2021-11-10 09:42:15'),
(53344, 10057, 44738, NULL, '2021-11-22 00:00:00.000', 'Initiated', 'Enrollment Application Status  Application Status PEP Ticket Number Submitted	18247429  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.  If you have chosen to apply with Medicaid and the CSHCN Services Program at the same time, applications for both programs will be processed concurrently. You may also apply for the CSHCN Services Program once your application to Medicaid has been approved and you have received a Medicaid Texas Provider Identifier (TPI).', NULL, NULL, '2021-11-15 14:48:30', '2021-11-15 14:48:30'),
(53345, 10057, 44738, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Issue Resolved, application submitted again.  Application Status PEP Ticket Number In Progress 18247429  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.', NULL, NULL, '2021-11-17 14:48:18', '2021-11-17 14:48:18'),
(53346, 10057, 44738, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status:  In Progress PEP Ticket Number:  18247429', NULL, NULL, '2021-12-01 13:06:44', '2021-12-01 13:06:44'),
(53347, 10057, 44738, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Checked Via Portal still in process.  Will call next week for follow-up', NULL, NULL, '2021-12-08 10:44:34', '2021-12-08 10:44:34'),
(53348, 10057, 44738, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Portal in updating process, will check next week.', NULL, NULL, '2021-12-14 11:21:34', '2021-12-14 11:21:34'),
(53349, 10057, 44738, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Call Comments:  Rep: Alexis - Ref code: 42900508000  Status: Need to wait, portal still in process.', NULL, NULL, '2021-12-21 10:47:51', '2021-12-21 10:47:51'),
(53350, 10057, 44738, NULL, '2022-01-04 00:00:00.000', 'In Process', 'I have checked still there is no option to add locations.  Portal still under maintenance process.  Regards, Steve Albert', NULL, NULL, '2021-12-28 13:18:01', '2021-12-28 13:18:01'),
(53351, 20067, 44738, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP  Good Afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the following applications. Application# 18226213 Application# 18247429  Your Early response will be highly appreciated. Thanks & regards, Syed Ahad.', NULL, NULL, '2022-01-20 14:50:17', '2022-01-20 14:50:17'),
(53352, 20067, 44738, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub:  Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP   Good Afternoon!  Hope this email finds you well. Kindly send me the welcome kit for provider Nubia Benavides & Edna Michi.  Thank you,', NULL, NULL, '2022-02-04 13:18:37', '2022-02-04 13:18:37'),
(53353, 20067, 44738, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Provider.relations@tmhp.com  Sub: RE: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP - CRM 2018774100  Thank you for contacting TMHP Provider Relations.  Your inquiry has been assigned to a Provider Relations Representative.  Your ticket number for this request is 2018774100.     The Provider Relations Representative will be contacting you to assist you in this matter.     If you need to contact us about this request, please submit and e-mail to provider.relations@tmhp.com  and reference the ticket number.     If immediate assistance is needed, please contact the TMHP Contact Center at 1-800-925-9126.     Thank you,  Texas Medicaid & Healthcare Partnership (TMHP) Provider Relations Department  Provider.Relations@tmhp.com', NULL, NULL, '2022-02-04 15:20:29', '2022-02-04 15:20:29'),
(53354, 20067, 44738, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub: Re: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP  Good Afternoon!  I would like to add the Secondary and Tertiary locations for the below-mentioned providers.  Attached are the W9 for both locations  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia O Benavides	1801371935 Edna Michi	1992293906	  Thank you, Syed Ahad.', NULL, NULL, '2022-03-04 14:12:46', '2022-03-04 14:12:46'),
(53355, 22077, 44738, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: provider.relations@tmhp.com  Subject: Re: FW: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP File Maintenance Walkthrough Appointment Request - CRM 2019063700  Hi,  In the previous email, we were advised that someone will contact us regarding our request. So far no one has contacted us. I would like to get the updates on the previously mentioned request.  Thanks, Alex', NULL, NULL, '2022-04-08 07:53:58', '2022-04-08 07:53:58'),
(53356, 10057, 44739, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-05 12:14:32', '2021-11-05 12:14:32'),
(53357, 10057, 44739, NULL, '2021-11-17 00:00:00.000', 'On Hold', 'SSN Required', NULL, NULL, '2021-11-10 09:42:08', '2021-11-10 09:42:08'),
(53358, 10057, 44739, NULL, '2021-11-22 00:00:00.000', 'Initiated', 'Enrollment Application Status   Application Status PEP Ticket Number Submitted		18247429  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.  If you have chosen to apply with Medicaid and the CSHCN Services Program at the same time, applications for both programs will be processed concurrently. You may also apply for the CSHCN Services Program once your application to Medicaid has been approved and you have received a Medicaid Texas Provider Identifier (TPI).', NULL, NULL, '2021-11-15 14:48:03', '2021-11-15 14:48:03'),
(53359, 10057, 44739, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Issue Resolved, application submitted again.  Application Status PEP Ticket Number In Progress 18247429  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.', NULL, NULL, '2021-11-17 14:48:07', '2021-11-17 14:48:07'),
(53360, 10057, 44739, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status:  In Progress PEP Ticket Number:  18247429', NULL, NULL, '2021-12-01 13:06:32', '2021-12-01 13:06:32'),
(53361, 10057, 44739, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Checked Via Portal still in process.  Will call next week for follow-up', NULL, NULL, '2021-12-08 10:44:29', '2021-12-08 10:44:29'),
(53362, 10057, 44739, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Portal in updating process, will check next week.', NULL, NULL, '2021-12-14 11:21:29', '2021-12-14 11:21:29'),
(53363, 10057, 44739, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Call Comments:  Rep: Alexis - Ref code: 42900508000  Status: Need to wait, portal still in process.', NULL, NULL, '2021-12-21 10:47:45', '2021-12-21 10:47:45'),
(53364, 10057, 44739, NULL, '2022-01-04 00:00:00.000', 'In Process', 'I have checked still there is no option to add locations.  Portal still under maintenance process.  Regards, Steve Albert', NULL, NULL, '2021-12-28 13:17:50', '2021-12-28 13:17:50'),
(53365, 20067, 44739, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP  Good Afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the following applications. Application# 18226213 Application# 18247429  Your Early response will be highly appreciated. Thanks & regards, Syed Ahad.', NULL, NULL, '2022-01-20 14:50:10', '2022-01-20 14:50:10'),
(53366, 20067, 44739, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub:  Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP   Good Afternoon!  Hope this email finds you well. Kindly send me the welcome kit for provider Nubia Benavides & Edna Michi.  Thank you,', NULL, NULL, '2022-02-04 13:18:16', '2022-02-04 13:18:16'),
(53367, 20067, 44739, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Provider.relations@tmhp.com  Sub: RE: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP - CRM 2018774100  Thank you for contacting TMHP Provider Relations.  Your inquiry has been assigned to a Provider Relations Representative.  Your ticket number for this request is 2018774100.     The Provider Relations Representative will be contacting you to assist you in this matter.     If you need to contact us about this request, please submit and e-mail to provider.relations@tmhp.com  and reference the ticket number.     If immediate assistance is needed, please contact the TMHP Contact Center at 1-800-925-9126.     Thank you,  Texas Medicaid & Healthcare Partnership (TMHP) Provider Relations Department  Provider.Relations@tmhp.com', NULL, NULL, '2022-02-04 15:20:23', '2022-02-04 15:20:23'),
(53368, 20067, 44739, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub: Re: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP  Good Afternoon!  I would like to add the Secondary and Tertiary locations for the below-mentioned providers.  Attached are the W9 for both locations  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia O Benavides	1801371935 Edna Michi	1992293906	  Thank you, Syed Ahad.', NULL, NULL, '2022-03-04 14:12:38', '2022-03-04 14:12:38'),
(53369, 22077, 44739, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: provider.relations@tmhp.com  Subject: 	Re: FW: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP File Maintenance Walkthrough Appointment Request - CRM 2019063700  Hi,  In the previous email, we were advised that someone will contact us regarding our request. So far no one has contacted us. I would like to get the updates on the previously mentioned request.  Thanks, Alex', NULL, NULL, '2022-04-08 07:53:06', '2022-04-08 07:53:06'),
(53370, 10057, 44740, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-05 12:15:43', '2021-11-05 12:15:43'),
(53371, 10057, 44740, NULL, '2021-11-17 00:00:00.000', 'On Hold', 'SSN Required', NULL, NULL, '2021-11-10 09:42:00', '2021-11-10 09:42:00'),
(53372, 10057, 44740, NULL, '2021-11-22 00:00:00.000', 'Initiated', 'Enrollment Application Status  Application Status PEP Ticket Number Submitted	18247429  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.  If you have chosen to apply with Medicaid and the CSHCN Services Program at the same time, applications for both programs will be processed concurrently. You may also apply for the CSHCN Services Program once your application to Medicaid has been approved and you have received a Medicaid Texas Provider Identifier (TPI).', NULL, NULL, '2021-11-15 14:47:45', '2021-11-15 14:47:45'),
(53373, 10057, 44740, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Issue Resolved, application submitted again.  Application Status PEP Ticket Number In Progress 18247429  Thank you for submitting your application to the Texas Medicaid & Healthcare Partnership (TMHP). You can check the status of your application anytime by visiting www.tmhp.com, selecting Access Provider Enrollment, and clicking View Existing Transactions.', NULL, NULL, '2021-11-17 14:47:51', '2021-11-17 14:47:51'),
(53374, 10057, 44740, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Application Status:  In Progress PEP Ticket Number:  18247429', NULL, NULL, '2021-12-01 13:05:49', '2021-12-01 13:05:49'),
(53375, 10057, 44740, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Checked Via Portal still in process.  Will call next week for follow-up', NULL, NULL, '2021-12-08 10:44:23', '2021-12-08 10:44:23'),
(53376, 10057, 44740, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Portal in updating process, will check next week.', NULL, NULL, '2021-12-14 11:21:24', '2021-12-14 11:21:24'),
(53377, 10057, 44740, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Call Comments:  Rep: Alexis - Ref code: 42900508000  Status: Need to wait, portal still in process.', NULL, NULL, '2021-12-21 10:47:39', '2021-12-21 10:47:39'),
(53378, 10057, 44740, NULL, '2022-01-04 00:00:00.000', 'In Process', 'I have checked still there is no option to add locations.  Portal still under maintenance process.  Regards, Steve Albert', NULL, NULL, '2021-12-28 13:17:44', '2021-12-28 13:17:44'),
(53379, 20067, 44740, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP  Good Afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the following applications. Application# 18226213 Application# 18247429  Your Early response will be highly appreciated. Thanks & regards, Syed Ahad.', NULL, NULL, '2022-01-20 14:50:02', '2022-01-20 14:50:02'),
(53380, 20067, 44740, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP  Good Afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the following applications. Application# 18226213 Application# 18247429  Your Early response will be highly appreciated. Thanks & regards, Syed Ahad.', NULL, NULL, '2022-01-20 14:50:02', '2022-01-20 14:50:02'),
(53381, 20067, 44740, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Provider.relations@tmhp.com  Sub:  Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP   Good Afternoon!  Hope this email finds you well. Kindly send me the welcome kit for provider Nubia Benavides & Edna Michi.  Thank you,', NULL, NULL, '2022-02-04 13:18:03', '2022-02-04 13:18:03'),
(53382, 20067, 44740, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Provider.relations@tmhp.com  Sub: RE: Enrollment Status || Valley Med Urgent Care || Edna Michi & Nubia Olivama Benavides || TMHP - CRM 2018774100  Thank you for contacting TMHP Provider Relations.  Your inquiry has been assigned to a Provider Relations Representative.  Your ticket number for this request is 2018774100.     The Provider Relations Representative will be contacting you to assist you in this matter.     If you need to contact us about this request, please submit and e-mail to provider.relations@tmhp.com  and reference the ticket number.     If immediate assistance is needed, please contact the TMHP Contact Center at 1-800-925-9126.     Thank you,  Texas Medicaid & Healthcare Partnership (TMHP) Provider Relations Department  Provider.Relations@tmhp.com', NULL, NULL, '2022-02-04 15:20:16', '2022-02-04 15:20:16'),
(53383, 20067, 44740, NULL, '2022-02-24 00:00:00.000', 'Approved', 'Called TMHP and spoke with Dwin Ref# 43213698000  TPI# 387437202 Enrolled on 11/01/2021 Credentialed on 11/18/2021 Ticket# 76283 Welcome letter Received through Fax', NULL, NULL, '2022-02-17 12:09:03', '2022-02-17 12:09:03'),
(53384, 11056, 44741, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-11 17:36:42', '2021-11-11 17:36:42'),
(53385, 11056, 44741, NULL, '2021-11-18 00:00:00.000', 'Initiated', 'Email sent to : patti.davidson@healthsmart.com & credentialing@anci-care.com  Sub : Enrollment Query - CBUC & GWMC - Anci-Care  Good afternoon!  Hope this email finds you well. Kindly assist me with the enrollment procedure for the below-mentioned provider with Anci-Care. Please guide me on how to proceed with the credentialing process for the provider with two locations.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Leticia Aleman-Listenbee  1154999654  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-11 17:37:08', '2021-11-11 17:37:08'),
(53386, 11056, 44741, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : Shane.Radford@healthsmart.com  Sub : Enrollment Query - CBUC & GWMC - Anci-Care  Ahmed,     I am responding to your below request.  Both sites have been completed and the credentialing information has been loaded.  Please feel free to contact me if you should need any additional information.     Thank you,     Shane Radford| Provider Relations  HealthSmart | Network Solutions  Office: 214 574 2664 ext. 202644  222 W Las Colinas Blvd | Suite 550 N | Irving, Tx 75039  Email: shane.radford@healthsmart.com', NULL, NULL, '2021-11-11 17:37:20', '2021-11-11 17:37:20'),
(53387, 11056, 44741, NULL, '2021-11-18 00:00:00.000', 'Approved', 'Email received from: shane.radford@healthsmart.com  Sub : Enrollment Query - CBUC & GWMC - Anci-Care  Good afternoon,  I will have to get the contract pulled and sent over so that we can forward you a copy of the contract.  I see that both of these locations were just recredentialed 9/16/2021. I will get the recredentialing letters as well and have those forwarded to you.  Please feel free to reach out to me if you should need any additional information.    Ahmed  Good morning,  I wanted to follow up on your request for the effective date and the welcome letter.  The effective date of the contract is 7/20/2017 and I have attached the recredentialing letter for your records.  I have requested a copy of the contract and I will forward to your attention as soon as it is returned to me.    Ahmed,  Good afternoon I have attached the requested contract for your records  Thank you,        Shane Radford| Provider Relations  HealthSmart | Network Solutions  Office: 214 574 2664 | Office: 214 574 1121  222 W Las Colinas Blvd | Suite 550 N | Irving, Tx 75039  Email: shane.radford@healthsmart.com  Ancillary contract.', NULL, NULL, '2021-11-11 17:39:40', '2021-11-11 17:39:40'),
(53388, 1019, 45682, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:09', '2021-11-12 13:19:09'),
(53389, 1019, 45682, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'Requested Initiated thru website  Thank You! Request ID for this Submission: 73197977  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.  ', NULL, NULL, '2021-11-12 16:49:55', '2021-11-12 16:49:55'),
(53390, 11056, 45682, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub:   Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Good afternoon!  Hope you are having a blessed day. Please provide me with the latest updates on the credentialing process of the provider, Lauren Powell NPI: 1285304980 under the facility Spectrum Neuro Behavioral Care LLC Tax Id: 83-4482753.  Please get back to me with this with the below query as well.  Thank you! Have a great day!', NULL, NULL, '2021-12-01 17:02:02', '2021-12-01 17:02:02'),
(53391, 19067, 45682, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:12:30', '2021-12-15 17:12:30'),
(53392, 19067, 45682, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:55:54', '2021-12-16 10:55:54'),
(53393, 19067, 45682, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:31:25', '2021-12-20 10:31:25'),
(53394, 19067, 45682, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:21:34', '2021-12-28 13:21:34'),
(53395, 19067, 45682, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:32:49', '2022-01-10 11:32:49'),
(53396, 19067, 45682, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  There are no changes for the providers listed below.  Thank you', NULL, NULL, '2022-01-30 12:11:56', '2022-01-30 12:11:56'),
(53397, 1019, 45682, NULL, '2022-02-08 00:00:00.000', 'In Process', 'Hello Laura,  Did the providers get linked on which we were waiting, and if yes please provide me there effective dates     Thank You, Hammad.', NULL, NULL, '2022-02-01 12:19:17', '2022-02-01 12:19:17'),
(53398, 19067, 45682, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Thank you', NULL, NULL, '2022-02-10 15:12:46', '2022-02-10 15:12:46'),
(53399, 19067, 45682, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Aetna Provider Communications  Subject: Welcome to our network. Let’s get started.  Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  Ready to get started? To help make your onboarding easy, just check out the attached welcome kit.    Register here to attend our new provider onboarding webinar - Doing business with Aetna® . Sessions are held on the second Tuesday and third Wednesday of each month from 1:00 p.m. – 2:15 p.m. ET. You\'ll discover additional online tools and resources to make your day-to-day Aetna tasks quick and simple.   ', NULL, NULL, '2022-02-10 16:01:38', '2022-02-10 16:01:38'),
(53400, 19067, 45682, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the following email     Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  ', NULL, NULL, '2022-02-14 14:03:25', '2022-02-14 14:03:25'),
(53401, 19067, 45682, NULL, '2022-02-21 00:00:00.000', 'Approved', 'See attachment of provider directory for location confirmation.', NULL, NULL, '2022-02-14 14:08:12', '2022-02-14 14:08:12'),
(53402, 1019, 45683, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:09', '2021-11-12 13:19:09'),
(53403, 1019, 45683, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'CAQH Application faxed at 8666127790.', NULL, NULL, '2021-11-12 16:58:07', '2021-11-12 16:58:07'),
(53404, 11056, 45683, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  provider.relations@beaconhealthoptions.com  Sub: Fwd: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good Morning Shashi/Dan,  I need an update on the credentialing process for the following providers.  Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-12-01 17:41:00', '2021-12-01 17:41:00'),
(53405, 11056, 45683, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:39:15', '2021-12-14 14:39:15'),
(53406, 19067, 45683, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:17:23', '2021-12-20 12:17:23'),
(53407, 19067, 45683, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:10:36', '2021-12-20 15:10:36'),
(53408, 19067, 45683, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:39:41', '2021-12-22 13:39:41'),
(53409, 19067, 45683, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:03:22', '2021-12-28 17:03:22'),
(53410, 19067, 45683, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:35:39', '2022-01-05 15:35:39'),
(53411, 19067, 45683, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:39:15', '2022-01-12 15:39:15'),
(53412, 19067, 45683, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458    Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:38:12', '2022-01-25 09:38:12'),
(53413, 19067, 45683, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582   Good Morning!  Hope you\'re doing well.  Any updates on the request below?   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 08:49:31', '2022-02-04 08:49:31'),
(53414, 19067, 45683, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:05:43', '2022-02-07 10:05:43'),
(53415, 19067, 45683, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:49:57', '2022-02-14 09:49:57'),
(53416, 1019, 45683, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the Welcome Letter from Beacon.  Effective Date: 01/25/2022 Provider ID: 1121445  See Attachment for the Welcome Letter and Location Confirmation.', NULL, NULL, '2022-02-14 09:58:16', '2022-02-14 09:58:16'),
(53417, 1019, 45684, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:09', '2021-11-12 13:19:09'),
(53418, 1019, 45684, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'CAQH Application faxed at 8666127790.', NULL, NULL, '2021-11-12 16:58:29', '2021-11-12 16:58:29'),
(53419, 11056, 45684, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  provider.relations@beaconhealthoptions.com  Sub: Fwd: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good Morning Shashi/Dan,  I need an update on the credentialing process for the following providers.  Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-12-01 17:40:50', '2021-12-01 17:40:50');
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
(53420, 11056, 45684, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:40:26', '2021-12-14 14:40:26'),
(53421, 19067, 45684, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:18:19', '2021-12-20 12:18:19'),
(53422, 19067, 45684, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:10:49', '2021-12-20 15:10:49'),
(53423, 19067, 45684, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:39:55', '2021-12-22 13:39:55'),
(53424, 19067, 45684, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:03:32', '2021-12-28 17:03:32'),
(53425, 19067, 45684, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:39:00', '2022-01-05 15:39:00'),
(53426, 19067, 45684, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:39:27', '2022-01-12 15:39:27'),
(53427, 19067, 45684, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458    Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:38:27', '2022-01-25 09:38:27'),
(53428, 19067, 45684, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582   Good Morning!  Hope you\'re doing well.  Any updates on the request below?   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 08:49:40', '2022-02-04 08:49:40'),
(53429, 19067, 45684, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:05:54', '2022-02-07 10:05:54'),
(53430, 19067, 45684, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:50:37', '2022-02-14 09:50:37'),
(53431, 1019, 45684, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the Welcome Letter from Beacon.  Effective Date: 01/25/2022 Provider ID: 1121445  See Attachment for the Welcome Letter and Location Confirmation.', NULL, NULL, '2022-02-14 10:05:05', '2022-02-14 10:05:05'),
(53432, 1019, 45685, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:09', '2021-11-12 13:19:09'),
(53433, 1019, 45685, NULL, '2021-11-22 00:00:00.000', 'Not Eligible', 'Received the following email from BCBS.  Please be advised that Blue Cross Blue Shield of Massachusetts does not currently credential LCSWs. ', NULL, NULL, '2021-11-15 08:50:10', '2021-11-15 08:50:10'),
(53434, 1019, 45686, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:09', '2021-11-12 13:19:09'),
(53435, 1019, 45686, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'Sent the following email to CCA.  Hello,  We want to enroll the following provider with CCA under our group, please see attached application. Let me know if anything else is required. ', NULL, NULL, '2021-11-12 17:13:38', '2021-11-12 17:13:38'),
(53436, 1019, 45686, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Received the following email from PNM CCA  Hello, Provider Lauren Powell, LCSW is effective 11/12/2021 at Spectrum Neuro Behavioral Care LLC under the TIN 834482753     Thank you   Sivakumar Kesavan  Provider Network Management  Commonwealth Care Alliance  2 Avenue De Lafayette 5th Floor  Boston MA 02111', NULL, NULL, '2021-11-16 15:23:34', '2021-11-16 15:23:34'),
(53437, 1019, 45687, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:10', '2021-11-12 13:19:10'),
(53438, 1019, 45687, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Waiting to get enrolled with Aetna first.', NULL, NULL, '2021-11-15 08:48:14', '2021-11-15 08:48:14'),
(53439, 1019, 45688, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:10', '2021-11-12 13:19:10'),
(53440, 1019, 45688, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'Not Eligible due to LCSW license. ', NULL, NULL, '2021-11-30 15:07:28', '2021-11-30 15:07:28'),
(53441, 1019, 45689, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:10', '2021-11-12 13:19:10'),
(53442, 1019, 45689, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'Application Initiated thru Magellan Portal.', NULL, NULL, '2021-11-12 17:26:09', '2021-11-12 17:26:09'),
(53443, 19067, 45689, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: pec@maximus.com Subject: Enrollment Status || Providers  || SNBCARE || || Magellan||  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. DiCostanzo, Allie	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza 1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980 100 New State Highway, Raynham, MA, 02767.   Hello,  Hope you\'re having a productive day.  Following are the providers with their respective NPIs\'. I want to know the Enrollment status for the providers with mentioned locations.  If the providers are enrolled then provide us with the effective date and welcome letter for each provider.  Kindly respond in a timely manner!  Thanks and Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 14:13:28', '2021-12-15 14:13:28'),
(53444, 19067, 45689, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: ARViviano@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan||   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. DiCostanzo, Allie	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza 1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980 100 New State Highway, Raynham, MA, 02767.   Hello,  Hope you\'re having a productive day.  Following are the providers with their respective NPIs\'. I want to know the Enrollment status for the providers with mentioned locations.  If the providers are enrolled then provide us with the effective date and welcome letter for each provider.  Kindly respond in a timely manner!  Thanks and Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 14:18:00', '2021-12-15 14:18:00'),
(53445, 19067, 45689, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan||   Good Afternoon,  Is there some information you are requesting? My colleague Angela does not manage providers, I am the Specialist for MA.  These kinds of request would come through me.     The letters are sent to the primary group. If your group is the primary group with the mailing address, then that letter is mailed to: 61 Lincoln St Ste 203 Framingham MA 01702-8264. Those letters are generated and sent by credentialing.     My email should also suffice for an effective date.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process.     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process.     Judy', NULL, NULL, '2021-12-15 16:43:00', '2021-12-15 16:43:00'),
(53446, 19067, 45689, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||   Hello!  Hope you are doing very well.  I would like to know the enrollment status of the following Providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Eliza Rodrigues	1821751405	100 New State Highway, Raynham, MA, 02767. Eliza Rodrigues	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	100 New State Highway, Raynham, MA, 02767. Helena Halterman	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Helena Halterman	1801473749	100 New State Highway, Raynham, MA, 02767. Fauzia Khan	1699761965	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-29 13:59:42', '2021-12-29 13:59:42'),
(53447, 19067, 45689, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||   Greetings!  Any updates on the previously mentioned requests?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 13:22:01', '2022-01-10 13:22:01'),
(53448, 19067, 45689, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: RE: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||    Good Afternoon,  You have some of the same providers we have already resolved on this list.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021…please remove as resolved. 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW…please remove from the roster.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process as of 12/29/2021     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process as of 12/29/2021.     Fauzia Wali Khan MIS 710629-000… has been linked to your group effective date 4/30/2021…please remove as resolved  Addresses:  61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     If you need to add any addresses you may so on the Magellan website.     Judy', NULL, NULL, '2022-02-11 10:08:34', '2022-02-11 10:08:34'),
(53449, 1019, 45689, NULL, '2022-02-21 00:00:00.000', 'Not Eligible', 'Received the following email from Magellan Sub: Lauren Powell 601544-951  Good morning,  The credentialing department has indicated that this provider does not Meet credentialing requirements and cannot be credentialed.  LICSW is required in Massachusetts. The provider does NOT hold that license.     Judy     Judith Wright  Network Management Specialist, PA/DE/MA Field Network Department  Magellan Healthcare, Commercial Network Management', NULL, NULL, '2022-02-14 14:00:47', '2022-02-14 14:00:47'),
(53450, 1019, 45690, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:10', '2021-11-12 13:19:10'),
(53451, 1019, 45690, NULL, '2021-11-22 00:00:00.000', 'Not Eligible', 'MassHealth doesn\'t enroll LCSW.', NULL, NULL, '2021-11-15 08:49:05', '2021-11-15 08:49:05'),
(53452, 1019, 45691, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:10', '2021-11-12 13:19:10'),
(53453, 19067, 45691, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||  Hello!  I want to enroll the following provider kindly advice the enrollment process  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Provider Name	NPI Lauren Powell	1285304980 Lauren Powell	1285304980   Regards,', NULL, NULL, '2022-02-11 10:48:30', '2022-02-11 10:48:30'),
(53454, 19067, 45691, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||    Lauren Powell will need to complete the attached form as well.     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159', NULL, NULL, '2022-02-17 13:16:31', '2022-02-17 13:16:31'),
(53455, 19067, 45691, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||  Hello!  Kindly see the attached form as per your request.  Regards. ', NULL, NULL, '2022-02-17 13:21:52', '2022-02-17 13:21:52'),
(53456, 19067, 45691, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||   Hi Ahmed,     On the form you have to write in the service description that you want to add MBHP to her contract under the Spectrum Neuro Behavioral group. Please complete that and send back to me.', NULL, NULL, '2022-02-17 14:23:22', '2022-02-17 14:23:22'),
(53457, 19067, 45691, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||   Hi Randy!  Kindly see the attachment.  Regards,', NULL, NULL, '2022-02-17 14:23:50', '2022-02-17 14:23:50'),
(53458, 19067, 45691, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||    Received, thank you.  ', NULL, NULL, '2022-02-21 10:01:36', '2022-02-21 10:01:36'),
(53459, 19067, 45691, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||    Hello,  Hope this email finds you well.  Any updates on the enrollment of the provider, Lauren Powell?   Regards, Hammad Ahmed', NULL, NULL, '2022-03-16 17:16:34', '2022-03-16 17:16:34'),
(53460, 22077, 45691, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Fwd: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Good Morning,  Kindly see the attached file as requested  Thanks', NULL, NULL, '2022-04-05 08:08:43', '2022-04-05 08:08:43'),
(53461, 22077, 45691, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Received, thank you.     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159  Please note my last day with company is 4/8/2022  Please direct any questions to mbhp_pr@beaconhealthoptions.com ', NULL, NULL, '2022-04-05 10:22:22', '2022-04-05 10:22:22'),
(53462, 1019, 45692, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:10', '2021-11-12 13:19:10'),
(53463, 1019, 45692, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'Application Initiated thru PECOS', NULL, NULL, '2021-11-12 17:28:01', '2021-11-12 17:28:01'),
(53464, 1019, 45692, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Attached is the Approval letter, Effective date 11/03/2021', NULL, NULL, '2021-11-16 15:34:30', '2021-11-16 15:34:30'),
(53465, 1019, 45693, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:10', '2021-11-12 13:19:10'),
(53466, 1019, 45693, NULL, '2021-11-23 00:00:00.000', 'On Hold', 'Waiting for Medicare PTAN to load in there system see below for Reference.  At this time, we are unable to process your request because one or more of the data elements entered into this tool did not match your local Medicare Administrative Contractor (A/B MAC). If you believe you have received this message in error, please contact your local A/B MAC to validate the accuracy of the provider information you have entered into this tool.  You can locate contact information for your local A/B MAC on the CMS MAC Website List page at https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/MAC-Website-List.  Reference Number :	21320001262 ', NULL, NULL, '2021-11-16 15:40:51', '2021-11-16 15:40:51'),
(53467, 1019, 45694, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:10', '2021-11-12 13:19:10'),
(53468, 1019, 45694, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'Not Eligible due to LCSW license. ', NULL, NULL, '2021-11-30 15:09:03', '2021-11-30 15:09:03'),
(53469, 1019, 45695, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:10', '2021-11-12 13:19:10'),
(53470, 1019, 45695, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'Tufts don\'t enroll LCSW.', NULL, NULL, '2021-11-30 17:26:04', '2021-11-30 17:26:04'),
(53471, 1019, 45696, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:10', '2021-11-12 13:19:10'),
(53472, 1019, 45696, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'Tufts don\'t enroll LCSW.', NULL, NULL, '2021-11-30 17:26:26', '2021-11-30 17:26:26'),
(53473, 1019, 45697, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:19:10', '2021-11-12 13:19:10'),
(53474, 19067, 45697, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Your application has been submitted and is currently waiting to be reviewed by our Network Management Team.', NULL, NULL, '2021-12-14 09:21:08', '2021-12-14 09:21:08'),
(53475, 19067, 45697, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com, kim.wise@optum.com  Subject: Enrollment Status || SNBCARE || Providers || UBH ||   Hello,  Hope you\'re having a productive day.  I would like to know the credentialing status of the following Providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Oliva Erin	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896 Lauren Powell	1285304980	100 New State HWY, Raynham, MA 02767 Lauren Powell	1285304980	61 Lincoln St. Suite 203, Framingham, MA 01702   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 12:37:44', '2021-12-29 12:37:44'),
(53476, 19067, 45697, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: Optum  Subject: Fwd: Optum Credentialing Application Cancelled for Lauren Powell    12/30/2021   Attn:  Alex Garrett, Credentialing Contact  snbc@claimsmedinc.com  snbc@claimsmedinc.com    RE:  Network Participation - Lauren Powell    Dear Clinician,  Thank you for your interest in becoming a participating clinician with Optum.  We have reviewed your application and determined that your license level does not meet the Optum credentialing standards.       We encourage you to visit providerexpress.com to review credentialing criteria specific to your area.  If you have any questions, please call Behavioral Network Services at 1-877-614-0484 and select the following options for assistance: Credentialing > Network Services > Credentialing to reach Provider Relations.   Sincerely,    Optum Behavioral Health Credentialing Department      a0b2T000007qJXI|AMTLetter|Letters    United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum  U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California    © 2021 Optum, Inc. All Rights Reserved  BH3315b_04/2021   ', NULL, NULL, '2022-01-03 09:21:03', '2022-01-03 09:21:03'),
(53477, 19067, 45697, NULL, '2022-01-10 00:00:00.000', 'Not Eligible', 'Email received from: Optum  Subject: Fwd: Optum Credentialing Application Cancelled for Lauren Powell    12/30/2021   Attn:  Alex Garrett, Credentialing Contact  snbc@claimsmedinc.com  snbc@claimsmedinc.com    RE:  Network Participation - Lauren Powell    Dear Clinician,  Thank you for your interest in becoming a participating clinician with Optum.  We have reviewed your application and determined that your license level does not meet the Optum credentialing standards.       We encourage you to visit providerexpress.com to review credentialing criteria specific to your area.  If you have any questions, please call Behavioral Network Services at 1-877-614-0484 and select the following options for assistance: Credentialing > Network Services > Credentialing to reach Provider Relations.   Sincerely,    Optum Behavioral Health Credentialing Department      a0b2T000007qJXI|AMTLetter|Letters    United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum  U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California    © 2021 Optum, Inc. All Rights Reserved  BH3315b_04/2021   ', NULL, NULL, '2022-01-03 09:22:24', '2022-01-03 09:22:24'),
(53478, 1019, 45698, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53479, 1019, 45698, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'Requested Initiated thru website  Thank You! Request ID for this Submission: 73197977  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.  ', NULL, NULL, '2021-11-12 16:49:42', '2021-11-12 16:49:42'),
(53480, 11056, 45698, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub:   Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Good afternoon!  Hope you are having a blessed day. Please provide me with the latest updates on the credentialing process of the provider, Lauren Powell NPI: 1285304980 under the facility Spectrum Neuro Behavioral Care LLC Tax Id: 83-4482753.  Please get back to me with this with the below query as well.  Thank you! Have a great day!', NULL, NULL, '2021-12-01 17:01:25', '2021-12-01 17:01:25'),
(53481, 19067, 45698, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:12:09', '2021-12-15 17:12:09'),
(53482, 19067, 45698, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:55:42', '2021-12-16 10:55:42'),
(53483, 19067, 45698, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:31:17', '2021-12-20 10:31:17'),
(53484, 19067, 45698, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:21:29', '2021-12-28 13:21:29'),
(53485, 19067, 45698, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:32:39', '2022-01-10 11:32:39'),
(53486, 19067, 45698, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  There are no changes for the providers listed below.  Thank you', NULL, NULL, '2022-01-30 12:12:14', '2022-01-30 12:12:14'),
(53487, 1019, 45698, NULL, '2022-02-08 00:00:00.000', 'In Process', 'Hello Laura,  Did the providers get linked on which we were waiting, and if yes please provide me there effective dates     Thank You, Hammad.', NULL, NULL, '2022-02-01 12:19:11', '2022-02-01 12:19:11'),
(53488, 19067, 45698, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Thank you', NULL, NULL, '2022-02-10 15:12:52', '2022-02-10 15:12:52'),
(53489, 19067, 45698, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Aetna Provider Communications  Subject: Welcome to our network. Let’s get started.  Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  Ready to get started? To help make your onboarding easy, just check out the attached welcome kit.    Register here to attend our new provider onboarding webinar - Doing business with Aetna® . Sessions are held on the second Tuesday and third Wednesday of each month from 1:00 p.m. – 2:15 p.m. ET. You\'ll discover additional online tools and resources to make your day-to-day Aetna tasks quick and simple.   ', NULL, NULL, '2022-02-10 16:01:34', '2022-02-10 16:01:34'),
(53490, 19067, 45698, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the following email     Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  ', NULL, NULL, '2022-02-14 14:03:31', '2022-02-14 14:03:31'),
(53491, 19067, 45698, NULL, '2022-02-21 00:00:00.000', 'Approved', 'See attachment of provider directory for location confirmation.', NULL, NULL, '2022-02-14 14:08:21', '2022-02-14 14:08:21'),
(53492, 1019, 45699, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53493, 1019, 45699, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'CAQH Application faxed at 8666127790.', NULL, NULL, '2021-11-12 16:57:58', '2021-11-12 16:57:58'),
(53494, 11056, 45699, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  provider.relations@beaconhealthoptions.com  Sub: Fwd: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good Morning Shashi/Dan,  I need an update on the credentialing process for the following providers.  Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-12-01 17:40:55', '2021-12-01 17:40:55'),
(53495, 11056, 45699, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:38:55', '2021-12-14 14:38:55'),
(53496, 19067, 45699, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:17:17', '2021-12-20 12:17:17'),
(53497, 19067, 45699, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:10:30', '2021-12-20 15:10:30');
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
(53498, 19067, 45699, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:39:34', '2021-12-22 13:39:34'),
(53499, 19067, 45699, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:03:17', '2021-12-28 17:03:17'),
(53500, 19067, 45699, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:35:46', '2022-01-05 15:35:46'),
(53501, 19067, 45699, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:40:22', '2022-01-05 15:40:22'),
(53502, 19067, 45699, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:39:07', '2022-01-12 15:39:07'),
(53503, 19067, 45699, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458    Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:38:06', '2022-01-25 09:38:06'),
(53504, 19067, 45699, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582   Good Morning!  Hope you\'re doing well.  Any updates on the request below?   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 08:49:35', '2022-02-04 08:49:35'),
(53505, 19067, 45699, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:05:38', '2022-02-07 10:05:38'),
(53506, 19067, 45699, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:50:05', '2022-02-14 09:50:05'),
(53507, 1019, 45699, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the Welcome Letter from Beacon.  Effective Date: 01/25/2022 Provider ID: 1121445  See Attachment for the Welcome Letter and Location Confirmation.', NULL, NULL, '2022-02-14 09:57:13', '2022-02-14 09:57:13'),
(53508, 1019, 45699, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the Welcome Letter from Beacon.  Effective Date: 01/25/2022 Provider ID: 1121445  See Attachment for the Welcome Letter and Location Confirmation.', NULL, NULL, '2022-02-14 10:03:46', '2022-02-14 10:03:46'),
(53509, 1019, 45700, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53510, 1019, 45700, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'CAQH Application faxed at 8666127790.', NULL, NULL, '2021-11-12 16:58:15', '2021-11-12 16:58:15'),
(53511, 11056, 45700, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  provider.relations@beaconhealthoptions.com  Sub: Fwd: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good Morning Shashi/Dan,  I need an update on the credentialing process for the following providers.  Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-12-01 17:40:32', '2021-12-01 17:40:32'),
(53512, 11056, 45700, NULL, '2021-12-21 00:00:00.000', 'In Process', '	 Email received from:  provider.relations@beaconhealthoptions.com  Sub:  RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS  Good afternoon,     Thank for following up:     1.       DiCostanzo, Allie; NPI# 1669045738 – Cred application is In-Process.  2.       Halterman, Helena; NPI# 1801473749 – Cred application is In-Process.  3.       Filoteo-Nichols, Dina; NPI# 1770021099 - Cred application is In-Process.  4.       Rodrigues, Eliza; NPI# 1821751405 - Cred application is In-Process.  5.       Powell, Lauren; NPI# 1285304980 - Cred application is In-Process.        Thank you!  Shashi Seth  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  General Inquiries: 800.397.1630  Direct Line: 781.994.7576  As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey . Thank you in advance!', NULL, NULL, '2021-12-14 14:40:31', '2021-12-14 14:40:31'),
(53513, 19067, 45700, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS    Good morning,.Hope you had a great weekend, I would like to know the enrollment status for mentioned providers.  Group NameSpectrum Neuro Behavioral Care LLCTax ID83-4482753 Group NPI1356906572Helena Halterman180147374961 Lincoln St., Suite 203, Framingham, MA 01702Helena Halterman1801473749100 NEW STATE HWY RAYNHAM, MA 02767-5423Allie DiCostanzo166904573863 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322Dina Filoteo-Nichols177002109961 Lincoln St., Suite 203, Framingham, MA 01702Dina Filoteo-Nichols1770021099100 NEW STATE HWY RAYNHAM, MA 02767-5423Eliza Rodrigues182175140561 Lincoln St., Suite 203, Framingham, MA 01702Eliza Rodrigues1821751405100 NEW STATE HWY RAYNHAM, MA 02767-5423Lauren Powell128530498061 Lincoln St., Suite 203, Framingham, MA 01702Lauren Powell1285304980100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kindly respond promptly,  Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 12:18:14', '2021-12-20 12:18:14'),
(53514, 19067, 45700, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: FW: RE: Enrollment Query || Group and Providers || SNBCARE || BHO/BHS    Good morning Alex,  The status for the following provider:  1.       DiCostanzo, Allie – Credentialing application is in-process  2.       Halterman, Helena - Credentialing application is in-process  3.       Filoteo-Nichols, Dina – Denied bc Provider is not board certified in a psychiatric specialty by ANCC. Please see attached.  4.       Rodrigues, Eliza – Credentialing application is in-process  5.       Powell, Lauren - Credentialing application is in-process', NULL, NULL, '2021-12-20 15:10:42', '2021-12-20 15:10:42'),
(53515, 19067, 45700, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS attn Middlesex County 12222021-4006789     Good Afternoon,     I have reviewed the provider files and noted below for each clinician.     Helena Halterman – app received 11.17.21 and still being processed – event 9258844  Allie Dicostanzo – app received 9.24.21 and still being processed – event 9225771  Dina Filoteo-Nichols – Denied – provider is not board certified in a psychiatric specialty by ANCC  Eliza Rodrigues – app received – initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.  Lauren Powell – app received 11.12.21 and still being processed – event 9256345     Thank you!  Sarah Oakes  Network Management Rep I, Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024     As we continue to strive to improve our provider’s experience, we would appreciate your feedback on dealing with our PR team and any issues you may have had by completing this 2 minute survey. Thank you in advance!', NULL, NULL, '2021-12-22 13:39:49', '2021-12-22 13:39:49'),
(53516, 19067, 45700, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS ||   Hello,  Hope you\'re doing well.  I would like to know the enrollment status of the providers mentioned before.  And if any provider is enrolled provide with their Effective date and Welcome Letter.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 17:03:27', '2021-12-28 17:03:27'),
(53517, 19067, 45700, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Secure email received from: notification@securemail-valueoptions.com/provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Good Morning,  Group Name  Spectrum Neuro Behavioral Care LLC   Tax ID  83-4482753  Group NPI  1356906572     Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844    Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771     Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied     Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.     Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.      Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345          Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations', NULL, NULL, '2022-01-05 15:38:54', '2022-01-05 15:38:54'),
(53518, 19067, 45700, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Re: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582    Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-12 15:39:21', '2022-01-12 15:39:21'),
(53519, 19067, 45700, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_01142022-4225458    Good Afternoon,     Please allow more time as the application process can take up to 90-120 days for completion. A welcome letter will be sent once credentialing is completed.     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.17.21 and still being processed – event 9258844        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.17.21 and still being processed – event 9258844        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  app received 9.24.21 and still being processed – event 9225771        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  initial app process termed – we pended notices for CANS attestation to be completed on 12.14.21 via email and fax and then on 12.22.21 we sent notice advising due to not receiving it back – we termed the initial app.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  app received 11.12.21 and still being processed – event 9256345        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  app received 11.12.21 and still being processed – event 9256345              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-01-25 09:38:17', '2022-01-25 09:38:17'),
(53520, 19067, 45700, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582   Good Morning!  Hope you\'re doing well.  Any updates on the request below?   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 08:49:45', '2022-02-04 08:49:45'),
(53521, 19067, 45700, NULL, '2022-02-14 00:00:00.000', 'In Process', 'Secure email received from: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099   Good Morning,     Group Name  Spectrum Neuro Behavioral Care LLC           Tax ID  83-4482753           Group NPI  1356906572                    Helena Halterman  1801473749  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Helena Halterman  1801473749  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Allie DiCostanzo  1669045738  63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Dina Filoteo-Nichols  1770021099  61 Lincoln St., Suite 203, Framingham, MA 01702  provider is not board certified in a psychiatric specialty by ANCC – app denied        Dina Filoteo-Nichols  1770021099  100 NEW STATE HWY RAYNHAM, MA 02767-5423  provider is not board certified in a psychiatric specialty by ANCC – app denied        Eliza Rodrigues  1821751405  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Eliza Rodrigues  1821751405  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  61 Lincoln St., Suite 203, Framingham, MA 01702  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.        Lauren Powell  1285304980  100 NEW STATE HWY RAYNHAM, MA 02767-5423  Credentialing approved by Medical Director – waiting for Data to load info – a welcome letter will be sent once complete. Please allow a little more time.              Thank you!  Sarah Oakes  Network Management Rep I , Northeast Provider Relations  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive, Suite 401  Woburn, MA 01801  Office: 1.800.397.1630  Direct Line: 1.781.496.4024', NULL, NULL, '2022-02-07 10:05:48', '2022-02-07 10:05:48'),
(53522, 19067, 45700, NULL, '2022-02-21 00:00:00.000', 'In Process', 'Email sent to: provider.relations@beaconhealthoptions.com  Subject: RE: Enrollment Query || Providers || SNBCARE || BHO/BHS || attn. Middlesex County 01052022-4114582_02072022-4462099    Hello,  Any updates on the providers welcome letter?  Regards, Hammad.', NULL, NULL, '2022-02-14 09:50:44', '2022-02-14 09:50:44'),
(53523, 1019, 45700, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the Welcome Letter from Beacon.  Effective Date: 01/25/2022 Provider ID: 1121445  See Attachment for the Welcome Letter and Location Confirmation.', NULL, NULL, '2022-02-14 10:04:02', '2022-02-14 10:04:02'),
(53524, 1019, 45701, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53525, 1019, 45701, NULL, '2021-11-22 00:00:00.000', 'Not Eligible', 'Received the following email from BCBS.  Please be advised that Blue Cross Blue Shield of Massachusetts does not currently credential LCSWs. ', NULL, NULL, '2021-11-15 08:50:00', '2021-11-15 08:50:00'),
(53526, 1019, 45702, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53527, 1019, 45702, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'Sent the following email to CCA.  Hello,  We want to enroll the following provider with CCA under our group, please see attached application. Let me know if anything else is required. ', NULL, NULL, '2021-11-12 17:13:06', '2021-11-12 17:13:06'),
(53528, 1019, 45702, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Received the following email from PNM CCA  Hello, Provider Lauren Powell, LCSW is effective 11/12/2021 at Spectrum Neuro Behavioral Care LLC under the TIN 834482753     Thank you   Sivakumar Kesavan  Provider Network Management  Commonwealth Care Alliance  2 Avenue De Lafayette 5th Floor  Boston MA 02111', NULL, NULL, '2021-11-16 15:23:25', '2021-11-16 15:23:25'),
(53529, 1019, 45703, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53530, 1019, 45703, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Waiting to get enrolled with Aetna first.', NULL, NULL, '2021-11-15 08:48:04', '2021-11-15 08:48:04'),
(53531, 1019, 45704, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53532, 1019, 45704, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'Not Eligible due to LCSW license. ', NULL, NULL, '2021-11-30 15:07:11', '2021-11-30 15:07:11'),
(53533, 1019, 45705, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53534, 1019, 45705, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'Application Initiated thru Magellan Portal.', NULL, NULL, '2021-11-12 17:25:39', '2021-11-12 17:25:39'),
(53535, 19067, 45705, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: pec@maximus.com Subject: Enrollment Status || Providers  || SNBCARE || || Magellan||  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. DiCostanzo, Allie	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza 1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980 100 New State Highway, Raynham, MA, 02767.   Hello,  Hope you\'re having a productive day.  Following are the providers with their respective NPIs\'. I want to know the Enrollment status for the providers with mentioned locations.  If the providers are enrolled then provide us with the effective date and welcome letter for each provider.  Kindly respond in a timely manner!  Thanks and Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 14:13:42', '2021-12-15 14:13:42'),
(53536, 19067, 45705, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: ARViviano@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan||   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. DiCostanzo, Allie	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza 1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980 100 New State Highway, Raynham, MA, 02767.   Hello,  Hope you\'re having a productive day.  Following are the providers with their respective NPIs\'. I want to know the Enrollment status for the providers with mentioned locations.  If the providers are enrolled then provide us with the effective date and welcome letter for each provider.  Kindly respond in a timely manner!  Thanks and Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 14:18:32', '2021-12-15 14:18:32'),
(53537, 19067, 45705, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan||   Good Afternoon,  Is there some information you are requesting? My colleague Angela does not manage providers, I am the Specialist for MA.  These kinds of request would come through me.     The letters are sent to the primary group. If your group is the primary group with the mailing address, then that letter is mailed to: 61 Lincoln St Ste 203 Framingham MA 01702-8264. Those letters are generated and sent by credentialing.     My email should also suffice for an effective date.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process.     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process.     Judy', NULL, NULL, '2021-12-15 16:42:47', '2021-12-15 16:42:47'),
(53538, 19067, 45705, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Re: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||   Hello!  Hope you are doing very well.  I would like to know the enrollment status of the following Providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Eliza Rodrigues	1821751405	100 New State Highway, Raynham, MA, 02767. Eliza Rodrigues	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Lauren Powell	1285304980	100 New State Highway, Raynham, MA, 02767. Helena Halterman	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Helena Halterman	1801473749	100 New State Highway, Raynham, MA, 02767. Fauzia Khan	1699761965	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Thanks & Regards, Ahmed, Hammad', NULL, NULL, '2021-12-29 13:59:34', '2021-12-29 13:59:34'),
(53539, 19067, 45705, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JWright@magellanhealth.com  Subject: Enrollment Status || Providers || SNBCARE || || Magellan ||   Greetings!  Any updates on the previously mentioned requests?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 13:21:55', '2022-01-10 13:21:55'),
(53540, 19067, 45705, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: JWright@magellanhealth.com  Subject: RE: FW: Enrollment Status || Providers || SNBCARE || || Magellan ||    Good Afternoon,  You have some of the same providers we have already resolved on this list.     Helena Lynn Halterman MIS 601536-453 has been linked to your group effective date 11/30/2021…please remove as resolved. 61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     Allie M Dicostanzo MIS 601537-942…does not meet credentialing requirements., needs an LICSW…please remove from the roster.     Eliza Rodrigues MIS 601542-706…the provider is being credentialed and is in process as of 12/29/2021     Lauren Powell MIS 601544-951…the provider is being credentialed and is in process as of 12/29/2021.     Fauzia Wali Khan MIS 710629-000… has been linked to your group effective date 4/30/2021…please remove as resolved  Addresses:  61 LINCOLN ST STE 203  FRAMINGHAM, MA 01702-8264     100 NEW STATE HWY  RAYNHAM, MA 02767-5423     If you need to add any addresses you may so on the Magellan website.     Judy', NULL, NULL, '2022-02-11 10:08:38', '2022-02-11 10:08:38'),
(53541, 1019, 45705, NULL, '2022-02-21 00:00:00.000', 'Not Eligible', 'Received the following email from Magellan Sub: Lauren Powell 601544-951  Good morning,  The credentialing department has indicated that this provider does not Meet credentialing requirements and cannot be credentialed.  LICSW is required in Massachusetts. The provider does NOT hold that license.     Judy     Judith Wright  Network Management Specialist, PA/DE/MA Field Network Department  Magellan Healthcare, Commercial Network Management', NULL, NULL, '2022-02-14 14:00:37', '2022-02-14 14:00:37'),
(53542, 1019, 45706, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53543, 1019, 45706, NULL, '2021-11-22 00:00:00.000', 'Not Eligible', 'MassHealth doesn\'t enroll LCSW.', NULL, NULL, '2021-11-15 08:48:53', '2021-11-15 08:48:53'),
(53544, 1019, 45707, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53545, 19067, 45707, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||  Hello!  I want to enroll the following provider kindly advice the enrollment process  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Provider Name	NPI Lauren Powell	1285304980 Lauren Powell	1285304980   Regards,', NULL, NULL, '2022-02-11 10:48:34', '2022-02-11 10:48:34'),
(53546, 19067, 45707, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||    Lauren Powell will need to complete the attached form as well.     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159', NULL, NULL, '2022-02-17 13:16:37', '2022-02-17 13:16:37'),
(53547, 19067, 45707, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||  Hello!  Kindly see the attached form as per your request.  Regards. ', NULL, NULL, '2022-02-17 13:21:57', '2022-02-17 13:21:57'),
(53548, 19067, 45707, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||   Hi Ahmed,     On the form you have to write in the service description that you want to add MBHP to her contract under the Spectrum Neuro Behavioral group. Please complete that and send back to me.', NULL, NULL, '2022-02-17 14:23:28', '2022-02-17 14:23:28'),
(53549, 19067, 45707, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||   Hi Randy!  Kindly see the attachment.  Regards,', NULL, NULL, '2022-02-17 14:23:57', '2022-02-17 14:23:57'),
(53550, 19067, 45707, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||    Received, thank you.  ', NULL, NULL, '2022-02-21 10:01:31', '2022-02-21 10:01:31'),
(53551, 19067, 45707, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Lauren Powell || MBHP ||    Hello,  Hope this email finds you well.  Any updates on the enrollment of the provider, Lauren Powell?   Regards, Hammad Ahmed', NULL, NULL, '2022-03-16 17:16:44', '2022-03-16 17:16:44'),
(53552, 22077, 45707, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Fwd: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Good Morning,  Kindly see the attached file as requested  Thanks', NULL, NULL, '2022-04-05 08:07:26', '2022-04-05 08:07:26'),
(53553, 22077, 45707, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Received, thank you.     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159  Please note my last day with company is 4/8/2022  Please direct any questions to mbhp_pr@beaconhealthoptions.com ', NULL, NULL, '2022-04-05 10:22:45', '2022-04-05 10:22:45'),
(53554, 1019, 45708, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53555, 1019, 45708, NULL, '2021-11-19 00:00:00.000', 'Initiated', 'Application Initiated thru PECOS', NULL, NULL, '2021-11-12 17:27:45', '2021-11-12 17:27:45'),
(53556, 1019, 45708, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Attached is the Approval letter, Effective date 11/03/2021', NULL, NULL, '2021-11-16 15:34:11', '2021-11-16 15:34:11'),
(53557, 1019, 45709, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53558, 1019, 45709, NULL, '2021-11-23 00:00:00.000', 'On Hold', 'Waiting for Medicare PTAN to load in there system see below for Reference.  At this time, we are unable to process your request because one or more of the data elements entered into this tool did not match your local Medicare Administrative Contractor (A/B MAC). If you believe you have received this message in error, please contact your local A/B MAC to validate the accuracy of the provider information you have entered into this tool.  You can locate contact information for your local A/B MAC on the CMS MAC Website List page at https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/MAC-Website-List.  Reference Number :	21320001262 ', NULL, NULL, '2021-11-16 15:40:43', '2021-11-16 15:40:43'),
(53559, 1019, 45710, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53560, 1019, 45710, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'Not Eligible due to LCSW license. ', NULL, NULL, '2021-11-30 15:08:06', '2021-11-30 15:08:06'),
(53561, 1019, 45711, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53562, 1019, 45711, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'Tufts don\'t enroll LCSW.', NULL, NULL, '2021-11-30 17:25:51', '2021-11-30 17:25:51'),
(53563, 1019, 45712, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53564, 1019, 45712, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'Tufts don\'t enroll LCSW.', NULL, NULL, '2021-11-30 17:26:15', '2021-11-30 17:26:15'),
(53565, 1019, 45713, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 13:36:02', '2021-11-12 13:36:02'),
(53566, 19067, 45713, NULL, '2021-12-21 00:00:00.000', 'Initiated', 'Your application has been submitted and is currently waiting to be reviewed by our Network Management Team.', NULL, NULL, '2021-12-14 09:20:39', '2021-12-14 09:20:39'),
(53567, 19067, 45713, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com, kim.wise@optum.com  Subject: Enrollment Status || SNBCARE || Providers || UBH ||   Hello,  Hope you\'re having a productive day.  I would like to know the credentialing status of the following Providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Oliva Erin	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896 Lauren Powell	1285304980	100 New State HWY, Raynham, MA 02767 Lauren Powell	1285304980	61 Lincoln St. Suite 203, Framingham, MA 01702   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 12:37:32', '2021-12-29 12:37:32'),
(53568, 19067, 45713, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: Optum  Subject: Fwd: Optum Credentialing Application Cancelled for Lauren Powell    12/30/2021   Attn:  Alex Garrett, Credentialing Contact  snbc@claimsmedinc.com  snbc@claimsmedinc.com    RE:  Network Participation - Lauren Powell    Dear Clinician,  Thank you for your interest in becoming a participating clinician with Optum.  We have reviewed your application and determined that your license level does not meet the Optum credentialing standards.       We encourage you to visit providerexpress.com to review credentialing criteria specific to your area.  If you have any questions, please call Behavioral Network Services at 1-877-614-0484 and select the following options for assistance: Credentialing > Network Services > Credentialing to reach Provider Relations.   Sincerely,    Optum Behavioral Health Credentialing Department      a0b2T000007qJXI|AMTLetter|Letters    United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum  U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California    © 2021 Optum, Inc. All Rights Reserved  BH3315b_04/2021   ', NULL, NULL, '2022-01-03 09:20:59', '2022-01-03 09:20:59'),
(53569, 19067, 45713, NULL, '2022-01-10 00:00:00.000', 'Not Eligible', 'Email received from: Optum  Subject: Fwd: Optum Credentialing Application Cancelled for Lauren Powell    12/30/2021   Attn:  Alex Garrett, Credentialing Contact  snbc@claimsmedinc.com  snbc@claimsmedinc.com    RE:  Network Participation - Lauren Powell    Dear Clinician,  Thank you for your interest in becoming a participating clinician with Optum.  We have reviewed your application and determined that your license level does not meet the Optum credentialing standards.       We encourage you to visit providerexpress.com to review credentialing criteria specific to your area.  If you have any questions, please call Behavioral Network Services at 1-877-614-0484 and select the following options for assistance: Credentialing > Network Services > Credentialing to reach Provider Relations.   Sincerely,    Optum Behavioral Health Credentialing Department      a0b2T000007qJXI|AMTLetter|Letters    United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum  U.S. Behavioral Health Plan, California doing business as OptumHealth Behavioral Solutions of California    © 2021 Optum, Inc. All Rights Reserved  BH3315b_04/2021   ', NULL, NULL, '2022-01-03 09:22:35', '2022-01-03 09:22:35'),
(53570, 10057, 45714, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-12 16:07:23', '2021-11-12 16:07:23'),
(53571, 10057, 45714, NULL, '2021-11-19 00:00:00.000', 'Approved', 'Email Received From : Bre_Waynes@corvel.com    November 12, 2021  Columbus Urgent Care, PA  RE: Jaya Jacob, NP  Dear Provider:  Welcome to the Texas CorCare Certified Network! Your credentials have been received and approved by our Credentialing Committee. Your effective date with our Network is 11/12/2021. Patients, Employers, Insurance Carriers, and other Providers will now be able to find your practice through our listings, and internet directories.  Please see attachments:', NULL, NULL, '2021-11-12 16:12:05', '2021-11-12 16:12:05'),
(53572, 10057, 45715, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-16 11:52:27', '2021-11-16 11:52:27'),
(53573, 10057, 45715, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Request Initiated through website.  Please see attachment: ', NULL, NULL, '2021-11-16 12:13:26', '2021-11-16 12:13:26'),
(53574, 10057, 45715, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Dear Provider:  Thank you for your interest in joining the Wellcare network.  Please allow us 30 calendar days to review your request.  A Centene contracting representative will reach out to you within 30 calendar days.  Please note:  In response to your request to join the Wellcare network, you may receive correspondence from a Superior Health Plan email address.   Thank you once again for your interest.  Sincerely, Network Management', NULL, NULL, '2021-11-17 10:02:40', '2021-11-17 10:02:40'),
(53575, 10057, 45715, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  I have submitted the remaining below mentioned provider forms via your website, let me know the update.  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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Garcia, Homero	1730564857 Juan Hernandez	1225617558 Lopez, Mayra	1265945125  Please find the attached forms for your reference as well.  Thanks & Regards,', NULL, NULL, '2021-11-30 16:10:06', '2021-11-30 16:10:06');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(53576, 10057, 45715, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned providers request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 15:37:05', '2021-12-07 15:37:05'),
(53577, 10057, 45715, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:29:43', '2021-12-17 15:29:43'),
(53578, 10057, 45715, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Thank you for reaching out. Can I get the welcome packets of mentioned providers?  Looking forward to hearing from you soon.  Regards,', NULL, NULL, '2021-12-27 12:56:52', '2021-12-27 12:56:52'),
(53579, 10057, 45715, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,  Here is a list of par providers for your contract, and the welcome letter.  Please see attachment.  Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-30 14:25:52', '2021-12-30 14:25:52'),
(53580, 20067, 45715, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || WellCare ||   Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Juan Hernandez	1225617558 Homero garcia	1730564857 Mayra Lopez	1265945125  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:52:27', '2022-01-05 17:52:27'),
(53581, 20067, 45715, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon!  Hope you had a great weekend. Any updates on the below-mentioned request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 14:22:37', '2022-01-18 14:22:37'),
(53582, 20067, 45715, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Received the effective date but not confirm for which location, Will approve the task next week after the confirmation.', NULL, NULL, '2022-01-31 09:49:16', '2022-01-31 09:49:16'),
(53583, 20067, 45715, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||   Good Morning,   Welcome letters will only have one address on them. The provider was requested to be loaded to 3 addresses and they are par for them all:', NULL, NULL, '2022-02-08 12:47:13', '2022-02-08 12:47:13'),
(53584, 10057, 45716, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-16 11:52:39', '2021-11-16 11:52:39'),
(53585, 10057, 45716, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Request Initiated through website.  Please see attachment: ', NULL, NULL, '2021-11-16 12:13:11', '2021-11-16 12:13:11'),
(53586, 10057, 45716, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Dear Provider:  Thank you for your interest in joining the Wellcare network.  Please allow us 30 calendar days to review your request.  A Centene contracting representative will reach out to you within 30 calendar days.  Please note:  In response to your request to join the Wellcare network, you may receive correspondence from a Superior Health Plan email address.   Thank you once again for your interest.  Sincerely, Network Management', NULL, NULL, '2021-11-17 10:02:34', '2021-11-17 10:02:34'),
(53587, 10057, 45716, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  I have submitted the remaining below mentioned provider forms via your website, let me know the update.  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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Garcia, Homero	1730564857 Juan Hernandez	1225617558 Lopez, Mayra	1265945125  Please find the attached forms for your reference as well.  Thanks & Regards,', NULL, NULL, '2021-11-30 16:10:00', '2021-11-30 16:10:00'),
(53588, 10057, 45716, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned providers request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 15:36:52', '2021-12-07 15:36:52'),
(53589, 10057, 45716, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:29:27', '2021-12-17 15:29:27'),
(53590, 10057, 45716, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Thank you for reaching out. Can I get the welcome packets of mentioned providers?  Looking forward to hearing from you soon.  Regards,', NULL, NULL, '2021-12-27 12:56:47', '2021-12-27 12:56:47'),
(53591, 10057, 45716, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,  Here is a list of par providers for your contract, and the welcome letter.  Please see attachment.  Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-30 14:23:17', '2021-12-30 14:23:17'),
(53592, 20067, 45716, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || WellCare ||   Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Juan Hernandez	1225617558 Homero garcia	1730564857 Mayra Lopez	1265945125  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:51:30', '2022-01-05 17:51:30'),
(53593, 20067, 45716, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon!  Hope you had a great weekend. Any updates on the below-mentioned request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 14:22:31', '2022-01-18 14:22:31'),
(53594, 20067, 45716, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Received the effective date but not confirm for which location, Will approve the task next week after the confirmation.', NULL, NULL, '2022-01-31 09:49:09', '2022-01-31 09:49:09'),
(53595, 20067, 45716, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||   Good Morning,   Welcome letters will only have one address on them. The provider was requested to be loaded to 3 addresses and they are par for them all:', NULL, NULL, '2022-02-08 12:47:46', '2022-02-08 12:47:46'),
(53596, 10057, 45717, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-16 11:52:51', '2021-11-16 11:52:51'),
(53597, 10057, 45717, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Request Initiated through website.  Please see attachment: ', NULL, NULL, '2021-11-16 12:13:00', '2021-11-16 12:13:00'),
(53598, 10057, 45717, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Dear Provider:  Thank you for your interest in joining the Wellcare network.  Please allow us 30 calendar days to review your request.  A Centene contracting representative will reach out to you within 30 calendar days.  Please note:  In response to your request to join the Wellcare network, you may receive correspondence from a Superior Health Plan email address.   Thank you once again for your interest.  Sincerely, Network Management', NULL, NULL, '2021-11-17 10:02:25', '2021-11-17 10:02:25'),
(53599, 10057, 45717, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  I have submitted the remaining below mentioned provider forms via your website, let me know the update.  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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Garcia, Homero	1730564857 Juan Hernandez	1225617558 Lopez, Mayra	1265945125  Please find the attached forms for your reference as well.  Thanks & Regards,', NULL, NULL, '2021-11-30 16:09:54', '2021-11-30 16:09:54'),
(53600, 10057, 45717, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned providers request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 15:36:44', '2021-12-07 15:36:44'),
(53601, 10057, 45717, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:29:14', '2021-12-17 15:29:14'),
(53602, 10057, 45717, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Thank you for reaching out. Can I get the welcome packets of mentioned providers?  Looking forward to hearing from you soon.  Regards,', NULL, NULL, '2021-12-27 12:56:42', '2021-12-27 12:56:42'),
(53603, 10057, 45717, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,  Here is a list of par providers for your contract, and the welcome letter.  Please see attachment.  Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-30 14:22:58', '2021-12-30 14:22:58'),
(53604, 20067, 45717, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || WellCare ||   Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Juan Hernandez	1225617558 Homero garcia	1730564857 Mayra Lopez	1265945125  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:50:42', '2022-01-05 17:50:42'),
(53605, 20067, 45717, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon!  Hope you had a great weekend. Any updates on the below-mentioned request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 14:22:26', '2022-01-18 14:22:26'),
(53606, 20067, 45717, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Received the effective date but not confirm for which location, Will approve the task next week after the confirmation.', NULL, NULL, '2022-01-31 09:49:00', '2022-01-31 09:49:00'),
(53607, 20067, 45717, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||   Good Morning,   Welcome letters will only have one address on them. The provider was requested to be loaded to 3 addresses and they are par for them all:', NULL, NULL, '2022-02-08 12:48:14', '2022-02-08 12:48:14'),
(53608, 10057, 45718, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-16 11:53:02', '2021-11-16 11:53:02'),
(53609, 10057, 45718, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Request Initiated through website.  Please see attachment: ', NULL, NULL, '2021-11-16 12:06:10', '2021-11-16 12:06:10'),
(53610, 10057, 45718, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Dear Provider:  Thank you for your interest in joining the Wellcare network.  Please allow us 30 calendar days to review your request.  A Centene contracting representative will reach out to you within 30 calendar days.  Please note:  In response to your request to join the Wellcare network, you may receive correspondence from a Superior Health Plan email address.   Thank you once again for your interest.  Sincerely, Network Management', NULL, NULL, '2021-11-17 10:04:32', '2021-11-17 10:04:32'),
(53611, 10057, 45718, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  I have submitted the remaining below mentioned provider forms via your website, let me know the update.  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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Garcia, Homero	1730564857 Juan Hernandez	1225617558 Lopez, Mayra	1265945125  Please find the attached forms for your reference as well.  Thanks & Regards,', NULL, NULL, '2021-11-30 16:09:48', '2021-11-30 16:09:48'),
(53612, 10057, 45718, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned providers request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 15:36:35', '2021-12-07 15:36:35'),
(53613, 10057, 45718, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:29:01', '2021-12-17 15:29:01'),
(53614, 10057, 45718, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Thank you for reaching out. Can I get the welcome packets of mentioned providers?  Looking forward to hearing from you soon.  Regards,', NULL, NULL, '2021-12-27 12:56:37', '2021-12-27 12:56:37'),
(53615, 10057, 45718, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,  Here is a list of par providers for your contract, and the welcome letter.  Please see attachment.  Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-30 14:22:08', '2021-12-30 14:22:08'),
(53616, 20067, 45718, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || WellCare ||   Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Juan Hernandez	1225617558 Homero garcia	1730564857 Mayra Lopez	1265945125  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:52:55', '2022-01-05 17:52:55'),
(53617, 20067, 45718, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon!  Hope you had a great weekend. Any updates on the below-mentioned request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 14:22:20', '2022-01-18 14:22:20'),
(53618, 20067, 45718, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Received the effective date but not confirm for which location, Will approve the task next week after the confirmation.', NULL, NULL, '2022-01-31 09:48:54', '2022-01-31 09:48:54'),
(53619, 20067, 45718, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||   Good Morning,   Welcome letters will only have one address on them. The provider was requested to be loaded to 3 addresses and they are par for them all: WELCOME LETTER (1).docx	Abidi,Syed Ahad Hassan ', NULL, NULL, '2022-02-08 12:51:24', '2022-02-08 12:51:24'),
(53620, 10057, 45719, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-16 11:53:11', '2021-11-16 11:53:11'),
(53621, 10057, 45719, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Request Initiated through website.  Please see attachment: ', NULL, NULL, '2021-11-16 12:05:57', '2021-11-16 12:05:57'),
(53622, 10057, 45719, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Dear Provider:  Thank you for your interest in joining the Wellcare network.  Please allow us 30 calendar days to review your request.  A Centene contracting representative will reach out to you within 30 calendar days.  Please note:  In response to your request to join the Wellcare network, you may receive correspondence from a Superior Health Plan email address.   Thank you once again for your interest.  Sincerely, Network Management', NULL, NULL, '2021-11-17 10:04:26', '2021-11-17 10:04:26'),
(53623, 10057, 45719, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  I have submitted the remaining below mentioned provider forms via your website, let me know the update.  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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Garcia, Homero	1730564857 Juan Hernandez	1225617558 Lopez, Mayra	1265945125  Please find the attached forms for your reference as well.  Thanks & Regards,', NULL, NULL, '2021-11-30 16:09:41', '2021-11-30 16:09:41'),
(53624, 10057, 45719, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned providers request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 15:36:27', '2021-12-07 15:36:27'),
(53625, 10057, 45719, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:28:47', '2021-12-17 15:28:47'),
(53626, 10057, 45719, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Thank you for reaching out. Can I get the welcome packets of mentioned providers?  Looking forward to hearing from you soon.  Regards,', NULL, NULL, '2021-12-27 12:56:31', '2021-12-27 12:56:31'),
(53627, 10057, 45719, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,  Here is a list of par providers for your contract, and the welcome letter.  Please see attachment.  Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-30 14:21:58', '2021-12-30 14:21:58'),
(53628, 20067, 45719, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || WellCare ||   Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Juan Hernandez	1225617558 Homero garcia	1730564857 Mayra Lopez	1265945125  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:52:44', '2022-01-05 17:52:44'),
(53629, 20067, 45719, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon!  Hope you had a great weekend. Any updates on the below-mentioned request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 14:21:59', '2022-01-18 14:21:59'),
(53630, 20067, 45719, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Received the effective date but not confirm for which location, Will approve the task next week after the confirmation.', NULL, NULL, '2022-01-31 09:48:47', '2022-01-31 09:48:47'),
(53631, 20067, 45719, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||   Good Morning,   Welcome letters will only have one address on them. The provider was requested to be loaded to 3 addresses and they are par for them all: WELCOME LETTER (1).docx	Abidi,Syed Ahad Hassan ', NULL, NULL, '2022-02-08 12:50:56', '2022-02-08 12:50:56'),
(53632, 10057, 45720, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-16 11:53:21', '2021-11-16 11:53:21'),
(53633, 10057, 45720, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Request Initiated through website.  Please see attachment: ', NULL, NULL, '2021-11-16 12:06:28', '2021-11-16 12:06:28'),
(53634, 10057, 45720, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Dear Provider:  Thank you for your interest in joining the Wellcare network.  Please allow us 30 calendar days to review your request.  A Centene contracting representative will reach out to you within 30 calendar days.  Please note:  In response to your request to join the Wellcare network, you may receive correspondence from a Superior Health Plan email address.   Thank you once again for your interest.  Sincerely, Network Management', NULL, NULL, '2021-11-17 10:04:21', '2021-11-17 10:04:21'),
(53635, 10057, 45720, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  I have submitted the remaining below mentioned provider forms via your website, let me know the update.  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	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Edna Michi	1992293906 Nubia Benavides	1801371935 Garcia, Homero	1730564857 Juan Hernandez	1225617558 Lopez, Mayra	1265945125  Please find the attached forms for your reference as well.  Thanks & Regards,', NULL, NULL, '2021-11-30 16:09:35', '2021-11-30 16:09:35'),
(53636, 10057, 45720, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned providers request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 15:36:17', '2021-12-07 15:36:17'),
(53637, 10057, 45720, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:28:32', '2021-12-17 15:28:32'),
(53638, 10057, 45720, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Thank you for reaching out. Can I get the welcome packets of mentioned providers?  Looking forward to hearing from you soon.  Regards,', NULL, NULL, '2021-12-27 12:56:24', '2021-12-27 12:56:24'),
(53639, 10057, 45720, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,  Here is a list of par providers for your contract, and the welcome letter.  Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-30 14:20:16', '2021-12-30 14:20:16'),
(53640, 20067, 45720, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || WellCare ||   Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Juan Hernandez	1225617558 Homero garcia	1730564857 Mayra Lopez	1265945125  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:52:36', '2022-01-05 17:52:36'),
(53641, 20067, 45720, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon!  Hope you had a great weekend. Any updates on the below-mentioned request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 14:21:49', '2022-01-18 14:21:49'),
(53642, 20067, 45720, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Received the effective date but not confirm for which location, Will approve the task next week after the confirmation.', NULL, NULL, '2022-01-31 09:48:41', '2022-01-31 09:48:41'),
(53643, 20067, 45720, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||   Good Morning,   Welcome letters will only have one address on them. The provider was requested to be loaded to 3 addresses and they are par for them all: WELCOME LETTER (1).docx	Abidi,Syed Ahad Hassan ', NULL, NULL, '2022-02-08 12:50:25', '2022-02-08 12:50:25'),
(53644, 11056, 45721, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-16 14:37:19', '2021-11-16 14:37:19'),
(53645, 11056, 45721, NULL, '2021-11-23 00:00:00.000', 'Initiated', 'Email sent to: hpdemo@uhc.com,  networkhelp@uhc.com  Sub : Status Update of recredentialing - Traci Mason - UHC - Statcare Minor Emergency Clinic   Good afternoon!  Hope you are having a great day. Has the re-credentialing been completed of the provider, Traci Mason? Have all the below mention locations been listed under the provider?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Traci Mason	1497127831  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-16 14:37:44', '2021-11-16 14:37:44'),
(53646, 11056, 45721, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Email received from: networkhelp@uhc.com  Sub : Secure Message from cameron_l_pickett@uhc.com  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry. I have included the product roster showing the demographic information, lines of business, and effective dates for the providers requested.      Additionally, if you are wanting the specific lines of business that the providers are linked to this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). Please see the attached handout for more information.    If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).    Please let us know if we can assist further.       Sincerely,       *--SecureDelivery--*    All locations are added. Please see the roster.', NULL, NULL, '2021-11-16 14:39:11', '2021-11-16 14:39:11'),
(53647, 1019, 45722, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-16 15:31:47', '2021-11-16 15:31:47'),
(53648, 1019, 45722, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'MassHealth cover state Medicaid for MA.', NULL, NULL, '2021-11-30 14:25:00', '2021-11-30 14:25:00'),
(53649, 1019, 45723, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-16 15:32:30', '2021-11-16 15:32:30'),
(53650, 1019, 45723, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'MassHealth cover state Medicaid for MA.', NULL, NULL, '2021-11-30 14:24:51', '2021-11-30 14:24:51'),
(53651, 1019, 45724, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-16 15:34:11', '2021-11-16 15:34:11'),
(53652, 1019, 45724, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'MassHealth cover state Medicaid for MA.', NULL, NULL, '2021-11-30 14:24:41', '2021-11-30 14:24:41'),
(53653, 1019, 45725, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-16 15:34:30', '2021-11-16 15:34:30'),
(53654, 1019, 45725, NULL, '2021-12-07 00:00:00.000', 'Not Eligible', 'MassHealth cover state Medicaid for MA.', NULL, NULL, '2021-11-30 14:24:31', '2021-11-30 14:24:31'),
(53655, 11056, 45726, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-17 17:53:25', '2021-11-17 17:53:25'),
(53656, 11056, 45726, NULL, '2021-11-24 00:00:00.000', 'Initiated', 'Email sent to : Angela Norman Angela_Norman@bcbstx.com, Geraldi Salazar  geraldi_salazar@bcbstx.com, provider_relations_houston@bcbstx.com, provider_relations_@bcbstx.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic -   Good afternoon!  Hope this email finds you well. Kindly provide me the latest updates on demographic updates under the facility TIN regarding updating and linking the highlighted location with the facility Tax ID.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & billing Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382 Contact no. 	361-556-5770 Fax no. 	361-556-5771  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-17 17:55:54', '2021-11-17 17:55:54'),
(53657, 11056, 45726, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from: provider_relations_houston@bcbstx.com geraldi_salazar@bcbstx.com angela_norman@bcbstx.com  Sub : RE: PHI RE: Enrollment Query - Statcare Minor Emergency Clinic - : Case Number - 03154940: Case Number - 03157644   Good Morning,  The effective date for the Rockport satellite location is 11/3/2021.   Yes,  2102 FM 2165 Rockport, TX address has been added to the providers per your request.   Please see attached provider roster report for your group. If you have any questions or need to make any changes feel free to send an email to your provider rep. Connie Traylor (Connie_Traylor@bcbstx.com).  Have a great day!  Best Regards,   Provider Relations-Houston BlueCross BlueShield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600, Houston, TX. 77027 Office: 713.663.1149 | Fax: 713.663.1227 | Email: Provider_Relations_Houston@bcbstx.com Visit our website:  www.bcbstx.com Experience.  Wellness.  Everywhere.  Thank you, Connie Traylor Network Management Consultant Blue Cross and Blue Shield of Texas Lubbock, Texas 79424 Ph: 806-798-6317', NULL, NULL, '2021-11-17 18:01:48', '2021-11-17 18:01:48'),
(53658, 11056, 45727, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-17 17:53:45', '2021-11-17 17:53:45'),
(53659, 11056, 45727, NULL, '2021-11-24 00:00:00.000', 'Initiated', 'Email sent to : Angela Norman Angela_Norman@bcbstx.com, Geraldi Salazar  geraldi_salazar@bcbstx.com, provider_relations_houston@bcbstx.com, provider_relations_@bcbstx.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic -   Good afternoon!  Hope this email finds you well. Kindly provide me the latest updates on demographic updates under the facility TIN regarding updating and linking the highlighted location with the facility Tax ID.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & billing Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382 Contact no. 	361-556-5770 Fax no. 	361-556-5771  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-17 17:55:43', '2021-11-17 17:55:43'),
(53660, 11056, 45727, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from: provider_relations_houston@bcbstx.com geraldi_salazar@bcbstx.com angela_norman@bcbstx.com  Sub : RE: PHI RE: Enrollment Query - Statcare Minor Emergency Clinic - : Case Number - 03154940: Case Number - 03157644   Good Morning,  The effective date for the Rockport satellite location is 11/3/2021.   Yes,  2102 FM 2165 Rockport, TX address has been added to the providers per your request.   Please see attached provider roster report for your group. If you have any questions or need to make any changes feel free to send an email to your provider rep. Connie Traylor (Connie_Traylor@bcbstx.com).  Have a great day!  Best Regards,   Provider Relations-Houston BlueCross BlueShield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600, Houston, TX. 77027 Office: 713.663.1149 | Fax: 713.663.1227 | Email: Provider_Relations_Houston@bcbstx.com Visit our website:  www.bcbstx.com Experience.  Wellness.  Everywhere.  Thank you, Connie Traylor Network Management Consultant Blue Cross and Blue Shield of Texas Lubbock, Texas 79424 Ph: 806-798-6317', NULL, NULL, '2021-11-17 18:02:08', '2021-11-17 18:02:08'),
(53661, 11056, 45728, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-17 17:53:45', '2021-11-17 17:53:45'),
(53662, 11056, 45728, NULL, '2021-11-24 00:00:00.000', 'Initiated', 'Email sent to : Angela Norman Angela_Norman@bcbstx.com, Geraldi Salazar  geraldi_salazar@bcbstx.com, provider_relations_houston@bcbstx.com, provider_relations_@bcbstx.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic -   Good afternoon!  Hope this email finds you well. Kindly provide me the latest updates on demographic updates under the facility TIN regarding updating and linking the highlighted location with the facility Tax ID.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & billing Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382 Contact no. 	361-556-5770 Fax no. 	361-556-5771  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-17 17:55:37', '2021-11-17 17:55:37'),
(53663, 11056, 45728, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from: provider_relations_houston@bcbstx.com geraldi_salazar@bcbstx.com angela_norman@bcbstx.com  Sub : RE: PHI RE: Enrollment Query - Statcare Minor Emergency Clinic - : Case Number - 03154940: Case Number - 03157644   Good Morning,  The effective date for the Rockport satellite location is 11/3/2021.   Yes,  2102 FM 2165 Rockport, TX address has been added to the providers per your request.   Please see attached provider roster report for your group. If you have any questions or need to make any changes feel free to send an email to your provider rep. Connie Traylor (Connie_Traylor@bcbstx.com).  Have a great day!  Best Regards,   Provider Relations-Houston BlueCross BlueShield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600, Houston, TX. 77027 Office: 713.663.1149 | Fax: 713.663.1227 | Email: Provider_Relations_Houston@bcbstx.com Visit our website:  www.bcbstx.com Experience.  Wellness.  Everywhere.  Thank you, Connie Traylor Network Management Consultant Blue Cross and Blue Shield of Texas Lubbock, Texas 79424 Ph: 806-798-6317', NULL, NULL, '2021-11-17 18:02:19', '2021-11-17 18:02:19'),
(53664, 11056, 45729, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-17 17:53:45', '2021-11-17 17:53:45'),
(53665, 11056, 45729, NULL, '2021-11-24 00:00:00.000', 'Initiated', 'Email sent to : Angela Norman Angela_Norman@bcbstx.com, Geraldi Salazar  geraldi_salazar@bcbstx.com, provider_relations_houston@bcbstx.com, provider_relations_@bcbstx.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic -   Good afternoon!  Hope this email finds you well. Kindly provide me the latest updates on demographic updates under the facility TIN regarding updating and linking the highlighted location with the facility Tax ID.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & billing Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382 Contact no. 	361-556-5770 Fax no. 	361-556-5771  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-17 17:55:31', '2021-11-17 17:55:31'),
(53666, 11056, 45729, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from: provider_relations_houston@bcbstx.com geraldi_salazar@bcbstx.com angela_norman@bcbstx.com  Sub : RE: PHI RE: Enrollment Query - Statcare Minor Emergency Clinic - : Case Number - 03154940: Case Number - 03157644   Good Morning,  The effective date for the Rockport satellite location is 11/3/2021.   Yes,  2102 FM 2165 Rockport, TX address has been added to the providers per your request.   Please see attached provider roster report for your group. If you have any questions or need to make any changes feel free to send an email to your provider rep. Connie Traylor (Connie_Traylor@bcbstx.com).  Have a great day!  Best Regards,   Provider Relations-Houston BlueCross BlueShield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600, Houston, TX. 77027 Office: 713.663.1149 | Fax: 713.663.1227 | Email: Provider_Relations_Houston@bcbstx.com Visit our website:  www.bcbstx.com Experience.  Wellness.  Everywhere.  Thank you, Connie Traylor Network Management Consultant Blue Cross and Blue Shield of Texas Lubbock, Texas 79424 Ph: 806-798-6317', NULL, NULL, '2021-11-17 18:02:29', '2021-11-17 18:02:29'),
(53667, 11056, 45730, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-17 17:53:45', '2021-11-17 17:53:45'),
(53668, 11056, 45730, NULL, '2021-11-24 00:00:00.000', 'Initiated', 'Email sent to : Angela Norman Angela_Norman@bcbstx.com, Geraldi Salazar  geraldi_salazar@bcbstx.com, provider_relations_houston@bcbstx.com, provider_relations_@bcbstx.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic -   Good afternoon!  Hope this email finds you well. Kindly provide me the latest updates on demographic updates under the facility TIN regarding updating and linking the highlighted location with the facility Tax ID.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & billing Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382 Contact no. 	361-556-5770 Fax no. 	361-556-5771  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-17 17:55:25', '2021-11-17 17:55:25'),
(53669, 11056, 45730, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from: provider_relations_houston@bcbstx.com geraldi_salazar@bcbstx.com angela_norman@bcbstx.com  Sub : RE: PHI RE: Enrollment Query - Statcare Minor Emergency Clinic - : Case Number - 03154940: Case Number - 03157644   Good Morning,  The effective date for the Rockport satellite location is 11/3/2021.   Yes,  2102 FM 2165 Rockport, TX address has been added to the providers per your request.   Please see attached provider roster report for your group. If you have any questions or need to make any changes feel free to send an email to your provider rep. Connie Traylor (Connie_Traylor@bcbstx.com).  Have a great day!  Best Regards,   Provider Relations-Houston BlueCross BlueShield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600, Houston, TX. 77027 Office: 713.663.1149 | Fax: 713.663.1227 | Email: Provider_Relations_Houston@bcbstx.com Visit our website:  www.bcbstx.com Experience.  Wellness.  Everywhere.  Thank you, Connie Traylor Network Management Consultant Blue Cross and Blue Shield of Texas Lubbock, Texas 79424 Ph: 806-798-6317', NULL, NULL, '2021-11-17 18:02:42', '2021-11-17 18:02:42'),
(53670, 11056, 45731, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-17 17:53:45', '2021-11-17 17:53:45'),
(53671, 11056, 45731, NULL, '2021-11-24 00:00:00.000', 'Initiated', 'Email sent to : Angela Norman Angela_Norman@bcbstx.com, Geraldi Salazar  geraldi_salazar@bcbstx.com, provider_relations_houston@bcbstx.com, provider_relations_@bcbstx.com  Sub: Enrollment Query - Statcare Minor Emergency Clinic -   Good afternoon!  Hope this email finds you well. Kindly provide me the latest updates on demographic updates under the facility TIN regarding updating and linking the highlighted location with the facility Tax ID.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & billing Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382 Contact no. 	361-556-5770 Fax no. 	361-556-5771  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-17 17:55:05', '2021-11-17 17:55:05'),
(53672, 11056, 45731, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from: provider_relations_houston@bcbstx.com geraldi_salazar@bcbstx.com angela_norman@bcbstx.com  Sub : RE: PHI RE: Enrollment Query - Statcare Minor Emergency Clinic - : Case Number - 03154940: Case Number - 03157644   Good Morning,  The effective date for the Rockport satellite location is 11/3/2021.   Yes,  2102 FM 2165 Rockport, TX address has been added to the providers per your request.   Please see attached provider roster report for your group. If you have any questions or need to make any changes feel free to send an email to your provider rep. Connie Traylor (Connie_Traylor@bcbstx.com).  Have a great day!  Best Regards,   Provider Relations-Houston BlueCross BlueShield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600, Houston, TX. 77027 Office: 713.663.1149 | Fax: 713.663.1227 | Email: Provider_Relations_Houston@bcbstx.com Visit our website:  www.bcbstx.com Experience.  Wellness.  Everywhere.  Thank you, Connie Traylor Network Management Consultant Blue Cross and Blue Shield of Texas Lubbock, Texas 79424 Ph: 806-798-6317', NULL, NULL, '2021-11-17 18:02:50', '2021-11-17 18:02:50'),
(53673, 11056, 45732, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-11-17 17:53:45', '2021-11-17 17:53:45');
