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
(9135, 3040, 12540, NULL, '2021-01-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment || Lira, Arturo Alejandro, Campos, Moses, Wright, Larry Donald, Potter, Deborah || Valley Med Urgent Care PLLC || UHC  Greetings,  Hope you are doing well. Please find below the information for practices and providers for enrollment in United Health care for our group Valley Med Urgent Care PLLC.  Provider 1: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502  Provider 2: Provider Name:  Moses Campos Provider NPI# 1558680009  Provider 3: Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Provider 4: Provider Name:  Deborah Potter Provider NPI# 1861914053   Practice 1: Practice Name: Valley Med Urgent Care PLLC   Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248    Thanks', NULL, NULL, '2021-01-08 18:04:56', '2021-01-08 18:04:56'),
(9136, 3040, 12540, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Request For Participation Form submitted online.  Waiting for the PR no.', NULL, NULL, '2021-01-11 17:11:10', '2021-01-11 17:11:10'),
(9137, 3040, 12540, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from: national_credentialing@uhc.com  Subject: Request for Credentialing  Re: Your Credentialing Application Has Been Received  Dear Larry D Wright:  Thank you for your interest in joining the UnitedHealthcare network. We’ve received your credentialing application and are reviewing it now to ensure we have everything needed to begin verifying your credentials. ', NULL, NULL, '2021-01-14 09:09:43', '2021-01-14 09:09:43'),
(9138, 3040, 12540, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Email rcvd from: national_credentialing@uhc.com  Subject: Credentialing Application  Re: We’re Ready to Review Your Credentialing Application  Dear LARRY WRIGHT:  Thank you for your interest in joining the UnitedHealthcare network. We’ve received your completed application and will now begin verifying your credentials. ', NULL, NULL, '2021-01-15 13:45:53', '2021-01-15 13:45:53'),
(9139, 3040, 12540, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Follow up email sent to: networkhelp@uhc.com,  hpdemo@uhc.com  Subject: Enrollment Status Update || Wright, Larry Donald || Valley Med Urgent Care PLLC || UHC ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Larry Donald Wright Provider NPI# 1033769765 MPIN# 7333147  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-22 13:29:14', '2021-01-22 13:29:14'),
(9140, 3040, 12540, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from cameron_l_pickett@uhc.com  Hello Asil,  Thank you for contacting Network Management Resource Team.  The request is still processing under the reference PR-5699436.  This type of request can take up 30 to 60 days for processing.  We apricate your patience as we are working diligently working to get it completed.  Cammie Pickett  Associate Network Contractor  Untied Healthcare  Network Management Resource Team (NMRT)  If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance; thank you.', NULL, NULL, '2021-01-25 15:13:49', '2021-01-25 15:13:49'),
(9141, 3040, 12540, NULL, '2021-02-08 00:00:00.000', 'In Process', 'This type of request can take up 30 to 60 days for processing.   ', NULL, NULL, '2021-02-01 16:51:28', '2021-02-01 16:51:28'),
(9142, 3040, 12540, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from cameron_l_pickett@uhc.com (01/25/2021 05:52:52 PM GMT)  Hello Asil,  Thank you for contacting Network Management Resource Team.  The request is still processing under the reference PR-5699436.  This type of request can take up 30 to 60 days for processing.  We apricate your patience as we are working diligently working to get it completed.  Cammie Pickett  Associate Network Contractor  Untied Healthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-02-08 14:10:01', '2021-02-08 14:10:01'),
(9143, 3040, 12540, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Follow up email sent to: networkhelp@uhc.com, hpdemo@uhc.com  Subject: Enrollment Status Update || Wright, Larry Donald || Valley Med Urgent Care PLLC || UHC ||  Hello,  This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Larry Donald Wright Provider NPI# 1033769765 MPIN# 7333147  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-15 13:01:22', '2021-02-15 13:01:22'),
(9144, 3040, 12540, NULL, '2021-02-23 00:00:00.000', 'Approved', 'We have confirmed, Larry Donald Wright, NP is contractually linked to TIN (81-5123542), Commercial products.  However, he will not be consider an in-network provider, until (03/23/2021).  We have enclosed product report it will provide his demographic and contracting information listed under TIN (81-5123542).', NULL, NULL, '2021-02-16 09:58:49', '2021-02-16 09:58:49'),
(9145, 3040, 12541, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-08 18:05:02', '2021-01-08 18:05:02'),
(9146, 3040, 12541, NULL, '2021-01-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment || Lira, Arturo Alejandro, Campos, Moses, Wright, Larry Donald, Potter, Deborah || Valley Med Urgent Care PLLC || UHC  Greetings,  Hope you are doing well. Please find below the information for practices and providers for enrollment in United Health care for our group Valley Med Urgent Care PLLC.  Provider 1: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502  Provider 2: Provider Name:  Moses Campos Provider NPI# 1558680009  Provider 3: Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Provider 4: Provider Name:  Deborah Potter Provider NPI# 1861914053   Practice 1: Practice Name: Valley Med Urgent Care PLLC   Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248    Thanks', NULL, NULL, '2021-01-08 18:05:13', '2021-01-08 18:05:13'),
(9147, 3040, 12541, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Request For Participation Form submitted online.  Waiting for the PR no.', NULL, NULL, '2021-01-11 17:11:16', '2021-01-11 17:11:16'),
(9148, 3040, 12541, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from: national_credentialing@uhc.com  Subject: Request for Credentialing  Re: Your Credentialing Application Has Been Received  Dear Larry D Wright:  Thank you for your interest in joining the UnitedHealthcare network. We’ve received your credentialing application and are reviewing it now to ensure we have everything needed to begin verifying your credentials. ', NULL, NULL, '2021-01-14 09:09:50', '2021-01-14 09:09:50'),
(9149, 3040, 12541, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Email rcvd from: national_credentialing@uhc.com  Subject: Credentialing Application  Re: We’re Ready to Review Your Credentialing Application  Dear LARRY WRIGHT:  Thank you for your interest in joining the UnitedHealthcare network. We’ve received your completed application and will now begin verifying your credentials. ', NULL, NULL, '2021-01-15 13:45:50', '2021-01-15 13:45:50'),
(9150, 3040, 12541, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Follow up email sent to: networkhelp@uhc.com,  hpdemo@uhc.com  Subject: Enrollment Status Update || Wright, Larry Donald || Valley Med Urgent Care PLLC || UHC ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Larry Donald Wright Provider NPI# 1033769765 MPIN# 7333147  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-22 13:29:06', '2021-01-22 13:29:06'),
(9151, 3040, 12541, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from cameron_l_pickett@uhc.com  Hello Asil,  Thank you for contacting Network Management Resource Team.  The request is still processing under the reference PR-5699436.  This type of request can take up 30 to 60 days for processing.  We apricate your patience as we are working diligently working to get it completed.  Cammie Pickett  Associate Network Contractor  Untied Healthcare  Network Management Resource Team (NMRT)  If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance; thank you.', NULL, NULL, '2021-01-25 15:13:37', '2021-01-25 15:13:37'),
(9152, 3040, 12541, NULL, '2021-02-08 00:00:00.000', 'In Process', 'This type of request can take up 30 to 60 days for processing.   ', NULL, NULL, '2021-02-01 16:51:42', '2021-02-01 16:51:42'),
(9153, 3040, 12541, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from cameron_l_pickett@uhc.com (01/25/2021 05:52:52 PM GMT)  Hello Asil,  Thank you for contacting Network Management Resource Team.  The request is still processing under the reference PR-5699436.  This type of request can take up 30 to 60 days for processing.  We apricate your patience as we are working diligently working to get it completed.  Cammie Pickett  Associate Network Contractor  Untied Healthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-02-08 14:09:44', '2021-02-08 14:09:44'),
(9154, 3040, 12541, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Follow up email sent to: networkhelp@uhc.com, hpdemo@uhc.com  Subject: Enrollment Status Update || Wright, Larry Donald || Valley Med Urgent Care PLLC || UHC ||  Hello,  This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Larry Donald Wright Provider NPI# 1033769765 MPIN# 7333147  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-15 13:01:36', '2021-02-15 13:01:36'),
(9155, 3040, 12541, NULL, '2021-02-23 00:00:00.000', 'Approved', 'We have confirmed, Larry Donald Wright, NP is contractually linked to TIN (81-5123542), Commercial products.  However, he will not be consider an in-network provider, until (03/23/2021).  We have enclosed product report it will provide his demographic and contracting information listed under TIN (81-5123542).', NULL, NULL, '2021-02-16 09:58:36', '2021-02-16 09:58:36'),
(9156, 3040, 12542, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-08 18:05:15', '2021-01-08 18:05:15'),
(9157, 3040, 12542, NULL, '2021-01-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment || Lira, Arturo Alejandro, Campos, Moses, Wright, Larry Donald, Potter, Deborah || Valley Med Urgent Care PLLC || UHC  Greetings,  Hope you are doing well. Please find below the information for practices and providers for enrollment in United Health care for our group Valley Med Urgent Care PLLC.  Provider 1: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502  Provider 2: Provider Name:  Moses Campos Provider NPI# 1558680009  Provider 3: Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Provider 4: Provider Name:  Deborah Potter Provider NPI# 1861914053   Practice 1: Practice Name: Valley Med Urgent Care PLLC   Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248    Thanks', NULL, NULL, '2021-01-08 18:05:26', '2021-01-08 18:05:26'),
(9158, 3040, 12542, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Request For Participation Form submitted online.  Waiting for the PR no.', NULL, NULL, '2021-01-11 17:11:22', '2021-01-11 17:11:22'),
(9159, 3040, 12542, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from: national_credentialing@uhc.com  Subject: Request for Credentialing  Re: Your Credentialing Application Has Been Received  Dear Larry D Wright:  Thank you for your interest in joining the UnitedHealthcare network. We’ve received your credentialing application and are reviewing it now to ensure we have everything needed to begin verifying your credentials. ', NULL, NULL, '2021-01-14 09:09:57', '2021-01-14 09:09:57'),
(9160, 3040, 12542, NULL, '2021-01-22 00:00:00.000', 'In Process', 'Email rcvd from: national_credentialing@uhc.com  Subject: Credentialing Application  Re: We’re Ready to Review Your Credentialing Application  Dear LARRY WRIGHT:  Thank you for your interest in joining the UnitedHealthcare network. We’ve received your completed application and will now begin verifying your credentials. ', NULL, NULL, '2021-01-15 13:45:48', '2021-01-15 13:45:48'),
(9161, 3040, 12542, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Follow up email sent to: networkhelp@uhc.com,  hpdemo@uhc.com  Subject: Enrollment Status Update || Wright, Larry Donald || Valley Med Urgent Care PLLC || UHC ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Larry Donald Wright Provider NPI# 1033769765 MPIN# 7333147  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-22 13:29:19', '2021-01-22 13:29:19'),
(9162, 3040, 12542, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from cameron_l_pickett@uhc.com  Hello Asil,  Thank you for contacting Network Management Resource Team.  The request is still processing under the reference PR-5699436.  This type of request can take up 30 to 60 days for processing.  We apricate your patience as we are working diligently working to get it completed.  Cammie Pickett  Associate Network Contractor  Untied Healthcare  Network Management Resource Team (NMRT)  If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance; thank you.', NULL, NULL, '2021-01-25 15:13:58', '2021-01-25 15:13:58'),
(9163, 3040, 12542, NULL, '2021-02-08 00:00:00.000', 'In Process', 'This type of request can take up 30 to 60 days for processing.   ', NULL, NULL, '2021-02-01 16:51:52', '2021-02-01 16:51:52'),
(9164, 3040, 12542, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from cameron_l_pickett@uhc.com (01/25/2021 05:52:52 PM GMT)  Hello Asil,  Thank you for contacting Network Management Resource Team.  The request is still processing under the reference PR-5699436.  This type of request can take up 30 to 60 days for processing.  We apricate your patience as we are working diligently working to get it completed.  Cammie Pickett  Associate Network Contractor  Untied Healthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-02-08 14:10:06', '2021-02-08 14:10:06'),
(9165, 3040, 12542, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Follow up email sent to: networkhelp@uhc.com, hpdemo@uhc.com  Subject: Enrollment Status Update || Wright, Larry Donald || Valley Med Urgent Care PLLC || UHC ||  Hello,  This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider: Provider Name: Larry Donald Wright Provider NPI# 1033769765 MPIN# 7333147  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-15 13:01:45', '2021-02-15 13:01:45'),
(9166, 3040, 12542, NULL, '2021-02-23 00:00:00.000', 'Approved', 'We have confirmed, Larry Donald Wright, NP is contractually linked to TIN (81-5123542), Commercial products.  However, he will not be consider an in-network provider, until (03/23/2021).  We have enclosed product report it will provide his demographic and contracting information listed under TIN (81-5123542).', NULL, NULL, '2021-02-16 09:58:41', '2021-02-16 09:58:41'),
(9167, 1006, 13522, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-11 11:50:58', '2021-01-11 11:50:58'),
(9168, 1006, 13522, NULL, '2021-01-18 00:00:00.000', 'Initiated', 'Contractor: NOVITAS SOLUTIONS, INC. State: TEXAS Type/Specialty: CLINIC/GROUP PRACTICE  Enrollment Type: 855B  Status: AWAITING PROCESSING   View Awaiting Processing Application for CLINIC/GROUP PRACTICE in TEXASOpens a window for viewing the current enrollment application Practice Location:  11925 SOUTHWEST FWY, STAFFORD, TX 77477-2300 Tracking ID: T010820210003199 Pending Reassignments Applications: 0 View/Manage Reassignments', NULL, NULL, '2021-01-11 11:51:19', '2021-01-11 11:51:19'),
(9169, 1006, 13522, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Resubmitted application with corrections:  \"      Application Tracking ID: T010820210003199        NPI: 1063008084        Medicare ID:        Name: Right Step Medical Center LLC        State: TX        Fee-for-Service Contractor: NOVITAS SOLUTIONS, INC.        MECHANICSBURG,PA,17055-1813 \"', NULL, NULL, '2021-01-20 14:12:30', '2021-01-20 14:12:30'),
(9170, 1006, 13522, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Received another deficiency, called to Kiffany @ 904-363-5406 for further clarification. ', NULL, NULL, '2021-01-28 17:36:04', '2021-01-28 17:36:04'),
(9171, 1006, 13522, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Received a call back from Kiffany, she informed that the deficiency is due to CMS-460. Filled out and sent correction via PECOS.', NULL, NULL, '2021-02-03 13:20:50', '2021-02-03 13:20:50'),
(9172, 1006, 13522, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent reconsideration request @ novitasJHPEappeals@novitas-solutions.com so request can be returned to processing, as making a new request was getting rejected.', NULL, NULL, '2021-02-12 13:27:30', '2021-02-12 13:27:30'),
(9173, 1006, 13522, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Sent f/u email @ NovitasJHPEAppeals@novitas-solutions.com', NULL, NULL, '2021-03-08 16:04:03', '2021-03-08 16:04:03'),
(9174, 1006, 13522, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Received the following reply from medenroll@novitas-solutions.com, need to allow more time as request might go on until May 2021: \"Good morning,  The reconsideration for Right Step Medical Center LLC is pending. As stated in the acknowledgement letter and email issued February 15, 2021, Novitas Solutions, Inc. has 90 days to review your Reconsideration request and render a decision. We are unable to discuss the progress on a case in the interim, and CMS does not allow escalation of appeals. They must be worked in first in, first out order. You may check the status of the Reconsideration on the Provider Enrollment Status Inquiry Tool on our website, using the Reference Number provided, 610439000.  A reconsideration request reviews whether or not an error was made at the time the initial determination was implemented. It does not reconsider the application for processing unless it is determined that an error was made by Novitas when the denial was processed. If you are seeking a faster solution than waiting for the appeal decision (due in May 2021), you have the option of withdrawing the appeal (in writing – an email from the owner is sufficient) and re-submitting the application once the 65 day appeal timeframe has lapsed from the February 3, 2021 denial letter (on or about April 9, 2021). The withdrawal is important because Provider Enrollment has instructions to return any application with a pending appeal. Please note that I am not instructing this action, just letting you know it is an option available to you that would likely result in a faster solution for Right Step Medical Center LLC since the reconsideration acknowledges the practice location was non-operational at the time of the site visit.  Thank you,  Natalie Son Provider Relations Hearing Specialist Novitas Solutions, Inc. Phone: (904) 363-5266 Fax: (904) 361-0614 Natalie.Son@novitas-solutions.com\"', NULL, NULL, '2021-03-15 12:03:27', '2021-03-15 12:03:27'),
(9175, 1006, 13522, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent following email @ medenroll@novitas-solutions.com:  \"Hello Natalie,   I appreciate the update, who would the owner need to email to rescind the appeal?   Thank you for the help.\"', NULL, NULL, '2021-03-23 10:42:59', '2021-03-23 10:42:59'),
(9176, 1006, 13522, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Sent another email @ medenroll@novitas-solutions.com:  Sub: Subject Replaced For Security Reasons (System Security)  \"Hello,   Please get back to me regarding my query as to whom the owner would need to email to rescind our appeal request?  Thank you.\"', NULL, NULL, '2021-04-05 17:08:43', '2021-04-05 17:08:43'),
(9177, 1005, 13522, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Called Natalie and left a VM.', NULL, NULL, '2021-04-16 10:15:39', '2021-04-16 10:15:39'),
(9178, 1006, 13522, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Sent following email to Dr. Jobi @ jobi ponraj drpjobiponraj@yahoo.com:  Sub: Medicare Appeal - Rescind Request  \"Hello Dr. Jobi,   As per my discussion with Medicare, you will need to send an email to NovitasJHPEAppeals@novitas-solutions.com with reference number: 610439000 requesting to rescind the appeal that we submitted to them. Please let me know once you\'ve done this, you should receive an email or mail informing you that it has been rescinded.   Thank you. \"', NULL, NULL, '2021-04-16 10:29:20', '2021-04-16 10:29:20'),
(9179, 1006, 13522, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Our reconsideration request has been rescinded, submitted another enrollment/reactivation request now to get group enrolled: \"Enrollment Tracking Information Applicant Name: RIGHT STEP MEDICAL CENTER LLC  Tracking ID: T041920210001497  Submitted Date: MON - APRIL 19 2021 01:22:33 PM EST  Submitted By: Jobi Ponraj  Contact Email(s): RSM@CLAIMSMEDINC.COM Reason(s) for submission: A Medicare Part B supplier is reactivating a deactivated Medicare billing number.\"', NULL, NULL, '2021-04-19 12:23:42', '2021-04-19 12:23:42'),
(9180, 1006, 13522, NULL, '2021-05-06 00:00:00.000', 'In Process', 'Enrollment request was pending on re-assignment requests, submitted those for all providers.', NULL, NULL, '2021-04-29 13:51:08', '2021-04-29 13:51:08'),
(9181, 1006, 13522, NULL, '2021-06-01 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Legal Business Name (LBN): RIGHT STEP MEDICAL CENTER LLC Provider/Supplier Type: CLINIC/GROUP PRACTICE National Provider Identifier (NPI): 1063008084 Provider Transaction Access Number (PTAN): 1P4805 PTAN Effective Date: FEBRUARY 01, 2021 Participation Status: PARTICIPATING PROVIDER  Welcome letter attached for reference. ', NULL, NULL, '2021-05-25 08:19:49', '2021-05-25 08:19:49'),
(9182, 1006, 13523, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-11 11:56:51', '2021-01-11 11:56:51'),
(9183, 1006, 13523, NULL, '2021-01-18 00:00:00.000', 'Initiated', 'Contractor: NOVITAS SOLUTIONS, INC. State: TEXAS Type/Specialty: NURSE PRACTITIONER Enrollment Type: 855I Status: AWAITING PROCESSING    Tracking ID: T011120210000861', NULL, NULL, '2021-01-11 11:57:25', '2021-01-11 11:57:25'),
(9184, 1006, 13523, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Group application deficiency has been corrected and request re-sent. ', NULL, NULL, '2021-01-20 14:42:08', '2021-01-20 14:42:08'),
(9185, 1006, 13523, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Received another deficiency, called to Kiffany @ 904-363-5406 for further clarification. ', NULL, NULL, '2021-01-28 17:36:11', '2021-01-28 17:36:11'),
(9186, 1006, 13523, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Need to wait for group reconsideration to be completed before we can move on with provider addition. ', NULL, NULL, '2021-03-15 12:04:07', '2021-03-15 12:04:07'),
(9187, 1006, 13523, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent following email @ medenroll@novitas-solutions.com:  \"Hello Natalie,   I appreciate the update, who would the owner need to email to rescind the appeal?   Thank you for the help.\"', NULL, NULL, '2021-03-23 10:43:05', '2021-03-23 10:43:05'),
(9188, 1006, 13523, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Sent another email @ medenroll@novitas-solutions.com:  Sub: Subject Replaced For Security Reasons (System Security)  \"Hello,   Please get back to me regarding my query as to whom the owner would need to email to rescind our appeal request?  Thank you.\"', NULL, NULL, '2021-04-05 17:08:49', '2021-04-05 17:08:49'),
(9189, 1006, 13523, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Sent following email to Dr. Jobi @ jobi ponraj drpjobiponraj@yahoo.com:  Sub: Medicare Appeal - Rescind Request  \"Hello Dr. Jobi,   As per my discussion with Medicare, you will need to send an email to NovitasJHPEAppeals@novitas-solutions.com with reference number: 610439000 requesting to rescind the appeal that we submitted to them. Please let me know once you\'ve done this, you should receive an email or mail informing you that it has been rescinded.   Thank you. \"', NULL, NULL, '2021-04-16 10:29:29', '2021-04-16 10:29:29'),
(9190, 1006, 13523, NULL, '2021-05-06 00:00:00.000', 'In Process', 'I resubmitted a reassignment request for the provider with the group. ', NULL, NULL, '2021-04-29 13:50:36', '2021-04-29 13:50:36'),
(9191, 1006, 13523, NULL, '2021-06-01 00:00:00.000', 'Approved', 'Application Tracking ID: T042920210001977   NPI ID: 1285270991   Medicare ID: 1P4818   Name: SHYBI VARGHESE  State: TX   Form Type: 855I  Date: 05/21/2021  Status: APPROVED', NULL, NULL, '2021-05-25 08:21:21', '2021-05-25 08:21:21'),
(9192, 1006, 13524, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-11 11:59:40', '2021-01-11 11:59:40'),
(9193, 1006, 13524, NULL, '2021-01-18 00:00:00.000', 'Initiated', 'Submitted reassingment application from PECOS: \"Enrollment ID: X01112021001075 Tracking ID: T011120210001088 Enrollment Status: PENDING E-SIGNATURES Submitted By: Glory Abraham\"', NULL, NULL, '2021-01-11 12:00:05', '2021-01-11 12:00:05'),
(9194, 1006, 13524, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Group application deficiency has been corrected and request re-sent. ', NULL, NULL, '2021-01-20 14:42:16', '2021-01-20 14:42:16'),
(9195, 1006, 13524, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Received another deficiency, called to Kiffany @ 904-363-5406 for further clarification. ', NULL, NULL, '2021-01-28 17:36:18', '2021-01-28 17:36:18'),
(9196, 1006, 13524, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Need to wait for group reconsideration to be completed before we can move on with provider addition. ', NULL, NULL, '2021-03-15 12:04:13', '2021-03-15 12:04:13'),
(9197, 1006, 13524, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent following email @ medenroll@novitas-solutions.com:  \"Hello Natalie,   I appreciate the update, who would the owner need to email to rescind the appeal?   Thank you for the help.\"', NULL, NULL, '2021-03-23 10:43:10', '2021-03-23 10:43:10'),
(9198, 1006, 13524, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Sent another email @ medenroll@novitas-solutions.com:  Sub: Subject Replaced For Security Reasons (System Security)  \"Hello,   Please get back to me regarding my query as to whom the owner would need to email to rescind our appeal request?  Thank you.\"', NULL, NULL, '2021-04-05 17:08:53', '2021-04-05 17:08:53'),
(9199, 1006, 13524, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Sent following email to Dr. Jobi @ jobi ponraj drpjobiponraj@yahoo.com:  Sub: Medicare Appeal - Rescind Request  \"Hello Dr. Jobi,   As per my discussion with Medicare, you will need to send an email to NovitasJHPEAppeals@novitas-solutions.com with reference number: 610439000 requesting to rescind the appeal that we submitted to them. Please let me know once you\'ve done this, you should receive an email or mail informing you that it has been rescinded.   Thank you. \"', NULL, NULL, '2021-04-16 10:29:35', '2021-04-16 10:29:35'),
(9200, 1006, 13524, NULL, '2021-05-06 00:00:00.000', 'In Process', 'I resubmitted a reassignment request for the provider with the group. ', NULL, NULL, '2021-04-29 13:50:32', '2021-04-29 13:50:32'),
(9201, 1006, 13524, NULL, '2021-06-01 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: GLORY ABRAHAM Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1194206490 Individual Provider Transaction Access Number (PTAN): 1P4976 Group Legal Business Name (LBN): RIGHT STEP MEDICAL CENTER LLC Group NPI: 1063008084 Group PTAN: 1P4805 Reassignment Effective Date: FEBRUARY 01, 2021', NULL, NULL, '2021-05-25 08:22:08', '2021-05-25 08:22:08'),
(9202, 3040, 13525, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-12 15:21:42', '2021-01-12 15:21:42'),
(9203, 3040, 13525, NULL, '2021-01-19 00:00:00.000', 'Initiated', 'Medicaid Initiated.  Application Status: Submitted PEP Ticket Number:  17508751 ', NULL, NULL, '2021-01-12 15:22:48', '2021-01-12 15:22:48'),
(9204, 3040, 13525, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Application in progress.  ', NULL, NULL, '2021-01-19 10:04:44', '2021-01-19 10:04:44'),
(9205, 3040, 13525, NULL, '2021-02-02 00:00:00.000', 'Approved', 'Taxes Medicaid Provider ID: 356585504  Effective Date: 12/01/2020', NULL, NULL, '2021-01-26 15:38:56', '2021-01-26 15:38:56'),
(9206, 3040, 13526, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-12 15:23:13', '2021-01-12 15:23:13'),
(9207, 3040, 13526, NULL, '2021-01-19 00:00:00.000', 'Initiated', 'Medicaid Initiated.  Application Status: Submitted PEP Ticket Number:  17508751 ', NULL, NULL, '2021-01-12 15:23:21', '2021-01-12 15:23:21'),
(9208, 3040, 13526, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Application in progress. ', NULL, NULL, '2021-01-19 10:04:46', '2021-01-19 10:04:46'),
(9209, 3040, 13526, NULL, '2021-02-02 00:00:00.000', 'Approved', 'Taxes Medicaid Provider ID: 356585504  Effective Date: 12/01/2020', NULL, NULL, '2021-01-26 15:38:57', '2021-01-26 15:38:57'),
(9210, 3040, 13527, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-12 15:51:05', '2021-01-12 15:51:05'),
(9211, 3040, 13527, NULL, '2021-01-19 00:00:00.000', 'Initiated', 'Request for participation form submitted online.  ', NULL, NULL, '2021-01-12 15:51:51', '2021-01-12 15:51:51'),
(9212, 3040, 13527, NULL, '2021-01-26 00:00:00.000', 'In Process', 'I had a word with (MARK) Aetna representative and he said they received the application and its in process.  Processing time: 60 business days  Application tracking no: PVB1234417', NULL, NULL, '2021-01-19 09:54:23', '2021-01-19 09:54:23'),
(9213, 3040, 13527, NULL, '2021-02-02 00:00:00.000', 'In Process', 'I had word with (EVA) with Aetna representative and she said the application is still in process. Allow 30 days', NULL, NULL, '2021-01-26 15:05:21', '2021-01-26 15:05:21'),
(9214, 3040, 13527, NULL, '2021-02-09 00:00:00.000', 'In Process', 'I had a word with (Madie R) and she advised that the application still in process.', NULL, NULL, '2021-02-02 09:55:52', '2021-02-02 09:55:52'),
(9215, 3040, 13527, NULL, '2021-02-16 00:00:00.000', 'In Process', 'I had a word with Aetna representative and he said the application is still in review status.   It will take 15-30 Business Days  Application received: 01/12/2021', NULL, NULL, '2021-02-09 09:52:49', '2021-02-09 09:52:49'),
(9216, 3040, 13527, NULL, '2021-02-23 00:00:00.000', 'In Process', 'I had a word with (Aetna) representative and he said the application is still in process. ', NULL, NULL, '2021-02-16 10:25:13', '2021-02-16 10:25:13'),
(9217, 3040, 13527, NULL, '2021-03-03 00:00:00.000', 'In Process', 'I had a word with (Nathan) Aetna representative and he said we have a urgent care contract and don\'t need to enroll the provider.  I sent the request for the group contract and it will receive with in 30 days.  ', NULL, NULL, '2021-02-24 10:09:01', '2021-02-24 10:09:01'),
(9218, 3046, 13527, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Had a word with Vince and he suggested to send a Fax on 859-455-8650, requesting for Facility Contract.', NULL, NULL, '2021-03-02 17:37:06', '2021-03-02 17:37:06'),
(9219, 3046, 13527, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Kindly find the attached fax.', NULL, NULL, '2021-03-05 17:45:29', '2021-03-05 17:45:29'),
(9220, 1006, 13527, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Faxed another request to get the group contract as the initial request did not have a business reason mentioned. Sent fax @ (859) 455-8650 ', NULL, NULL, '2021-03-23 15:26:13', '2021-03-23 15:26:13'),
(9221, 1006, 13527, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent a f/u email @ \"Widow, Shuntell M\" shuntell.widow@aetna.com:  Sub: [SEND SECURE] Aetna General Business #NAF413559  \"Hello Shuntell M,   Could you please send us the contract again as there is no message or attachment listed on the email?  Thank you. \"', NULL, NULL, '2021-06-04 14:47:05', '2021-06-04 14:47:05'),
(9222, 1006, 13527, NULL, '2021-06-16 00:00:00.000', 'Approved', 'The copy of the executed urgentcare contract has been received and is attached for reference in the main group tasks. Both the locations are added under the group. Ref# 6023635857', NULL, NULL, '2021-06-09 09:32:07', '2021-06-09 09:32:07'),
(9223, 3040, 13528, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-12 15:51:54', '2021-01-12 15:51:54'),
(9224, 3040, 13528, NULL, '2021-01-19 00:00:00.000', 'Initiated', 'Request for participation form submitted online. ', NULL, NULL, '2021-01-12 15:51:59', '2021-01-12 15:51:59'),
(9225, 3040, 13528, NULL, '2021-01-26 00:00:00.000', 'In Process', 'I had a word with (MARK) Aetna representative and he said they received the application and its in process.  Processing time: 60 business days  Application tracking no: PVB1234417', NULL, NULL, '2021-01-19 09:54:25', '2021-01-19 09:54:25'),
(9226, 3040, 13528, NULL, '2021-02-02 00:00:00.000', 'In Process', 'I had word with (EVA) with Aetna representative and she said the application is still in process. Allow 30 days', NULL, NULL, '2021-01-26 15:05:29', '2021-01-26 15:05:29'),
(9227, 3040, 13528, NULL, '2021-02-09 00:00:00.000', 'In Process', 'I had a word with (Madie R) and she advised that the application still in process.', NULL, NULL, '2021-02-02 09:55:59', '2021-02-02 09:55:59'),
(9228, 3040, 13528, NULL, '2021-02-16 00:00:00.000', 'In Process', 'I had a word with Aetna representative and he said the application is still in review status.   It will take 15-30 Business Days  Application received: 01/12/2021', NULL, NULL, '2021-02-09 09:52:54', '2021-02-09 09:52:54'),
(9229, 3040, 13528, NULL, '2021-02-23 00:00:00.000', 'In Process', 'I had a word with (Aetna) representative and he said the application is still in process. ', NULL, NULL, '2021-02-16 10:25:19', '2021-02-16 10:25:19'),
(9230, 3040, 13528, NULL, '2021-03-03 00:00:00.000', 'In Process', 'I had a word with (Nathan) Aetna representative and he said we have a urgent care contract and don\'t need to enroll the provider.  I sent the request for the group contract and it will receive with in 30 days. ', NULL, NULL, '2021-02-24 10:09:11', '2021-02-24 10:09:11'),
(9231, 3046, 13528, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Had a word with Vince and he suggested to send a Fax on 859-455-8650, requesting for Facility Contract.', NULL, NULL, '2021-03-02 17:36:51', '2021-03-02 17:36:51'),
(9232, 1006, 13528, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Faxed another request to get the group contract as the initial request did not have a business reason mentioned. Sent fax @ (859) 455-8650 ', NULL, NULL, '2021-03-23 15:49:07', '2021-03-23 15:49:07'),
(9233, 1006, 13528, NULL, '2021-06-16 00:00:00.000', 'Approved', 'The copy of the executed urgentcare contract has been received and is attached for reference in the main group tasks. Both the locations are added under the group. Ref# 6023635857', NULL, NULL, '2021-06-09 09:31:36', '2021-06-09 09:31:36'),
(9234, 3040, 13529, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-13 15:33:09', '2021-01-13 15:33:09'),
(9235, 3040, 13529, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Provider enrollment for submitted online.   For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.', NULL, NULL, '2021-01-13 15:34:00', '2021-01-13 15:34:00'),
(9236, 3040, 13529, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email sent to:pr.south@healthsmart.com  Subject: Provider Application – Fernandus  Greetings,  Hope you are doing well. Please find the attached the demographic information form as requested.   If you need any additional information please call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-13 15:34:24', '2021-01-13 15:34:24'),
(9237, 3040, 13529, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Follow up email sent to: pr.south@healthsmart.com  Subject: Provider Application – Fernandus  Greetings,  Hope you are doing well. I wanted to know the status of enrollment for the below mentioned provider.  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2:   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Information:Provider Name: Limy FernandusProvider NPI# 1972005189  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-20 10:49:10', '2021-01-20 10:49:10'),
(9238, 3040, 13529, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Follow up sent to: pr.south@healthsmart.com  Subject: Provider Application – Fernandus  Greetings,  Hope you are doing well. I just wanted to know the enrollment status of the below mentioned provider.  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2:   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Information: Provider Name: Limy  Fernandus Provider NPI# 1972005189  Please reply to me as soon as you get a chance. Waiting for your response.  Thanks ', NULL, NULL, '2021-01-27 11:10:20', '2021-01-27 11:10:20'),
(9239, 3040, 13529, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email rcvd from: pr.south@healthsmart.com  Subject:  Provider Application – Fernandus  Adil,  Please allow 30 to 45 days for this to be completed.', NULL, NULL, '2021-01-27 12:57:44', '2021-01-27 12:57:44'),
(9240, 3040, 13529, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Please allow 30 to 45 days for this to be completed.', NULL, NULL, '2021-02-03 10:05:53', '2021-02-03 10:05:53'),
(9241, 3040, 13529, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Follow up email sent to: pr.south@healthsmart.com  Subject:  Provider Application – Fernandus  Good Morning,  This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2:   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Information: Provider Name: Limy  Fernandus Provider NPI# 1972005189  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-10 10:30:31', '2021-02-10 10:30:31'),
(9242, 3040, 13529, NULL, '2021-02-18 00:00:00.000', 'Approved', 'Email rcvd from: pr.south@healthsmart.com  Subject: Provider Application – Fernandus  Fernandus, Limy- effective date 12/1/2020', NULL, NULL, '2021-02-11 09:49:49', '2021-02-11 09:49:49'),
(9243, 3040, 13530, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-14 12:55:11', '2021-01-14 12:55:11'),
(9244, 3040, 13530, NULL, '2021-01-21 00:00:00.000', 'Initiated', 'Enrollment application process through Cigna call center.  Cigna provider ID no: 9121288 Application no: 12458343 ', NULL, NULL, '2021-01-14 12:57:49', '2021-01-14 12:57:49'),
(9245, 3040, 13530, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Application in process.', NULL, NULL, '2021-01-21 09:20:27', '2021-01-21 09:20:27'),
(9246, 3040, 13530, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Application is still in process', NULL, NULL, '2021-01-28 16:51:54', '2021-01-28 16:51:54'),
(9247, 3040, 13530, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email rcvd from: ONBEloquaNotice@cigna.com  Subject: Cigna Credentialing Status Update: Application Received  Re:	Reference number 12458343 Application to participate in the Cigna medical network Dear KATHERINE PATERSON,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.', NULL, NULL, '2021-02-01 09:54:49', '2021-02-01 09:54:49'),
(9248, 3040, 13530, NULL, '2021-02-15 00:00:00.000', 'In Process', 'I had a word with (Joaya) Cigna representative and she said the application is still in process  Processing time 90-120 Business days  Credentialing started 01/29/21  ', NULL, NULL, '2021-02-08 12:28:43', '2021-02-08 12:28:43'),
(9249, 3040, 13530, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-15 10:49:52', '2021-02-15 10:49:52'),
(9250, 3046, 13530, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: ONBEloquaNotice@cigna.com Subject: Request for Enrollment Status Update || Katherine D Paterson || Ref # 12458343 || Cigna || GWMC Good Morning, Greetings I would like to request you to kindly update the status for the enrollment application for the below mentioned provider. Practice Details: Practice Name: George West Medical Clinic Practice NPI: 1427509264 Tax ID: 81-1890349 Address: 504A Houston Street, Live Oak County, George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine D Provider NPI: 1164776548 Thank you', NULL, NULL, '2021-03-08 09:58:48', '2021-03-08 09:58:48'),
(9251, 3046, 13530, NULL, '2021-03-26 00:00:00.000', 'In Process', 'email sent to: Intake_PDM@cigna.com Subject: Request for Enrollment Status Update || Katherine D Paterson || Ref # 12458343 || Cigna || CBUC Greetings I hope you are doing well. Would you mind me requesting you for the updated status for the enrollment application for the below mentioned provider. Practice Details: Practice Name: Coastal Bend Urgent Care Practice NPI: 1427509264 Tax ID:81-1890349 Address:301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Provider Details: Provider Name: Paterson, Katherine D Provider NPI: 1164776548 Thank you', NULL, NULL, '2021-03-19 12:28:38', '2021-03-19 12:28:38'),
(9252, 1006, 13530, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent a f/u email @ PDM COGZ PDMCOGZ@cigna.com & intake_pdm@cigna.com:  Sub: Enrollment Query - CBUC/GWMC - Cigna  \"Hello,   I wanted to verify if the following group and providers were enrolled with Cigna under the mentioned addresses:   Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-06-09 10:11:05', '2021-06-09 10:11:05'),
(9253, 1006, 13530, NULL, '2021-07-06 00:00:00.000', 'Approved', 'Katherine Paterson:  Eff: 12/01/2020 Provider ID# 9121288  Ref# Ivan C 06/29/2021  Location confirmation is attached for reference. ', NULL, NULL, '2021-06-29 12:13:52', '2021-06-29 12:13:52'),
(9254, 3040, 13531, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-14 12:55:15', '2021-01-14 12:55:15'),
(9255, 3040, 13531, NULL, '2021-01-21 00:00:00.000', 'Initiated', 'Enrollment application submitted through online.   Cigna provider ID no: 9121288 Application no: 12458343', NULL, NULL, '2021-01-14 12:59:03', '2021-01-14 12:59:03'),
(9256, 3040, 13531, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Application in process.', NULL, NULL, '2021-01-21 09:20:34', '2021-01-21 09:20:34'),
(9257, 3040, 13531, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Application is still in process', NULL, NULL, '2021-01-28 16:51:47', '2021-01-28 16:51:47'),
(9258, 3040, 13531, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email rcvd from: ONBEloquaNotice@cigna.com  Subject: Cigna Credentialing Status Update: Application Received  Re:	Reference number 12458343 Application to participate in the Cigna medical network Dear KATHERINE PATERSON,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.', NULL, NULL, '2021-02-01 09:54:43', '2021-02-01 09:54:43'),
(9259, 3040, 13531, NULL, '2021-02-15 00:00:00.000', 'In Process', 'I had a word with (Joaya) Cigna representative and she said the application is still in process  Processing time 90-120 Business days  Credentialing started 01/29/21  ', NULL, NULL, '2021-02-08 12:28:46', '2021-02-08 12:28:46'),
(9260, 3040, 13531, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-15 10:49:41', '2021-02-15 10:49:41'),
(9261, 3046, 13531, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: ONBEloquaNotice@cigna.com Subject: Request for Enrollment Status Update || Katherine D Paterson || Ref # 12458343 || Cigna || CBUC   Good Morning, Greetings I would like to request you to kindly update the status for the enrollment application for below mentioned provider. Practice Details:Practice Name: Coastal Bend Urgent Care Practice NPI: 1427509264 Tax ID:81-1890349 Address:301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Provider Details: Provider Name: Paterson, Katherine D Provider NPI: 1164776548 Thank you', NULL, NULL, '2021-03-08 09:52:12', '2021-03-08 09:52:12'),
(9262, 3046, 13531, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: Intake_PDM@cigna.com Subject: Request for Enrollment Status Update || Katherine D Paterson || Ref # 12458343 || Cigna || GWMC  Greetings Kindly advise the updated status for the enrollment application for the below mentioned provider. Practice Details: Practice Name: George West Medical Clinic Practice NPI: 1427509264 Tax ID: 81-1890349 Address: 504A Houston Street, Live Oak County, George West , TX 78022-3663 Provider Details: Provider Name: Paterson, Katherine D Provider NPI: 1164776548  Thank you', NULL, NULL, '2021-03-18 13:45:37', '2021-03-18 13:45:37');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(9263, 1006, 13531, NULL, '2021-05-21 00:00:00.000', 'In Process', 'Sent f/u email @ Intake_PDM@cigna.com:  Sub: Enrollment Status - Katherine Paterson - CBUC  \"Hello,  I hope you\'re doing well, I wanted to get an update on the enrollment status for the following providers and group: Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264  Provider Name: Katherine Paterson  NPI# 1164776548  Provider Name: Jennifer Tudor  NPI# 1720455835  Provider Name: Mercedita Flynn NPI# 1619166188  Please get back to me as soon as possible as this request has been pending for the past few months.   Thank you. \"', NULL, NULL, '2021-05-05 13:23:42', '2021-05-05 13:23:42'),
(9264, 1006, 13531, NULL, '2021-05-20 00:00:00.000', 'In Process', 'We received the following update from pdmcogz@cigna.com: \"Hi,     The below provider’s are contracted under the tax id 811890349     PROVIDER NAME  PID  EFFECTIVE DATE  TAX ID  STATUS  Coastal Bend Urgent Care, LLC  9355952  7/6/2017  811890349  Contracted  Katherine Paterson  9121288  12/1/2020  811890349  Contracted  Jennifer Tudor  4740849  12/1/2016  811890349  Contracted  Mercedita Flynn  7168847  12/1/2016  811890349  Contracted\"', NULL, NULL, '2021-05-06 08:17:42', '2021-05-06 08:17:42'),
(9265, 1006, 13531, NULL, '2021-05-07 00:00:00.000', 'Approved', 'Provider is effective as of: 12/01/2020.', NULL, NULL, '2021-05-07 08:30:52', '2021-05-07 08:30:52'),
(9266, 3040, 13532, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-14 13:44:05', '2021-01-14 13:44:05'),
(9267, 3040, 13532, NULL, '2021-01-21 00:00:00.000', 'Initiated', 'Greetings,  Hope you are doing well. I want to add the below provider in an existing group. Below are the details of the practice and provider.  Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Tax ID# 81-1890349 NPI# 1427509264 Address:301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2:  Practice Name: George West Medical Clinic Tax ID# 81-1890349 NPI# 1427509264 Address: 504A Houston Street Live Oak County George West , TX 78022-3663  Provider Information:  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-14 13:45:47', '2021-01-14 13:45:47'),
(9268, 3040, 13532, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Follow up email sent: KMoten4@humana.com  Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  Greetings,  Hope you are doing well. This a follow up email regarding the below mentioned provider. I wanted to enroll that provider in an existing group.   Practice 1: Practice Name:Coastal Bend Urgent Care, LLC Tax ID# 81-1890349 NPI# 1427509264 Address:301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name:George West Medical Clinic Tax ID# 81-1890349 NPI# 1427509264 Address:504A Houston Street Live Oak County George West , TX 78022-3663  Provider Information: Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 15:06:50', '2021-01-21 15:06:50'),
(9269, 3040, 13532, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  Greetings,  Hope you are doing well. Please find the attached the re-credentialing application form along with the requested documents.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-22 10:37:52', '2021-01-22 10:37:52'),
(9270, 3040, 13532, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  > Hello, This provider needs to be re-credentialed. Please complete the attached re-credentialing application and return to me with the following documents: DEA, Malpractice Insurance, License, CV. ', NULL, NULL, '2021-01-22 10:39:17', '2021-01-22 10:39:17'),
(9271, 3040, 13532, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  Good Morning,  I submitted the application for review. Please allow 90 days.', NULL, NULL, '2021-01-29 12:06:14', '2021-01-29 12:06:14'),
(9272, 3040, 13532, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  Good Morning Katherina,  Hope you doing well. Please note we need to do credentialing for Katherine D Paterson not the re-credentialing. Kindly check and advise.  Waiting to hear from you soon and have a good weekend.  Thanks ', NULL, NULL, '2021-02-12 09:31:20', '2021-02-12 09:31:20'),
(9273, 3040, 13532, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to:  kmoten4@humana.com  Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  Greetings Katherine,  I just want to double check with you we need to do the credentialing for the below mentioned provider.  Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Tax ID# 81-1890349 NPI# 1427509264 Address:301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Tax ID# 81-1890349 NPI# 1427509264 Address:504A Houston Street Live Oak County George West , TX 78022-3663  Provider Information: Provider Name: Katherine Paterson Provider NPI# 1164776548  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-19 15:14:43', '2021-02-19 15:14:43'),
(9274, 3040, 13532, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to:  kmoten4@humana.com  Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  Greetings Katherine,  I just want to double check with you we need to do the credentialing for the below mentioned provider.  Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Tax ID# 81-1890349 NPI# 1427509264 Address:301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Tax ID# 81-1890349 NPI# 1427509264 Address:504A Houston Street Live Oak County George West , TX 78022-3663  Provider Information: Provider Name: Katherine Paterson Provider NPI# 1164776548  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-19 15:14:48', '2021-02-19 15:14:48'),
(9275, 3046, 13532, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare || Hello Katherine, Hope my email finds you well. Kindly advise how much time is required for the below mentioned provider to be enrolled in the existing group:  Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Tax ID# 81-1890349 NPI# 1427509264 Address:301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Tax ID# 81-1890349 NPI# 1427509264 Address:504A Houston Street Live Oak County George West , TX 78022-3663  Provider Information: Provider Name: Katherine Paterson Provider NPI# 1164776548  Your quick response in this regard is highly appreciated.  Thank you', NULL, NULL, '2021-02-26 09:57:01', '2021-02-26 09:57:01'),
(9276, 1006, 13532, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Received the following update from Katherine Moten KMoten4@humana.com: \"Hello,  I submitted the credentialing application for this provider on 1/22/2021 – please allow 90 days for processing.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"', NULL, NULL, '2021-03-01 15:47:09', '2021-03-01 15:47:09'),
(9277, 3046, 13532, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Hello Katherine,  Hope my email finds you well.  Kindly advise how much time is required for the below mentioned provider to be enrolled in the existing group:  Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Tax ID# 81-1890349 NPI# 1427509264 Address:301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Tax ID# 81-1890349 NPI# 1427509264 Address:504A Houston Street Live Oak County George West , TX 78022-3663  Provider Information: Provider Name: Katherine Paterson Provider NPI# 1164776548  Your quick response in this regard is highly appreciated.  Thank you.', NULL, NULL, '2021-03-19 12:21:13', '2021-03-19 12:21:13'),
(9278, 3046, 13532, NULL, '2021-03-26 00:00:00.000', 'New/Not Initiated', 'Reply from: KMoten4@humana.com Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  She is still being credentialed. Please allow 90 days.', NULL, NULL, '2021-03-19 12:46:29', '2021-03-19 12:46:29'),
(9279, 1006, 13532, NULL, '2021-03-29 00:00:00.000', 'In Process', NULL, NULL, NULL, '2021-03-22 08:39:09', '2021-03-22 08:39:09'),
(9280, 1006, 13532, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com:  Sub: Enrollment Status - CBUC/GWMC - Tricare  \"Hello Katherine,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following provider under our group:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548  Please get back to me as soon as you\'re able to. Thank you.\"', NULL, NULL, '2021-06-09 12:01:53', '2021-06-09 12:01:53'),
(9281, 1006, 13532, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com & Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment Status - CBUC/GWMC - Tricare  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers were enrolled with Tricare or not? If not, please let me know what is required to get them enrolled. The information is as follows:   Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-25 10:00:02', '2021-06-25 10:00:02'),
(9282, 1006, 13532, NULL, '2021-07-21 00:00:00.000', 'In Process', 'We received the following response from Yvonne:  \"Good Morning Brad,     Costal Bend Urgent Care address location is not in my area.  Katherine Moten is the TRICARE Liaison for Beeville and George West Texas. The street address happened to have a street name of Houston.  Katherine can assist you with any additional questions. You do not need to include me on the emails for her area.     I work Houston ,Galveston and the surrounding areas of these cities.        Here is the status: We show the tax id as network. The current status for each provider are listed below. You can check status on a provider by creating a log in on the provider Portal or search online under find care. Both can be found on the humanamilitary.com website.     Provider Name: Flynn, Mercedita N- we show has been added to both address locations. Provider NPI# 1619166188  Provider Name: Katherine Paterson- we show this provider is not affiliated to this group tax id you need to complete the spreadsheet to add this provider to this tax id. Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M- we show has been added to both address locations Provider NPI# 1720455835\"  Tried calling Katherine but no one picked up, left VM and resent f/u email @ :  \"Hello Katherine,   I hope you\'re doing well, please get back to me on this as soon as you\'re able.  Thanks. \"', NULL, NULL, '2021-07-14 17:13:29', '2021-07-14 17:13:29'),
(9283, 11056, 13532, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : 	ywyatt@humana.com, & KMoten4@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good evening!  Hope all is well. I want to inquire about the spreadsheet to affiliate the provider Katherine Paterson to this group tax id, which you were going to provide in the month of July but haven\'t yet. Please provide it soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any documents or information regarding this feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 14:50:19', '2021-08-18 14:50:19'),
(9284, 11056, 13532, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good morning Yvonne!  Hope this email finds you well. Thank you so much for your prompt response and submission of request to Provider network to display Katherine Paterson as network under the Beeville, Texas location. Could you please update me with the latest enrollment status of the below mentioned providers ?  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you have any questions or concerns feel free to reach out to me. Waiting to hear back from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-24 11:00:40', '2021-08-24 11:00:40'),
(9285, 11056, 13532, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email received from : ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good Morning Ahmed,    I have submitted a request to Provider network to display Katherine Paterson as network under the Beeville, Texas location.        Thanks,  Yvonne W. Wyatt,  Humana Military  TRICARE Community Liaison II  Houston/Galveston  502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com     https://www.humanamilitary.com/coronavirus/provider     https://infocenter.humana-military.com/provider/service/Account/Login     Certification takes 90 days, and I do not have visual access to check the status. To check the status on a Tricare Certification applications, Please call WPS at  800-444-5445 and ask to speak to the Certfication Unit.     Certification applications forms please visit: https://www.humanamilitary.com/provider/education-and-resources/quick-access/forms Certification Fax: 608-221-7535  Provider Handbook: http://apps.humana.com/marketing/documents.asp?file=3262194', NULL, NULL, '2021-09-02 10:20:43', '2021-09-02 10:20:43'),
(9286, 11056, 13532, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Email received from : ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon Ahmed,  I am doing well, thanks  This tax id do not appear in my area. Katherine can assist you with your questions.   Thanks, Yvonne  Emailed at KMoten4@humana.com to get updates.', NULL, NULL, '2021-09-20 13:14:25', '2021-09-20 13:14:25'),
(9287, 11056, 13532, NULL, '2021-09-27 00:00:00.000', 'In Process', 'I have words with Jada H & Rheshonda at 18004445445. Both advised me to fax the form for the credentialing process and the form has been faxed at 608-221-7535  Katherine - is credentialed and in network  Ref code : 13844672   Please see the attachment.', NULL, NULL, '2021-09-20 15:55:46', '2021-09-20 15:55:46'),
(9288, 11056, 13532, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com & ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good Morning  Ahmed,     Katherine, has taken another position.  This address location do not appear in my area. I will assist you with this question but any additional questions please reach out to Jacqueline Trenz. I have include her on this email.  You do not need to include me on the emails for this area    Provider Details: Provider Name: Flynn, Mercedita N  Provider NPI# 1619166188 - Show affiliated with this group tax id but is not display on the portal a request was submitted to update. Allow up to five business days to process.   Provider Name: Katherine Paterson- Show affiliated with this group tax id and is displayed  Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811 - Do not appear in our system as TRICARE certified. Below is the link to the certification application for you to complete and fax to WPS.', NULL, NULL, '2021-09-30 15:51:58', '2021-09-30 15:51:58'),
(9289, 11056, 13532, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare   Good afternoon!  Hope all is well with you. Please assist with the below at your earliest opportunity.  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 & Queries Katherine Paterson	1164776548 : Please provide eff date & Please update the main                           location with proper address on your director  Mercedita Flynn	1619166188 : Latest updates on this application Monica Gonzalez	1871132811 : We have faxed the certification and credentialing                                      application to Tricare.  If you have any questions or require additional information or documents please don\'t hesitate in contacting me. Please see the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-07 16:16:59', '2021-10-07 16:16:59'),
(9290, 11056, 13532, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Please allow 90 days for processing of Ms. Gonzalez.  Application was faxed 9/20/2021.      Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-14 16:05:29', '2021-10-14 16:05:29'),
(9291, 11056, 13532, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Hello Jacqueline!  Hope you are doing great. Please help me out with the issue mentioned below:  Katherine Paterson - The main location is not appearing in your directory.  Mercedita Flynn - The secondary location is not appearing in your directory.  Please also see the attachments related to this. Kindly sort this out for me as soon as possible.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-22 10:34:54', '2021-10-22 10:34:54'),
(9292, 11056, 13532, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub:  Enrollment Status Updates - CBUC/GWMC - Tricare   Good morning,     The correct locations are showing up in my systems, so I have to send this the my provider administration team for a review.  Please email  a copy of the W-9 for the group so I can send my request.   Have provided them with their demands.', NULL, NULL, '2021-11-09 15:47:26', '2021-11-09 15:47:26'),
(9293, 11056, 13532, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from:  jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon,   K Paterson, Effective affiliation date is 8/18/2021 with TIN 81-1890349 at 301 S Hillside Dr, Suite 4, Beeville Tx 78102  Cert. date:  10/18/2021  Please see the attached welcome letter.', NULL, NULL, '2021-11-17 16:57:40', '2021-11-17 16:57:40'),
(9294, 3040, 13533, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-14 13:45:57', '2021-01-14 13:45:57'),
(9295, 3040, 13533, NULL, '2021-01-21 00:00:00.000', 'Initiated', 'Greetings,  Hope you are doing well. I want to add the below provider in an existing group. Below are the details of the practice and provider.  Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Tax ID# 81-1890349 NPI# 1427509264 Address:301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2:  Practice Name: George West Medical Clinic Tax ID# 81-1890349 NPI# 1427509264 Address: 504A Houston Street Live Oak County George West , TX 78022-3663  Provider Information:  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-14 13:46:08', '2021-01-14 13:46:08'),
(9296, 3040, 13533, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Follow up email sent: KMoten4@humana.com  Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  Greetings,  Hope you are doing well. This a follow up email regarding the below mentioned provider. I wanted to enroll that provider in an existing group.   Practice 1: Practice Name:Coastal Bend Urgent Care, LLC Tax ID# 81-1890349 NPI# 1427509264 Address:301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name:George West Medical Clinic Tax ID# 81-1890349 NPI# 1427509264 Address:504A Houston Street Live Oak County George West , TX 78022-3663  Provider Information: Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 15:07:09', '2021-01-21 15:07:09'),
(9297, 3040, 13533, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  Greetings,  Hope you are doing well. Please find the attached the re-credentialing application form along with the requested documents.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-22 10:38:04', '2021-01-22 10:38:04'),
(9298, 3040, 13533, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  > Hello, This provider needs to be re-credentialed. Please complete the attached re-credentialing application and return to me with the following documents: DEA, Malpractice Insurance, License, CV. ', NULL, NULL, '2021-01-22 10:39:24', '2021-01-22 10:39:24'),
(9299, 3040, 13533, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  Good Morning,  I submitted the application for review. Please allow 90 days.', NULL, NULL, '2021-01-29 12:05:47', '2021-01-29 12:05:47'),
(9300, 3040, 13533, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  Good Morning Katherina,  Hope you doing well. Please note we need to do credentialing for Katherine D Paterson not the re-credentialing. Kindly check and advise.  Waiting to hear from you soon and have a good weekend.  Thanks ', NULL, NULL, '2021-02-12 09:31:09', '2021-02-12 09:31:09'),
(9301, 3040, 13533, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to:  kmoten4@humana.com  Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  Greetings Katherine,  I just want to double check with you we need to do the credentialing for the below mentioned provider.  Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Tax ID# 81-1890349 NPI# 1427509264 Address:301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Tax ID# 81-1890349 NPI# 1427509264 Address:504A Houston Street Live Oak County George West , TX 78022-3663  Provider Information: Provider Name: Katherine Paterson Provider NPI# 1164776548  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-19 15:14:52', '2021-02-19 15:14:52'),
(9302, 3046, 13533, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Good Morning,  I submitted the application for review. Please allow 90 days.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-02-26 09:30:01', '2021-02-26 09:30:01'),
(9303, 3046, 13533, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare || Hello Katherine, Hope my email finds you well. Kindly advise how much time is required for the below mentioned provider to be enrolled in the existing group:  Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Tax ID# 81-1890349 NPI# 1427509264 Address:301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Tax ID# 81-1890349 NPI# 1427509264 Address:504A Houston Street Live Oak County George West , TX 78022-3663  Provider Information: Provider Name: Katherine Paterson Provider NPI# 1164776548  Your quick response in this regard is highly appreciated.  Thank you', NULL, NULL, '2021-02-26 09:39:19', '2021-02-26 09:39:19'),
(9304, 1006, 13533, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Received the following update from Katherine Moten KMoten4@humana.com: \"Hello,  I submitted the credentialing application for this provider on 1/22/2021 – please allow 90 days for processing.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"', NULL, NULL, '2021-03-01 15:47:24', '2021-03-01 15:47:24'),
(9305, 3046, 13533, NULL, '2021-03-25 00:00:00.000', 'In Process', 'email sent to: kmoten4@humana.com Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  Hello Katherine, Hope you are doing well. Would you mind me asking about the updated status for credentialing application for the below mentioned provider:  Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Tax ID# 81-1890349 NPI# 1427509264 Address:301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Tax ID# 81-1890349 NPI# 1427509264 Address:504A Houston Street Live Oak County George West , TX 78022-3663  Provider Information: Provider Name: Katherine Paterson Provider NPI# 1164776548  Your quick response in this regard is highly appreciated. Thank you.', NULL, NULL, '2021-03-18 13:53:25', '2021-03-18 13:53:25'),
(9306, 3046, 13533, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Reply from: KMoten4@humana.com Subject: Enroll Provider In Existing Group || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || Tricare ||  She is still being credentialed. Please allow 90 days.', NULL, NULL, '2021-03-19 12:46:42', '2021-03-19 12:46:42'),
(9307, 1006, 13533, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com:  Sub: Enrollment Status - CBUC/GWMC - Tricare  \"Hello Katherine,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following provider under our group:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548  Please get back to me as soon as you\'re able to. Thank you.\"', NULL, NULL, '2021-06-09 12:01:44', '2021-06-09 12:01:44'),
(9308, 1006, 13533, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com & Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment Status - CBUC/GWMC - Tricare  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers were enrolled with Tricare or not? If not, please let me know what is required to get them enrolled. The information is as follows:   Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-25 09:59:56', '2021-06-25 09:59:56'),
(9309, 1006, 13533, NULL, '2021-07-21 00:00:00.000', 'In Process', 'We received the following response from Yvonne:  \"Good Morning Brad,     Costal Bend Urgent Care address location is not in my area.  Katherine Moten is the TRICARE Liaison for Beeville and George West Texas. The street address happened to have a street name of Houston.  Katherine can assist you with any additional questions. You do not need to include me on the emails for her area.     I work Houston ,Galveston and the surrounding areas of these cities.        Here is the status: We show the tax id as network. The current status for each provider are listed below. You can check status on a provider by creating a log in on the provider Portal or search online under find care. Both can be found on the humanamilitary.com website.     Provider Name: Flynn, Mercedita N- we show has been added to both address locations. Provider NPI# 1619166188  Provider Name: Katherine Paterson- we show this provider is not affiliated to this group tax id you need to complete the spreadsheet to add this provider to this tax id. Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M- we show has been added to both address locations Provider NPI# 1720455835\"  Tried calling Katherine but no one picked up, left VM and resent f/u email @ :  \"Hello Katherine,   I hope you\'re doing well, please get back to me on this as soon as you\'re able.  Thanks. \"', NULL, NULL, '2021-07-14 17:13:26', '2021-07-14 17:13:26'),
(9310, 11056, 13533, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : 	ywyatt@humana.com, & KMoten4@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good evening!  Hope all is well. I want to inquire about the spreadsheet to affiliate the provider Katherine Paterson to this group tax id, which you were going to provide in the month of July but haven\'t yet. Please provide it soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any documents or information regarding this feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 14:50:11', '2021-08-18 14:50:11'),
(9311, 11056, 13533, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good morning Yvonne!  Hope this email finds you well. Thank you so much for your prompt response and submission of request to Provider network to display Katherine Paterson as network under the Beeville, Texas location. Could you please update me with the latest enrollment status of the below mentioned providers ?  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you have any questions or concerns feel free to reach out to me. Waiting to hear back from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-24 11:00:33', '2021-08-24 11:00:33'),
(9312, 11056, 13533, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email received from : ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good Morning Ahmed,    I have submitted a request to Provider network to display Katherine Paterson as network under the Beeville, Texas location.        Thanks,  Yvonne W. Wyatt,  Humana Military  TRICARE Community Liaison II  Houston/Galveston  502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com     https://www.humanamilitary.com/coronavirus/provider     https://infocenter.humana-military.com/provider/service/Account/Login     Certification takes 90 days, and I do not have visual access to check the status. To check the status on a Tricare Certification applications, Please call WPS at  800-444-5445 and ask to speak to the Certfication Unit.     Certification applications forms please visit: https://www.humanamilitary.com/provider/education-and-resources/quick-access/forms Certification Fax: 608-221-7535  Provider Handbook: http://apps.humana.com/marketing/documents.asp?file=3262194', NULL, NULL, '2021-09-02 10:19:14', '2021-09-02 10:19:14'),
(9313, 11056, 13533, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Email received from : ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon Ahmed,  I am doing well, thanks  This tax id do not appear in my area. Katherine can assist you with your questions.   Thanks, Yvonne  Emailed at KMoten4@humana.com to get updates.', NULL, NULL, '2021-09-20 13:14:19', '2021-09-20 13:14:19'),
(9314, 11056, 13533, NULL, '2021-09-27 00:00:00.000', 'In Process', 'I have words with Jada H & Rheshonda at 18004445445. Both advised me to fax the form for the credentialing process and the form has been faxed at 608-221-7535  Katherine - is credentialed and in network  Ref code : 13844672   Please see the attachment.', NULL, NULL, '2021-09-20 15:55:21', '2021-09-20 15:55:21'),
(9315, 11056, 13533, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com & ywyatt@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good Morning  Ahmed,     Katherine, has taken another position.  This address location do not appear in my area. I will assist you with this question but any additional questions please reach out to Jacqueline Trenz. I have include her on this email.  You do not need to include me on the emails for this area    Provider Details: Provider Name: Flynn, Mercedita N  Provider NPI# 1619166188 - Show affiliated with this group tax id but is not display on the portal a request was submitted to update. Allow up to five business days to process.   Provider Name: Katherine Paterson- Show affiliated with this group tax id and is displayed  Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811 - Do not appear in our system as TRICARE certified. Below is the link to the certification application for you to complete and fax to WPS.', NULL, NULL, '2021-09-30 15:51:52', '2021-09-30 15:51:52'),
(9316, 11056, 13533, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare   Good afternoon!  Hope all is well with you. Please assist with the below at your earliest opportunity.  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 & Queries Katherine Paterson	1164776548 : Please provide eff date & Please update the main                           location with proper address on your director  Mercedita Flynn	1619166188 : Latest updates on this application Monica Gonzalez	1871132811 : We have faxed the certification and credentialing                                      application to Tricare.  If you have any questions or require additional information or documents please don\'t hesitate in contacting me. Please see the attachment.  Thank you! Have a great day!', NULL, NULL, '2021-10-07 16:15:36', '2021-10-07 16:15:36'),
(9317, 11056, 13533, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Please allow 90 days for processing of Ms. Gonzalez.  Application was faxed 9/20/2021.      Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-14 16:04:40', '2021-10-14 16:04:40'),
(9318, 11056, 13533, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Hello Jacqueline!  Hope you are doing great. Please help me out with the issue mentioned below:  Katherine Paterson - The main location is not appearing in your directory.  Mercedita Flynn - The secondary location is not appearing in your directory.  Please also see the attachments related to this. Kindly sort this out for me as soon as possible.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-22 10:35:14', '2021-10-22 10:35:14'),
(9319, 11056, 13533, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub:  Enrollment Status Updates - CBUC/GWMC - Tricare   Good morning,     The correct locations are showing up in my systems, so I have to send this the my provider administration team for a review.  Please email  a copy of the W-9 for the group so I can send my request.   Have provided them with their demands.', NULL, NULL, '2021-11-09 15:47:20', '2021-11-09 15:47:20'),
(9320, 11056, 13533, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email received from:  jtrenz@humana.com  Sub : Enrollment Status Updates - CBUC/GWMC - Tricare  Good afternoon,   K Paterson, Effective affiliation date is 8/18/2021 with TIN 81-1890349 at 301 S Hillside Dr, Suite 4, Beeville Tx 78102  Cert. date:  10/18/2021  Please see the attached welcome letter.', NULL, NULL, '2021-11-17 16:57:13', '2021-11-17 16:57:13'),
(9321, 1006, 13534, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-15 09:52:49', '2021-01-15 09:52:49'),
(9322, 1006, 13534, NULL, '2021-01-22 00:00:00.000', 'Initiated', ' Application Tracking ID: T011520210000354        NPI: 1710576004        Medicare ID:         Name: JUSTIN  SOULIERE          State: RI        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.                 INDIANAPOLIS,IN,46207-7149', NULL, NULL, '2021-01-15 09:52:56', '2021-01-15 09:52:56'),
(9323, 1006, 13534, NULL, '2021-01-29 00:00:00.000', 'Approved', 'Application Tracking ID: T011520210000354   NPI ID: 1710576004   Medicare ID: U400717326   Name: JUSTIN SOULIERE  State: RI   Form Type: 855I  Date: 01/22/2021  Status: APPROVED', NULL, NULL, '2021-01-22 15:19:52', '2021-01-22 15:19:52'),
(9324, 3040, 13535, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-15 15:12:06', '2021-01-15 15:12:06'),
(9325, 3040, 13535, NULL, '2021-01-22 00:00:00.000', 'Initiated', 'Provider on boarding form submitted online.   See attachments', NULL, NULL, '2021-01-15 15:12:43', '2021-01-15 15:12:43'),
(9326, 3040, 13535, NULL, '2021-01-22 00:00:00.000', 'In Process', 'This email is confirmation we have received your request, case number 02140379, for COASTAL BEND URGENT CARE LLC.', NULL, NULL, '2021-01-15 16:05:24', '2021-01-15 16:05:24'),
(9327, 3040, 13535, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Still in progress.', NULL, NULL, '2021-01-25 10:49:00', '2021-01-25 10:49:00'),
(9328, 3040, 13535, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.  Practice 1:  Practice Name: Coastal Bend Urgent Care, LLC Practice NPI#  1427509264 Practice Tax ID# 81-1890349 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Practice NPI#  1427509264 Practice Tax ID# 81-1890349 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider: Provider Name: Paterson, Katherine D Provider NPI# 1164776548  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-01 16:06:54', '2021-02-01 16:06:54'),
(9329, 3040, 13535, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || BCBS || : Case Number - 02184197  Greetings,  Hope you are doing well. Please find the attached provider on boarding form for Paterson, Katherine D. We already submitted the provider on boarding form on 01/15/2021.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-08 12:56:50', '2021-02-08 12:56:50'),
(9330, 3040, 13535, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Email rcvd from: provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || BCBS || : Case Number - 02184197  Good Afternoon Adil,  Thank you for your email. K.Paterson is currently under tax ID 811890349 under both addresses. She is out of network when it comes to plans. Here is the link to join our network to start the process to get her signed up with health plans.  https://www.bcbstx.com/provider/network/network_participation.html  Thanks,  Mona Dixon', NULL, NULL, '2021-02-08 12:57:36', '2021-02-08 12:57:36'),
(9331, 3040, 13535, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Email sent to; provider_relations_houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Re: Enrollment Status || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || BCBS ||    Greetings,  I just wanted to follow up regarding the enrollment status of the below mentioned provider. Application was submitted on 01/15/2021.  Practice 1:  Practice Name: Coastal Bend Urgent Care, LLC Practice NPI#  1427509264 Practice Tax ID# 81-1890349 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324   Practice 2: Practice Name: George West Medical Clinic Practice NPI#  1427509264 Practice Tax ID# 81-1890349 Practice Address: 504A Houston Street George West , TX 78022-3663   Provider: Provider Name: Paterson, Katherine D Provider NPI# 1164776548  Please get back to me as soon as you can get the chance. Waiting for your response.   Thanks', NULL, NULL, '2021-02-15 10:56:19', '2021-02-15 10:56:19'),
(9332, 3040, 13535, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Email rcvd from: provider_relations_south_texas@bcbstx.com  Subject: Enrollment Status || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || BCBS || : Case Number - 02184196  Hello,  The provider in question, is currently non-participating with the group.  The Provider On-Boarding request, is still in processing.  Sincerely,  Network Management Southwest Region Blue Cross Blue Shield of Texas ', NULL, NULL, '2021-02-22 10:09:37', '2021-02-22 10:09:37'),
(9333, 3046, 13535, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email sent to: rovider_relations_houston@bcbstx.com; tx_standard_contracting_team@bcbstx.com Subject: Enrollment Status || Paterson, Katherine D || Coastal Bend Urgent Care & George West Medical Clinic || BCBS ||  Hello Katherine,  Hello,  Hope my email finds you well. I would like to request for the enrollment status for the below mentioned provider, I would also like to make a note here that the application was submitted on 01/15/2021.  Practice 1:Practice Name: Coastal Bend Urgent Care, LLC Practice NPI#  1427509264 Practice Tax ID# 81-1890349 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324   Practice 2: Practice Name: George West Medical Clinic Practice NPI#  1427509264 Practice Tax ID# 81-1890349 Practice Address: 504A Houston Street George West , TX 78022-3663   Provider: Provider Name: Paterson, Katherine D Provider NPI# 1164776548  Your quick response in this regard is highly appreciated.  Thank you', NULL, NULL, '2021-03-02 10:05:34', '2021-03-02 10:05:34'),
(9334, 3046, 13535, NULL, '2021-03-10 00:00:00.000', 'Approved', 'Received an approval email from tx_standard_contracting_team@bcbstx.com. Also, please find the attached roster effective date 02/23/2021.', NULL, NULL, '2021-03-03 15:19:42', '2021-03-03 15:19:42'),
(9335, 3040, 13536, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-15 15:12:36', '2021-01-15 15:12:36'),
(9336, 3040, 13536, NULL, '2021-01-22 00:00:00.000', 'Initiated', 'Provider on boarding form submitted online.   See attachments', NULL, NULL, '2021-01-15 15:13:12', '2021-01-15 15:13:12'),
(9337, 3040, 13536, NULL, '2021-01-22 00:00:00.000', 'In Process', 'This email is confirmation we have received your request, case number 02140379, for COASTAL BEND URGENT CARE LLC.', NULL, NULL, '2021-01-15 16:05:32', '2021-01-15 16:05:32'),
(9338, 3040, 13536, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-01-22 12:10:22', '2021-01-22 12:10:22'),
(9339, 3040, 13536, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.  Practice 1:  Practice Name: Coastal Bend Urgent Care, LLC Practice NPI#  1427509264 Practice Tax ID# 81-1890349 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Practice NPI#  1427509264 Practice Tax ID# 81-1890349 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider: Provider Name: Paterson, Katherine D Provider NPI# 1164776548  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-01 16:07:05', '2021-02-01 16:07:05'),
(9340, 3040, 13536, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || BCBS || : Case Number - 02184197  Greetings,  Hope you are doing well. Please find the attached provider on boarding form for Paterson, Katherine D. We already submitted the provider on boarding form on 01/15/2021.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-08 12:56:57', '2021-02-08 12:56:57'),
(9341, 3040, 13536, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Email rcvd from: provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || BCBS || : Case Number - 02184197  Good Afternoon Adil,  Thank you for your email. K.Paterson is currently under tax ID 811890349 under both addresses. She is out of network when it comes to plans. Here is the link to join our network to start the process to get her signed up with health plans.  https://www.bcbstx.com/provider/network/network_participation.html  Thanks,  Mona Dixon', NULL, NULL, '2021-02-08 12:57:41', '2021-02-08 12:57:41');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(9342, 3040, 13536, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Email sent to; provider_relations_houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Re: Enrollment Status || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || BCBS ||    Greetings,  I just wanted to follow up regarding the enrollment status of the below mentioned provider. Application was submitted on 01/15/2021.  Practice 1:  Practice Name: Coastal Bend Urgent Care, LLC Practice NPI#  1427509264 Practice Tax ID# 81-1890349 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324   Practice 2: Practice Name: George West Medical Clinic Practice NPI#  1427509264 Practice Tax ID# 81-1890349 Practice Address: 504A Houston Street George West , TX 78022-3663   Provider: Provider Name: Paterson, Katherine D Provider NPI# 1164776548  Please get back to me as soon as you can get the chance. Waiting for your response.   Thanks', NULL, NULL, '2021-02-15 10:56:27', '2021-02-15 10:56:27'),
(9343, 3040, 13536, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Email rcvd from: provider_relations_south_texas@bcbstx.com  Subject: Enrollment Status || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || BCBS || : Case Number - 02184196  Hello,  The provider in question, is currently non-participating with the group.  The Provider On-Boarding request, is still in processing.  Sincerely,  Network Management Southwest Region Blue Cross Blue Shield of Texas ', NULL, NULL, '2021-02-22 10:09:39', '2021-02-22 10:09:39'),
(9344, 3046, 13536, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email sent to; provider_relations_houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Re: Enrollment Status || Paterson, Katherine D || Coastal Bend Urgent Care, LLC & George West Medical Clinic || BCBS ||    Greetings, Hope my email finds you in good health. I would like to request that I am sending you this email in regards to the enrollment update status for below mentioned providers, I would also like to make a note here that the application was submitted on 01/15/2021.  Practice 1:  Practice Name: Coastal Bend Urgent Care, LLC Practice NPI#  1427509264 Practice Tax ID# 81-1890349 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324   Practice 2: Practice Name: George West Medical Clinic Practice NPI#  1427509264 Practice Tax ID# 81-1890349 Practice Address: 504A Houston Street George West , TX 78022-3663   Provider: Provider Name: Paterson, Katherine D Provider NPI# 1164776548  Your quick response in this regard is highly appreciated. Thank you. ', NULL, NULL, '2021-03-02 10:31:00', '2021-03-02 10:31:00'),
(9345, 3046, 13536, NULL, '2021-03-10 00:00:00.000', 'Approved', 'Received an approval email from tx_standard_contracting_team@bcbstx.com. Also, please find the attached roster effective date 02/23/2021.', NULL, NULL, '2021-03-03 15:20:02', '2021-03-03 15:20:02'),
(9346, 3040, 13537, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-15 16:32:44', '2021-01-15 16:32:44'),
(9347, 3040, 13537, NULL, '2021-01-22 00:00:00.000', 'Initiated', 'Email sent to:	networkhelp@uhc.com  Subject: Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic || Paterson, Katherine D || UHC ||  Greetings,  Hope you are doing well. Please find below the information for practice and providers for enrollment in United Health care for our group Coastal Bend Urgent Care, LLC and George West Medical Clinic.  Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663   Provider Information: Provider Name: Katherine D Paterson Provider NPI# 1164776548  If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thanks.', NULL, NULL, '2021-01-15 16:33:42', '2021-01-15 16:33:42'),
(9348, 3040, 13537, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Request For Participation Form submitted online. ', NULL, NULL, '2021-01-18 10:32:16', '2021-01-18 10:32:16'),
(9349, 3040, 13537, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up Email sent to: networkhelp@uhc.com  Subject: Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic || Paterson, Katherine D || UHC ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider. I already submitted the Participation Request form as requested in your previous email.   Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider Information: Provider Name: Katherine D Paterson Provider NPI# 1164776548  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-25 10:55:33', '2021-01-25 10:55:33'),
(9350, 3040, 13537, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic || Paterson, Katherine D || UHC ||  Good Afternoon,  Thank you for contacting the Network Management Resource Team. A provider has to first meet the criteria for credentialing before contracting can begin. In order to credential this provider, please first make sure that the provider\'s CAQH application is up to date and has been attested. Next, submit this request electronically via the following hyperlink: https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html.   Onboard Pro is not yet available to all participating medical groups. To find out if your TIN is eligible, go to the Request for Participation (RFP) After entering your TIN, you’ll either be rerouted to Onboard Pro or you’ll complete your request in RFP. Please see the attached FAQ.  Please let us know if we can assist further via email.  This was sent by a general email box. \"Reply\" messages are automatically deleted and will not receive a response. Please direct all replies, questions, or concerns to Network Management to Networkhelp@uhc.com', NULL, NULL, '2021-01-25 10:56:36', '2021-01-25 10:56:36'),
(9351, 3040, 13537, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Email rcvd from: national_credentialing@uhc.com  Subject: Credentialing Application  MPIN#: 3679009  Re: We’re Ready to Review Your Credentialing Application  Dear KATHERINE PATERSON:  Thank you for your interest in joining the UnitedHealthcare network. We’ve received your completed application and will now begin verifying your credentials. Here’s what you need to know about the next steps:', NULL, NULL, '2021-01-25 14:51:42', '2021-01-25 14:51:42'),
(9352, 3040, 13537, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from tammye_bosley@uhc.com  Thank you for contacting the Network Management Resource Team. A provider has to first meet the criteria for credentialing before contracting can begin. In order to credential this provider, please first make sure that the provider\'s CAQH application is up to date and has been attested. Next, submit this request electronically via the following hyperlink: https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html.    Onboard Pro is not yet available to all participating medical groups. To find out if your TIN is eligible, go to the Request for Participation (RFP) After entering your TIN, you’ll either be rerouted to Onboard Pro or you’ll complete your request in RFP. Please see the attached FAQ.   Please note:  Credentialing may take up to 60 days and Contracting May take up to 60 days.  For questions related to credentialing, benefits or claim status, please utilize www.uhcprovider.com  Please let us know if we can assist further via email. ', NULL, NULL, '2021-01-25 15:10:31', '2021-01-25 15:10:31'),
(9353, 3040, 13537, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Follow up email sent to: networkhelp@uhc.com  Subject: Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic || Paterson, Katherine D || UHC ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. I already submitted the Participation Request form as requested in your previous email.  Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider Information: Provider Name: Katherine D Paterson Provider NPI# 1164776548  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-01 13:26:06', '2021-02-01 13:26:06'),
(9354, 3040, 13537, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email rcvd from: national_credentialing@uhc.com  Subject: Request for Credentialing  1/29/2021  Katherine Paterson adil@claimsmedinc.com MPIN#: 3679009  Re: Duplicate Request for Credentialing Dear Katherine Paterson: We’re letting you know that we recently received a duplicate credentialing request for you. Our National Credentialing Center is already reviewing your credentialing application and verifying your credentials. What happens next? We’ll disregard the duplicate credentialing request and continue with our current credentialing review. Here’s what you need to know about the next steps:', NULL, NULL, '2021-02-01 13:39:38', '2021-02-01 13:39:38'),
(9355, 3040, 13537, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic || Paterson, Katherine D || UHC ||  Good Afternoon,  Thank you for contacting the Network Management Resource Team.  Your provider KATHERINE D PATERSON credentialing was started on 01/22/21 and is still in process. Credentialing can take 25-30 days and if approved will be sent to contracting that can take up to 30-45 business days.  Please let us know if we can assist further via email.', NULL, NULL, '2021-02-08 12:47:38', '2021-02-08 12:47:38'),
(9356, 3040, 13537, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-15 11:02:41', '2021-02-15 11:02:41'),
(9357, 3040, 13537, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject:  Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic || Paterson, Katherine D || UHC ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned provider.   Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider Information: Provider Name: Katherine D Paterson Provider NPI# 1164776548  Please get back to me as soon as you can get a chance. Waiting for your response.  Thanks ', NULL, NULL, '2021-02-22 10:15:00', '2021-02-22 10:15:00'),
(9358, 3046, 13537, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic || Paterson, Katherine D || UHC ||  Greetings, Hope my email finds you well. I would like to request for the enrollment status for the below mentioned provider: Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider Information: Provider Name: Katherine D Paterson Provider NPI# 1164776548 Your prompt reply would be highly appreciated. Thanks ', NULL, NULL, '2021-03-02 10:36:53', '2021-03-02 10:36:53'),
(9359, 3046, 13537, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Hello  Hope you are doing well.  Kindly advise the enrollment status for the enrollment for the below mentioned provider:  Provider Details: Provider Full Name: Paterson, Katherine D NPI: 1164776548  Practice Details 1: Practice Name: Coastal Bend Urgent Care Practice Tax-ID: 81-1890349 Practice NPI: 1427509264 Practice Address: 01 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Details 2: Practice Name: George West Medical Clinic Practice Tax-ID: 81-1890349 Practice NPI: 1427509264 Practice Address: 504A Houston Street, Live Oak County, George West , TX 78022-3663  Your quick response in this regard will be highly appreciated.  Thank you.', NULL, NULL, '2021-03-10 15:35:38', '2021-03-10 15:35:38'),
(9360, 3046, 13537, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com Subject: Request forRequest for Enrollment Status || Katherine D Paterson || CBUC & GWMC || MultiPlan ||  Greetings Hope my email finds you well. Kindly advise the updated enrollment status of the below mentioned provider which was submitted online.  Please note that the MultiPlan Service Case Number is 7527268: Practice 1 Details: Name: Coastal Bend Urgent Care NPI:     1427509264 Tax ID: 81-1890349 Address: 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Practice 2 Details: Name: George West Medical Clinic NPI:     1427509264 Tax ID: 81-1890349 Address: 504A Houston Street Live Oak County George West , TX 78022-3663 Provider Details:  Name: Katherine D  Paterson NPI:    1164776548  Your quick response in this regard is highly appreciated. Thank you', NULL, NULL, '2021-03-19 13:11:15', '2021-03-19 13:11:15'),
(9361, 1006, 13537, NULL, '2021-05-03 00:00:00.000', 'In Process', 'We received the following email from United_Healthcare_Provider_Operations@uhc.com:  Sub: Secure message from United_Healthcare_Provider_Operations@uhc.com  \"UnitedHealthcare Insurance Company  Good news! We’ve completed the provider/group updates you requested on Mar 9, 2021 4:15:24 AM. Your request was assigned reference number PR-5780573 .  Please see the attached report for details. For your convenience, your original submission is also attached.  For questions pertaining to this communication, contact us at submission_inquiry@uhc.com.  Please include the reference number in the subject line of your email.  Thank you. UnitedHealthcare Provider Operations *--SecureDelivery--* PLEASE DO NOT REPLY TO THIS EMAIL ADDRESS Doc#: PCA-3-19-00360-PO-EM_07262019 © 2019 United HealthCare Services, Inc.\"', NULL, NULL, '2021-04-26 08:04:56', '2021-04-26 08:04:56'),
(9362, 1006, 13537, NULL, '2021-05-25 00:00:00.000', 'In Process', 'We received the following update from UHC:  \"5/17/2021  KATHERINE PATERSON cbuc@claimsmedinc.com  Re: Status on Your Request to Join Our Network and Next Steps  Dear KATHERINE PATERSON:  Thank you for your interest in joining the UnitedHealthcare network. Here\'s an update on your request:  Activity	Status Step 1 – Credentialing Review	Completed on 5/14/2021. We’ve verified that you meet UnitedHealthcare’s basic credentialing requirements. Step 2 – Contract Loaded	Pending. We’ll be in touch if we need any additional information to complete your contract or add you to an existing contract. Step 3 – Ready to See Patients	Pending. We’ll notify you of the date you can begin seeing patients as a network provider.\"', NULL, NULL, '2021-05-18 08:58:49', '2021-05-18 08:58:49'),
(9363, 1006, 13537, NULL, '2021-06-16 00:00:00.000', 'Approved', 'The provider is approved with UHC now, UHC roster is attached for confirmation and the plans are listed on it.', NULL, NULL, '2021-06-09 13:47:06', '2021-06-09 13:47:06'),
(9364, 3040, 13538, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-15 16:33:52', '2021-01-15 16:33:52'),
(9365, 3040, 13538, NULL, '2021-01-22 00:00:00.000', 'Initiated', 'Email sent to:	networkhelp@uhc.com  Subject: Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic || Paterson, Katherine D || UHC ||  Greetings,  Hope you are doing well. Please find below the information for practice and providers for enrollment in United Health care for our group Coastal Bend Urgent Care, LLC and George West Medical Clinic.  Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663   Provider Information: Provider Name: Katherine D Paterson Provider NPI# 1164776548  If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thanks.', NULL, NULL, '2021-01-15 16:34:04', '2021-01-15 16:34:04'),
(9366, 3040, 13538, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Request For Participation Form submitted online. ', NULL, NULL, '2021-01-18 10:32:11', '2021-01-18 10:32:11'),
(9367, 3040, 13538, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up Email sent to: networkhelp@uhc.com  Subject: Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic || Paterson, Katherine D || UHC ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider. I already submitted the Participation Request form as requested in your previous email.   Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider Information: Provider Name: Katherine D Paterson Provider NPI# 1164776548  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-25 10:55:25', '2021-01-25 10:55:25'),
(9368, 3040, 13538, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic || Paterson, Katherine D || UHC ||  Good Afternoon,  Thank you for contacting the Network Management Resource Team. A provider has to first meet the criteria for credentialing before contracting can begin. In order to credential this provider, please first make sure that the provider\'s CAQH application is up to date and has been attested. Next, submit this request electronically via the following hyperlink: https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html.   Onboard Pro is not yet available to all participating medical groups. To find out if your TIN is eligible, go to the Request for Participation (RFP) After entering your TIN, you’ll either be rerouted to Onboard Pro or you’ll complete your request in RFP. Please see the attached FAQ.  Please let us know if we can assist further via email.  This was sent by a general email box. \"Reply\" messages are automatically deleted and will not receive a response. Please direct all replies, questions, or concerns to Network Management to Networkhelp@uhc.com', NULL, NULL, '2021-01-25 10:56:31', '2021-01-25 10:56:31'),
(9369, 3040, 13538, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Email rcvd from: national_credentialing@uhc.com  Subject: Credentialing Application  MPIN#: 3679009  Re: We’re Ready to Review Your Credentialing Application  Dear KATHERINE PATERSON:  Thank you for your interest in joining the UnitedHealthcare network. We’ve received your completed application and will now begin verifying your credentials. Here’s what you need to know about the next steps:', NULL, NULL, '2021-01-25 14:51:31', '2021-01-25 14:51:31'),
(9370, 3040, 13538, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from tammye_bosley@uhc.com  Thank you for contacting the Network Management Resource Team. A provider has to first meet the criteria for credentialing before contracting can begin. In order to credential this provider, please first make sure that the provider\'s CAQH application is up to date and has been attested. Next, submit this request electronically via the following hyperlink: https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html.    Onboard Pro is not yet available to all participating medical groups. To find out if your TIN is eligible, go to the Request for Participation (RFP) After entering your TIN, you’ll either be rerouted to Onboard Pro or you’ll complete your request in RFP. Please see the attached FAQ.   Please note:  Credentialing may take up to 60 days and Contracting May take up to 60 days.  For questions related to credentialing, benefits or claim status, please utilize www.uhcprovider.com  Please let us know if we can assist further via email. ', NULL, NULL, '2021-01-25 15:10:02', '2021-01-25 15:10:02'),
(9371, 3040, 13538, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Follow up email sent to: networkhelp@uhc.com  Subject: Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic || Paterson, Katherine D || UHC ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. I already submitted the Participation Request form as requested in your previous email.  Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider Information: Provider Name: Katherine D Paterson Provider NPI# 1164776548  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-01 13:25:43', '2021-02-01 13:25:43'),
(9372, 3040, 13538, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Email rcvd from: national_credentialing@uhc.com  Subject: Request for Credentialing  1/29/2021  Katherine Paterson adil@claimsmedinc.com MPIN#: 3679009  Re: Duplicate Request for Credentialing Dear Katherine Paterson: We’re letting you know that we recently received a duplicate credentialing request for you. Our National Credentialing Center is already reviewing your credentialing application and verifying your credentials. What happens next? We’ll disregard the duplicate credentialing request and continue with our current credentialing review. Here’s what you need to know about the next steps:', NULL, NULL, '2021-02-01 13:39:16', '2021-02-01 13:39:16'),
(9373, 3040, 13538, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic || Paterson, Katherine D || UHC ||  Good Afternoon,  Thank you for contacting the Network Management Resource Team.  Your provider KATHERINE D PATERSON credentialing was started on 01/22/21 and is still in process. Credentialing can take 25-30 days and if approved will be sent to contracting that can take up to 30-45 business days.  Please let us know if we can assist further via email.', NULL, NULL, '2021-02-08 12:47:32', '2021-02-08 12:47:32'),
(9374, 3040, 13538, NULL, '2021-02-22 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-15 11:02:36', '2021-02-15 11:02:36'),
(9375, 3040, 13538, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject:  Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic || Paterson, Katherine D || UHC ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned provider.   Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider Information: Provider Name: Katherine D Paterson Provider NPI# 1164776548  Please get back to me as soon as you can get a chance. Waiting for your response.  Thanks ', NULL, NULL, '2021-02-22 10:14:50', '2021-02-22 10:14:50'),
(9376, 3046, 13538, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com Subject:  Enrollment || Coastal Bend Urgent Care, LLC, George West Medical Clinic ||  Paterson, Katherine D || UHC ||  Hello, Hope my email finds you in good health. I would like to request you that I am sending you this email in regards to the enrollment update status for below mentioned provider: Practice 1: Practice Name: Coastal Bend Urgent Care, LLC Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice 2: Practice Name: George West Medical Clinic Practice NPI# 1427509264 Practice Tax ID# 81-1890349 Address: 504A Houston Street George West , TX 78022-3663  Provider Information: Provider Name: Katherine D Paterson Provider NPI# 1164776548  I hope to hear from you soon. Thanks ', NULL, NULL, '2021-03-02 10:13:35', '2021-03-02 10:13:35'),
(9377, 3046, 13538, NULL, '2021-03-16 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com Subject: Request for Enrollment Status || Paterson, Katherine D || CBUC & GWC || UHC ||  Hello Hope you are doing well. Kindly advise the enrollment status for the enrollment for the below mentioned provider:  Provider Details: Provider Full Name: Paterson, Katherine D NPI: 1164776548  Practice Details 1: Practice Name: Coastal Bend Urgent Care Practice Details: Tax-ID: 81-1890349 Practice NPI: 1427509264 Practice Address: 01 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Practice Details 2: Practice Name: George West Medical Clinic Practice Tax-ID: 81-1890349 Practice NPI: 1427509264 Practice Address: 504A Houston Street, Live Oak County, George West , TX 78022-3663 Your quick response in this regard will be highly appreciated. Thank you.', NULL, NULL, '2021-03-09 12:24:42', '2021-03-09 12:24:42'),
(9378, 3046, 13538, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com Subject: Request forRequest for Enrollment Status || Katherine D Paterson || CBUC & GWMC || MultiPlan ||  Greetings Hope my email finds you well. Kindly advise the updated enrollment status of the below mentioned provider which was submitted online.  Please note that the MultiPlan Service Case Number is 7527268: Practice 1 Details: Name: Coastal Bend Urgent Care NPI:     1427509264 Tax ID: 81-1890349 Address: 301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Practice 2 Details: Name: George West Medical Clinic NPI:     1427509264 Tax ID: 81-1890349 Address: 504A Houston Street Live Oak County George West , TX 78022-3663 Provider Details:  Name: Katherine D  Paterson NPI:    1164776548  Your quick response in this regard is highly appreciated. Thank you', NULL, NULL, '2021-03-18 16:57:26', '2021-03-18 16:57:26'),
(9379, 1006, 13538, NULL, '2021-05-03 00:00:00.000', 'In Process', 'We received the following email from United_Healthcare_Provider_Operations@uhc.com:  Sub: Secure message from United_Healthcare_Provider_Operations@uhc.com  \"UnitedHealthcare Insurance Company  Good news! We’ve completed the provider/group updates you requested on Mar 9, 2021 4:15:24 AM. Your request was assigned reference number PR-5780573 .  Please see the attached report for details. For your convenience, your original submission is also attached.  For questions pertaining to this communication, contact us at submission_inquiry@uhc.com.  Please include the reference number in the subject line of your email.  Thank you. UnitedHealthcare Provider Operations *--SecureDelivery--* PLEASE DO NOT REPLY TO THIS EMAIL ADDRESS Doc#: PCA-3-19-00360-PO-EM_07262019 © 2019 United HealthCare Services, Inc.\"', NULL, NULL, '2021-04-26 08:04:52', '2021-04-26 08:04:52'),
(9380, 1006, 13538, NULL, '2021-05-25 00:00:00.000', 'In Process', 'We received the following update from UHC:  \"5/17/2021  KATHERINE PATERSON cbuc@claimsmedinc.com  Re: Status on Your Request to Join Our Network and Next Steps  Dear KATHERINE PATERSON:  Thank you for your interest in joining the UnitedHealthcare network. Here\'s an update on your request:  Activity	Status Step 1 – Credentialing Review	Completed on 5/14/2021. We’ve verified that you meet UnitedHealthcare’s basic credentialing requirements. Step 2 – Contract Loaded	Pending. We’ll be in touch if we need any additional information to complete your contract or add you to an existing contract. Step 3 – Ready to See Patients	Pending. We’ll notify you of the date you can begin seeing patients as a network provider.\"', NULL, NULL, '2021-05-18 08:58:35', '2021-05-18 08:58:35'),
(9381, 1006, 13538, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ NMRT networkhelp@uhc.com:  Sub: Enrollment Status - CBUC - UHC  \"Hello,  I wanted to get an update regarding the enrollment status for the following providers under the mentioned group:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  Provider Name: Katherine Paterson NPI# 1164776548  Please get back to me as soon as possible.  Thank you. \'', NULL, NULL, '2021-06-04 14:59:51', '2021-06-04 14:59:51'),
(9382, 1006, 13538, NULL, '2021-06-16 00:00:00.000', 'Approved', 'The provider is approved with UHC now, UHC roster is attached for confirmation and the plans are listed on it.', NULL, NULL, '2021-06-09 13:46:56', '2021-06-09 13:46:56'),
(9383, 3040, 13539, NULL, NULL, 'New/Not Initiated', ' ', NULL, NULL, '2021-01-18 17:14:08', '2021-01-18 17:14:08'),
(9384, 3040, 13539, NULL, '2021-01-25 00:00:00.000', 'Initiated', 'Request initiated online.   Service Case Number:	7482785', NULL, NULL, '2021-01-18 17:14:52', '2021-01-18 17:14:52'),
(9385, 3040, 13539, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Add Provider in Group Contract || Lira, Arturo Alejandro || Valley Med Urgent Care || Multiplan ||  Greetings,  Hope you are doing well. Please find the attached link letter for linking the provider with Multiplan with an existing In-network Tax-ID.    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-01-26 13:51:59', '2021-01-26 13:51:59'),
(9386, 3040, 13539, NULL, '2021-02-16 00:00:00.000', 'In Process', 'I had a word with (Anna) Multiplan representative and she advised they received the Link letter and application is still in process.  Will take 60 Business days.', NULL, NULL, '2021-02-02 12:29:04', '2021-02-02 12:29:04'),
(9387, 3040, 13539, NULL, '2021-03-09 00:00:00.000', 'In Process', 'I had a word with (Multiplan) representative and she said the application received on 02/12/21 and it will take 60 business days. ', NULL, NULL, '2021-02-16 15:31:14', '2021-02-16 15:31:14'),
(9388, 3040, 13539, NULL, '2021-03-16 00:00:00.000', 'Approved', 'Email rcvd from: notification@multiplan-secure.com  Subject: SECURE: MultiPlan Network Participation (13896453-9876749)  Dear Provider:  Welcome! Your application has been processed, effective 2/10/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks.', NULL, NULL, '2021-03-09 10:33:33', '2021-03-09 10:33:33'),
(9389, 3040, 13540, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-18 17:15:13', '2021-01-18 17:15:13'),
(9390, 3040, 13540, NULL, '2021-01-25 00:00:00.000', 'Initiated', 'Request initiated online.   Service Case Number:	7482785', NULL, NULL, '2021-01-18 17:15:28', '2021-01-18 17:15:28'),
(9391, 3040, 13540, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Add Provider in Group Contract || Lira, Arturo Alejandro || Valley Med Urgent Care || Multiplan ||  Greetings,  Hope you are doing well. Please find the attached link letter for linking the provider with Multiplan with an existing In-network Tax-ID.    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-01-26 13:51:52', '2021-01-26 13:51:52'),
(9392, 3040, 13540, NULL, '2021-02-09 00:00:00.000', 'In Process', 'I had a word with (Anna) Multiplan representative and she advised they received the Link letter and application is still in process.  Will take 60 Business days.', NULL, NULL, '2021-02-02 12:30:53', '2021-02-02 12:30:53'),
(9393, 3040, 13540, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-09 10:28:35', '2021-02-09 10:28:35'),
(9394, 3040, 13540, NULL, '2021-03-09 00:00:00.000', 'In Process', 'I had a word with (Multiplan) representative and she said the application received on 02/12/21 and it will take 60 business days. ', NULL, NULL, '2021-02-16 15:31:01', '2021-02-16 15:31:01'),
(9395, 3040, 13540, NULL, '2021-03-16 00:00:00.000', 'Approved', 'Email rcvd from: notification@multiplan-secure.com  Subject: SECURE: MultiPlan Network Participation (13896453-9876749)  Dear Provider:  Welcome! Your application has been processed, effective 2/10/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks.', NULL, NULL, '2021-03-09 10:33:22', '2021-03-09 10:33:22'),
(9396, 3040, 13541, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-18 17:15:49', '2021-01-18 17:15:49'),
(9397, 3040, 13541, NULL, '2021-01-25 00:00:00.000', 'Initiated', 'Request initiated online.   Service Case Number:	7482785', NULL, NULL, '2021-01-18 17:16:02', '2021-01-18 17:16:02'),
(9398, 3040, 13541, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Add Provider in Group Contract || Lira, Arturo Alejandro || Valley Med Urgent Care || Multiplan ||  Greetings,  Hope you are doing well. Please find the attached link letter for linking the provider with Multiplan with an existing In-network Tax-ID.    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-01-26 13:52:04', '2021-01-26 13:52:04'),
(9399, 3040, 13541, NULL, '2021-02-09 00:00:00.000', 'In Process', 'I had a word with (Anna) Multiplan representative and she advised they received the Link letter and application is still in process.  Will take 60 Business days.', NULL, NULL, '2021-02-02 12:31:00', '2021-02-02 12:31:00'),
(9400, 3040, 13541, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-09 10:28:41', '2021-02-09 10:28:41'),
(9401, 3040, 13541, NULL, '2021-03-09 00:00:00.000', 'In Process', 'I had a word with (Multiplan) representative and she said the application received on 02/12/21 and it will take 60 business days. ', NULL, NULL, '2021-02-16 15:31:27', '2021-02-16 15:31:27'),
(9402, 3040, 13541, NULL, '2021-03-16 00:00:00.000', 'Approved', 'Email rcvd from: notification@multiplan-secure.com  Subject: SECURE: MultiPlan Network Participation (13896453-9876749)  Dear Provider:  Welcome! Your application has been processed, effective 2/10/2021 and we are pleased to have you join MultiPlan as a participating provider in our provider networks.', NULL, NULL, '2021-03-09 10:33:27', '2021-03-09 10:33:27'),
(9403, 3040, 13542, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-18 17:26:55', '2021-01-18 17:26:55'),
(9404, 3040, 13542, NULL, '2021-01-25 00:00:00.000', 'Initiated', 'Request initiated through online.   Service Case Number:	7482804', NULL, NULL, '2021-01-18 17:28:49', '2021-01-18 17:28:49'),
(9405, 3040, 13542, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Add Provider in Group Contract || Wright, Larry Donald || Valley Med Urgent Care || Multiplan ||  Greetings,  Hope you are doing well. Please find the attached link letter for linking the provider with Multiplan with an existing In-network Tax-ID.    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-26 13:49:14', '2021-01-26 13:49:14'),
(9406, 3040, 13542, NULL, '2021-02-09 00:00:00.000', 'In Process', 'I had a word (Anna) Multiplan representative and she said they didn\'t received the Link letter and requested to send it again.  ', NULL, NULL, '2021-02-02 13:20:54', '2021-02-02 13:20:54'),
(9407, 3040, 13542, NULL, '2021-02-16 00:00:00.000', 'Approved', 'Welcome letter received.  See attachment.', NULL, NULL, '2021-02-09 12:13:14', '2021-02-09 12:13:14'),
(9408, 3040, 13543, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-18 17:28:59', '2021-01-18 17:28:59'),
(9409, 3040, 13543, NULL, '2021-01-25 00:00:00.000', 'Initiated', 'Request initiated through online.   Service Case Number:	7482804', NULL, NULL, '2021-01-18 17:29:14', '2021-01-18 17:29:14'),
(9410, 3040, 13543, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Add Provider in Group Contract || Wright, Larry Donald || Valley Med Urgent Care || Multiplan ||  Greetings,  Hope you are doing well. Please find the attached link letter for linking the provider with Multiplan with an existing In-network Tax-ID.    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-01-26 13:49:06', '2021-01-26 13:49:06'),
(9411, 3040, 13543, NULL, '2021-02-09 00:00:00.000', 'In Process', 'I had a word (Anna) Multiplan representative and she said they didn\'t received the Link letter and requested to send it again.  ', NULL, NULL, '2021-02-02 12:34:35', '2021-02-02 12:34:35'),
(9412, 3040, 13543, NULL, '2021-02-16 00:00:00.000', 'Approved', 'Welcome letter received.  See attachment.', NULL, NULL, '2021-02-09 12:13:01', '2021-02-09 12:13:01'),
(9413, 3040, 13544, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-18 17:29:35', '2021-01-18 17:29:35'),
(9414, 3040, 13544, NULL, '2021-01-25 00:00:00.000', 'Initiated', 'Request initiated through online.   Service Case Number:	7482804', NULL, NULL, '2021-01-18 17:29:44', '2021-01-18 17:29:44'),
(9415, 3040, 13544, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Add Provider in Group Contract || Wright, Larry Donald || Valley Med Urgent Care || Multiplan ||  Greetings,  Hope you are doing well. Please find the attached link letter for linking the provider with Multiplan with an existing In-network Tax-ID.    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-26 13:49:19', '2021-01-26 13:49:19'),
(9416, 3040, 13544, NULL, '2021-02-09 00:00:00.000', 'In Process', 'I had a word with (Anna) Multiplan representative and she said they didn\'t received the Link Letter and requested to send it again.', NULL, NULL, '2021-02-02 12:35:41', '2021-02-02 12:35:41'),
(9417, 3040, 13544, NULL, '2021-02-16 00:00:00.000', 'Approved', 'Welcome letter received.  See attachment.', NULL, NULL, '2021-02-09 12:13:20', '2021-02-09 12:13:20'),
(9418, 3040, 13545, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-19 14:17:48', '2021-01-19 14:17:48'),
(9419, 3040, 13545, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Email sent to: Ryan.Gardner@multiplan.com,   macosta1@wellmed.net  Subject: Recredentialing Request for Eder Hernandez, PA  Greetings,  Hope you are doing well. Please find the attached information that you requested in your previous email.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks    ', NULL, NULL, '2021-01-19 14:18:48', '2021-01-19 14:18:48'),
(9420, 3040, 13545, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Email rcvd from: Ryan.Gardner@multiplan.com  Subject: Recredentialing Request for Eder Hernandez, PA  Good morning,  Attached to this e-mail is a request for missing information.  In order to continue the re-credentialing process for Mr. Eder Hernandez, we will need the provider’s hospital affiliation.  Please note: The provider must sign and date the attached form.  It would be greatly appreciated if you could review the attached documents and respond with the required information.  You can reply to this e-mail or fax 781-487-4993.  Thank you, ', NULL, NULL, '2021-01-19 14:19:42', '2021-01-19 14:19:42'),
(9421, 3040, 13545, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email sent to: Ryan.Gardner@multiplan.com  Subject: Re-credentialing Request for Eder Hernandez, PA  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166       Provider Name:  Eder Francisco Hernandez Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-26 14:26:25', '2021-01-26 14:26:25'),
(9422, 3040, 13545, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider enrolled with Multiplan.   Please see attachment. ', NULL, NULL, '2021-03-25 13:46:37', '2021-03-25 13:46:37'),
(9423, 1006, 13546, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-19 15:54:29', '2021-01-19 15:54:29'),
(9424, 1006, 13546, NULL, '2021-01-26 00:00:00.000', 'Initiated', 'Submitted enrollment request via UBH provider portal. Attached for reference. ', NULL, NULL, '2021-01-19 15:54:53', '2021-01-19 15:54:53'),
(9425, 1006, 13546, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Sent following follow-up email @ NMRT networkhelp@uhc.com: \"Hello,   I want to get an update regarding the enrollment status for the following provider as we submitted a TIN update form for the provider quite recently:   Provider Name: Lynnetta Loveland NPI# 1598163602 TIN# 83-4482753  Please let me know what the expected time-frame is for the completion of this request?  Thanks. \"', NULL, NULL, '2021-01-27 11:37:16', '2021-01-27 11:37:16'),
(9426, 1006, 13546, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Received a call from UBH requesting group address and phone/fax#, gave them to the rep.  Request# PR-5709964', NULL, NULL, '2021-02-02 11:10:09', '2021-02-02 11:10:09'),
(9427, 1006, 13546, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent another F/u @ NMRT networkhelp@uhc.com', NULL, NULL, '2021-02-12 17:05:14', '2021-02-12 17:05:14'),
(9428, 1006, 13546, NULL, '2021-02-22 00:00:00.000', 'Approved', 'Lynnetta is in-network with our group as of 01/01/2021. Approval confirmation attached for reference.   Ref# Chris N 02/15/2021', NULL, NULL, '2021-02-15 13:13:57', '2021-02-15 13:13:57'),
(9429, 3040, 13547, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-19 16:43:12', '2021-01-19 16:43:12'),
(9430, 3040, 13547, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Hope you are doing well. Please find the attached the group roaster and contract coversheet along with the documents that you requested in your previous email.  If I add the provider in the contract so that provider will be In-network or out of network?  If you need any additional information please feel free to call or email me. Waiting to hear from you.  Thanks', NULL, NULL, '2021-01-19 16:43:45', '2021-01-19 16:43:45'),
(9431, 3040, 13547, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Email rcvd from: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Good afternoon Adil, Please complete the group roster, contract coversheet ( indicate the group NPI number) and return both documents with a W9. As always, please insure CAQH is up to date and complete, and all information including CAQH and NPI information is correct. I see you have a NP within the group, do you want the provider added to the contract or do you wish the NP go through a credentialing process with panel. Please let me know when you return the documents. If you have any question, please let me know. Thank you.', NULL, NULL, '2021-01-19 16:44:06', '2021-01-19 16:44:06'),
(9432, 3040, 13547, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment of below mentioned providers. As per your previous email I sent all the requested documents.  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-26 12:58:20', '2021-01-26 12:58:20'),
(9433, 3040, 13547, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Good afternoon, Yes I have received your email and information, I will get to it as soon as possible. Thank you. ', NULL, NULL, '2021-01-26 14:51:49', '2021-01-26 14:51:49'),
(9434, 3040, 13547, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Follow up email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the group and providers mentioned below.  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  If its possible for you to advise me the time frame of processing. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-02 10:06:25', '2021-02-02 10:06:25'),
(9435, 3040, 13547, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  I will review by Friday, I currently have other requests that are head of yours. Thank you.', NULL, NULL, '2021-02-09 12:53:48', '2021-02-09 12:53:48'),
(9436, 3040, 13547, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Do you wish your NP go through credentialing process with panel assignment or do you simply want them added to the contract ?', NULL, NULL, '2021-02-09 12:54:53', '2021-02-09 12:54:53'),
(9437, 3040, 13547, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  I really appreciate your prompt response. The NP needs to be added to the agreement.  Let me know if you have any other questions.  Thanks', NULL, NULL, '2021-02-09 12:57:16', '2021-02-09 12:57:16'),
(9438, 3040, 13547, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Contracts were signed and they are effective 4/1/21.', NULL, NULL, '2021-02-10 16:41:50', '2021-02-10 16:41:50'),
(9439, 3040, 13547, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Hope you are doing well. Please advise me the effective date you gave me is for the both providers.  Thanks  ', NULL, NULL, '2021-02-17 17:47:58', '2021-02-17 17:47:58'),
(9440, 3040, 13547, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Waiting for the welcome letter.  Effective date: 04/01/2021', NULL, NULL, '2021-02-18 16:44:11', '2021-02-18 16:44:11'),
(9441, 3040, 13547, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Please refer the effective date of your contract which 4/1/21 for the TAX ID. Any services billed prior to your effective date will be out of network. Thank you. ', NULL, NULL, '2021-02-25 13:55:36', '2021-02-25 13:55:36');
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
(9442, 3040, 13547, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Can you please send me the executed contracts.  Thanks', NULL, NULL, '2021-02-25 13:56:19', '2021-02-25 13:56:19'),
(9443, 3040, 13547, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  I have sent you the contracts last week, the executed contracts were also sent to you when they were signed by my VP. You have 2 copies', NULL, NULL, '2021-02-25 13:57:02', '2021-02-25 13:57:02'),
(9444, 3040, 13547, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-04 15:51:18', '2021-03-04 15:51:18'),
(9445, 3040, 13547, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Hello Micheal,  Hope you are doing well. Can you please advise me when I will received the welcome letter as I received the executed contract and effective date 04/01/2021.   Thank you  ', NULL, NULL, '2021-03-05 16:42:53', '2021-03-05 16:42:53'),
(9446, 3040, 13547, NULL, '2021-03-15 00:00:00.000', 'Approved', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Good afternoon, The contract did not require credentialing so there is no welcome letter issued.', NULL, NULL, '2021-03-08 16:52:38', '2021-03-08 16:52:38'),
(9447, 3040, 13548, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-19 16:44:12', '2021-01-19 16:44:12'),
(9448, 3040, 13548, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Hope you are doing well. Please find the attached the group roaster and contract coversheet along with the documents that you requested in your previous email.  If I add the provider in the contract so that provider will be In-network or out of network?  If you need any additional information please feel free to call or email me. Waiting to hear from you.  Thanks', NULL, NULL, '2021-01-19 16:44:35', '2021-01-19 16:44:35'),
(9449, 3040, 13548, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Email rcvd from: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Good afternoon Adil, Please complete the group roster, contract coversheet ( indicate the group NPI number) and return both documents with a W9. As always, please insure CAQH is up to date and complete, and all information including CAQH and NPI information is correct. I see you have a NP within the group, do you want the provider added to the contract or do you wish the NP go through a credentialing process with panel. Please let me know when you return the documents. If you have any question, please let me know. Thank you.', NULL, NULL, '2021-01-19 16:45:02', '2021-01-19 16:45:02'),
(9450, 3040, 13548, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment of below mentioned providers. As per your previous email I sent all the requested documents.  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-26 12:58:35', '2021-01-26 12:58:35'),
(9451, 3040, 13548, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Good afternoon, Yes I have received your email and information, I will get to it as soon as possible. Thank you. ', NULL, NULL, '2021-01-26 14:52:00', '2021-01-26 14:52:00'),
(9452, 3040, 13548, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Follow up email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the group and providers mentioned below.  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  If its possible for you to advise me the time frame of processing. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-02 10:06:39', '2021-02-02 10:06:39'),
(9453, 3040, 13548, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Contract signed.   See attachment.', NULL, NULL, '2021-02-03 15:03:09', '2021-02-03 15:03:09'),
(9454, 3040, 13548, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Follow up email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of below mentioned providers.  Practice Name: Ladot Healthcare LLC Practice NPI# 1912502626 Practice Tax ID# 85-2432283 Address: 2577 Madison Avenue League City , TX 77573  Provider Name: Oladipo Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  Please get back to me once you get the chance. Waiting for your response.  Thanks', NULL, NULL, '2021-02-10 10:20:04', '2021-02-10 10:20:04'),
(9455, 3040, 13548, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Contracts were signed and they are effective 4/1/21.', NULL, NULL, '2021-02-10 16:42:01', '2021-02-10 16:42:01'),
(9456, 3040, 13548, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Greetings,  Hope you are doing well. Please advise me the effective date you gave me is for the both providers.  Thanks  ', NULL, NULL, '2021-02-17 17:48:14', '2021-02-17 17:48:14'),
(9457, 3040, 13548, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Waiting for the welcome letter.  Effective date: 04/01/2021', NULL, NULL, '2021-02-18 16:44:24', '2021-02-18 16:44:24'),
(9458, 3040, 13548, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-04 15:51:46', '2021-03-04 15:51:46'),
(9459, 3040, 13548, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Hello Micheal,  Hope you are doing well. Can you please advise me when I will received the welcome letter as I received the executed contract and effective date 04/01/2021.   Thank you  ', NULL, NULL, '2021-03-05 16:42:58', '2021-03-05 16:42:58'),
(9460, 3040, 13548, NULL, '2021-03-15 00:00:00.000', 'Approved', 'Email rcvd from: MDuffee@humana.com  Subject: Humana Contracting - Dada Oladipo Ayowole MD  Good afternoon, The contract did not require credentialing so there is no welcome letter issued.', NULL, NULL, '2021-03-08 16:52:50', '2021-03-08 16:52:50'),
(9461, 1006, 13549, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-20 14:20:11', '2021-01-20 14:20:11'),
(9462, 1006, 13549, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Reassignment request submitted via PECOS. ', NULL, NULL, '2021-01-20 14:20:36', '2021-01-20 14:20:36'),
(9463, 1006, 13549, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Received another deficiency, called to Kiffany @ 904-363-5406 for further clarification. ', NULL, NULL, '2021-01-28 17:36:37', '2021-01-28 17:36:37'),
(9464, 1006, 13549, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Need to wait for group reconsideration to be completed before we can move on with provider addition. ', NULL, NULL, '2021-03-15 12:04:22', '2021-03-15 12:04:22'),
(9465, 1006, 13549, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent following email @ medenroll@novitas-solutions.com:  \"Hello Natalie,   I appreciate the update, who would the owner need to email to rescind the appeal?   Thank you for the help.\"', NULL, NULL, '2021-03-23 10:43:15', '2021-03-23 10:43:15'),
(9466, 1006, 13549, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Sent another email @ medenroll@novitas-solutions.com:  Sub: Subject Replaced For Security Reasons (System Security)  \"Hello,   Please get back to me regarding my query as to whom the owner would need to email to rescind our appeal request?  Thank you.\"', NULL, NULL, '2021-04-05 17:08:56', '2021-04-05 17:08:56'),
(9467, 1006, 13549, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Sent following email to Dr. Jobi @ jobi ponraj drpjobiponraj@yahoo.com:  Sub: Medicare Appeal - Rescind Request  \"Hello Dr. Jobi,   As per my discussion with Medicare, you will need to send an email to NovitasJHPEAppeals@novitas-solutions.com with reference number: 610439000 requesting to rescind the appeal that we submitted to them. Please let me know once you\'ve done this, you should receive an email or mail informing you that it has been rescinded.   Thank you. \"', NULL, NULL, '2021-04-16 10:29:40', '2021-04-16 10:29:40'),
(9468, 1006, 13549, NULL, '2021-05-06 00:00:00.000', 'In Process', 'I resubmitted a reassignment request for the provider with the group. ', NULL, NULL, '2021-04-29 13:50:25', '2021-04-29 13:50:25'),
(9469, 1006, 13549, NULL, '2021-06-01 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: RAMEGOWDA BELAKERE Individual Specialty: FAMILY MEDICINE Individual National Provider Identifier (NPI): 1235166687 Individual Provider Transaction Access Number (PTAN): 1P5000 Group Legal Business Name (LBN): RIGHT STEP MEDICAL CENTER LLC Group NPI: 1063008084 Group PTAN: 1P4805 Reassignment Effective Date: FEBRUARY 01, 2021', NULL, NULL, '2021-05-25 08:23:14', '2021-05-25 08:23:14'),
(9470, 3040, 13550, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-20 16:55:43', '2021-01-20 16:55:43'),
(9471, 3040, 13550, NULL, '2021-01-27 00:00:00.000', 'Initiated', 'Provider Application form submitted online.  See attachments ', NULL, NULL, '2021-01-20 16:56:46', '2021-01-20 16:56:46'),
(9472, 3040, 13550, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. Please find the attached Individual Provider Contracting form as per the email received from Superior Health Plan.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-22 17:14:27', '2021-01-22 17:14:27'),
(9473, 3040, 13550, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 13:11:15', '2021-01-29 13:11:15'),
(9474, 3040, 13550, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello,  We received your completed application on (1.22.21).  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thanks  Felicia Napier', NULL, NULL, '2021-02-02 17:13:59', '2021-02-02 17:13:59'),
(9475, 3040, 13550, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-16 12:24:55', '2021-02-16 12:24:55'),
(9476, 3040, 13550, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Please get back to me as soon as you get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-23 13:49:35', '2021-02-23 13:49:35'),
(9477, 3040, 13550, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello  We received your completed application on 1/22/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan', NULL, NULL, '2021-03-02 14:32:57', '2021-03-02 14:32:57'),
(9478, 3040, 13550, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-12 15:51:02', '2021-03-12 15:51:02'),
(9479, 3040, 13550, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: Christiean.Gutierrez@superiorhealthplan.com,  Subject: Credentialing Request; LARRY WRIGHT_1033769765  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in the Superior Health plan for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details:  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 TertiaryAddress:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-04-14 15:17:39', '2021-04-14 15:17:39'),
(9480, 1006, 13550, NULL, '2021-04-26 00:00:00.000', 'In Process', 'We received the following update from Superior @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  \"Hello  We received your completed application on 1/22/2021. Your projected effective date is 5/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and a welcome packet will be sent.   Thank you, Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan\"', NULL, NULL, '2021-04-19 08:10:59', '2021-04-19 08:10:59'),
(9481, 3040, 13550, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan |  Hello,   Please advise me the enrollment status for the below mentioned provider. Application was received on 01/22/2021. Can you please send me the welcome letter.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Waiting for your response.   Thanks', NULL, NULL, '2021-05-05 08:31:37', '2021-05-05 08:31:37'),
(9482, 3040, 13550, NULL, '2021-05-12 00:00:00.000', 'Approved', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Subject: LARRY DONALD WRIGHT WELCOME LETTER  LARRY DONALD WRIGHT VALLEY MED URGENT CARE PLLC VMUC@CLAIMSMEDINC.COM  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:  05/01/2021                                                   C/ 48008', NULL, NULL, '2021-05-05 12:42:59', '2021-05-05 12:42:59'),
(9483, 3040, 13551, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-20 16:57:22', '2021-01-20 16:57:22'),
(9484, 3040, 13551, NULL, '2021-01-27 00:00:00.000', 'Initiated', 'Provider Application form submitted online.  See attachments ', NULL, NULL, '2021-01-20 16:57:29', '2021-01-20 16:57:29'),
(9485, 3040, 13551, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. Please find the attached Individual Provider Contracting form as per the email received from Superior Health Plan.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-22 17:14:32', '2021-01-22 17:14:32'),
(9486, 3040, 13551, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 13:10:33', '2021-01-29 13:10:33'),
(9487, 3040, 13551, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello,  We received your completed application on (1.22.21).  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thanks  Felicia Napier', NULL, NULL, '2021-02-02 17:14:09', '2021-02-02 17:14:09'),
(9488, 3040, 13551, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-02-09 10:24:43', '2021-02-09 10:24:43'),
(9489, 3040, 13551, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-16 12:25:01', '2021-02-16 12:25:01'),
(9490, 3040, 13551, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Please get back to me as soon as you get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-23 13:49:30', '2021-02-23 13:49:30'),
(9491, 3040, 13551, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello  We received your completed application on 1/22/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan', NULL, NULL, '2021-03-02 14:32:51', '2021-03-02 14:32:51'),
(9492, 3040, 13551, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-12 15:50:58', '2021-03-12 15:50:58'),
(9493, 3040, 13551, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: Christiean.Gutierrez@superiorhealthplan.com,  Subject: Credentialing Request; LARRY WRIGHT_1033769765  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in the Superior Health plan for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details:  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 TertiaryAddress:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-04-14 15:17:44', '2021-04-14 15:17:44'),
(9494, 1006, 13551, NULL, '2021-04-26 00:00:00.000', 'In Process', 'We received the following update from Superior @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  \"Hello  We received your completed application on 1/22/2021. Your projected effective date is 5/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and a welcome packet will be sent.   Thank you, Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan\" ', NULL, NULL, '2021-04-19 08:11:16', '2021-04-19 08:11:16'),
(9495, 3040, 13551, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan |  Hello,   Please advise me the enrollment status for the below mentioned provider. Application was received on 01/22/2021. Can you please send me the welcome letter.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Waiting for your response.   Thanks', NULL, NULL, '2021-05-05 08:31:41', '2021-05-05 08:31:41'),
(9496, 3040, 13551, NULL, '2021-05-12 00:00:00.000', 'Approved', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Subject: LARRY DONALD WRIGHT WELCOME LETTER  LARRY DONALD WRIGHT VALLEY MED URGENT CARE PLLC VMUC@CLAIMSMEDINC.COM  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:  05/01/2021                                                   C/ 48008', NULL, NULL, '2021-05-05 12:43:00', '2021-05-05 12:43:00'),
(9497, 3040, 13552, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-20 16:57:58', '2021-01-20 16:57:58'),
(9498, 3040, 13552, NULL, '2021-01-27 00:00:00.000', 'Initiated', 'Provider Application form submitted online.  See attachments ', NULL, NULL, '2021-01-20 16:58:04', '2021-01-20 16:58:04'),
(9499, 3040, 13552, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. Please find the attached Individual Provider Contracting form as per the email received from Superior Health Plan.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-22 17:14:36', '2021-01-22 17:14:36'),
(9500, 3040, 13552, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 13:11:27', '2021-01-29 13:11:27'),
(9501, 3040, 13552, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello,  We received your completed application on (1.22.21).  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thanks  Felicia Napier', NULL, NULL, '2021-02-02 17:14:18', '2021-02-02 17:14:18'),
(9502, 3040, 13552, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-16 12:25:07', '2021-02-16 12:25:07'),
(9503, 3040, 13552, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Please get back to me as soon as you get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-23 13:49:49', '2021-02-23 13:49:49'),
(9504, 3040, 13552, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello  We received your completed application on 1/22/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan', NULL, NULL, '2021-03-02 14:33:05', '2021-03-02 14:33:05'),
(9505, 3040, 13552, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-12 15:51:07', '2021-03-12 15:51:07'),
(9506, 3040, 13552, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: Christiean.Gutierrez@superiorhealthplan.com,  Subject: Credentialing Request; LARRY WRIGHT_1033769765  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in the Superior Health plan for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details:  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 TertiaryAddress:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-04-14 15:17:49', '2021-04-14 15:17:49'),
(9507, 1006, 13552, NULL, '2021-04-26 00:00:00.000', 'In Process', 'We received the following update from Superior @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan ||  \"Hello  We received your completed application on 1/22/2021. Your projected effective date is 5/1/2021. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and a welcome packet will be sent.   Thank you, Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan\" ', NULL, NULL, '2021-04-19 08:11:21', '2021-04-19 08:11:21'),
(9508, 3040, 13552, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || LARRY DONALD WRIGHT || Valley Med Urgent Care PLLC || Superior Health Plan |  Hello,   Please advise me the enrollment status for the below mentioned provider. Application was received on 01/22/2021. Can you please send me the welcome letter.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Waiting for your response.   Thanks', NULL, NULL, '2021-05-05 08:31:45', '2021-05-05 08:31:45'),
(9509, 3040, 13552, NULL, '2021-05-12 00:00:00.000', 'Approved', 'Email sent to: ECMExecutionTeam@superiorhealthplan.com  Subject: LARRY DONALD WRIGHT WELCOME LETTER  LARRY DONALD WRIGHT VALLEY MED URGENT CARE PLLC VMUC@CLAIMSMEDINC.COM  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:  05/01/2021                                                   C/ 48008', NULL, NULL, '2021-05-05 12:43:01', '2021-05-05 12:43:01'),
(9510, 3040, 13553, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-20 17:06:29', '2021-01-20 17:06:29'),
(9511, 3040, 13553, NULL, '2021-01-27 00:00:00.000', 'Initiated', 'Provider Application submitted online.  See attachments', NULL, NULL, '2021-01-20 17:07:04', '2021-01-20 17:07:04'),
(9512, 3040, 13553, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. Please find the attached Individual Provider Contracting form as per the email received from Superior Health Plan.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-01-22 17:12:16', '2021-01-22 17:12:16'),
(9513, 3040, 13553, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 13:14:44', '2021-01-29 13:14:44'),
(9514, 3040, 13553, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello,  We received your completed application on (1.22.21).  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thanks  Felicia Napier', NULL, NULL, '2021-02-02 17:16:14', '2021-02-02 17:16:14'),
(9515, 3040, 13553, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-16 12:25:17', '2021-02-16 12:25:17'),
(9516, 3040, 13553, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  Waiting for your response.   Thanks', NULL, NULL, '2021-02-23 13:52:02', '2021-02-23 13:52:02'),
(9517, 3040, 13553, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello  We received your completed application on 1/22/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan', NULL, NULL, '2021-03-02 14:34:15', '2021-03-02 14:34:15'),
(9518, 3040, 13553, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-12 15:51:43', '2021-03-12 15:51:43'),
(9519, 3040, 13553, NULL, '2021-05-12 00:00:00.000', 'Approved', 'Email rcvd from: ECMExecutionTeam@superiorhealthplan.com  Subject: MOSES CAMPOS WELCOME LETTER  MOSES CAMPOS VALLEY MED URGENT CARE PLLC VMUC@CLAIMSMEDINC.COM  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:   05/01/2021                                                  C/ 48009', NULL, NULL, '2021-05-05 12:50:01', '2021-05-05 12:50:01'),
(9520, 3040, 13554, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-20 17:07:22', '2021-01-20 17:07:22'),
(9521, 3040, 13554, NULL, '2021-01-27 00:00:00.000', 'Initiated', 'Provider Application submitted online.  See attachments', NULL, NULL, '2021-01-20 17:07:28', '2021-01-20 17:07:28'),
(9522, 3040, 13554, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. Please find the attached Individual Provider Contracting form as per the email received from Superior Health Plan.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-22 17:12:22', '2021-01-22 17:12:22'),
(9523, 3040, 13554, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 13:14:37', '2021-01-29 13:14:37'),
(9524, 3040, 13554, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello,  We received your completed application on (1.22.21).  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thanks  Felicia Napier', NULL, NULL, '2021-02-02 17:16:24', '2021-02-02 17:16:24'),
(9525, 3040, 13554, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-16 12:25:22', '2021-02-16 12:25:22'),
(9526, 3040, 13554, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  Waiting for your response.   Thanks', NULL, NULL, '2021-02-23 13:51:55', '2021-02-23 13:51:55'),
(9527, 3040, 13554, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello  We received your completed application on 1/22/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan', NULL, NULL, '2021-03-02 14:33:58', '2021-03-02 14:33:58'),
(9528, 3040, 13554, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-12 15:51:52', '2021-03-12 15:51:52'),
(9529, 3040, 13554, NULL, '2021-05-12 00:00:00.000', 'Approved', 'Email rcvd from: ECMExecutionTeam@superiorhealthplan.com  Subject: MOSES CAMPOS WELCOME LETTER  MOSES CAMPOS VALLEY MED URGENT CARE PLLC VMUC@CLAIMSMEDINC.COM  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:   05/01/2021                                                  C/ 48009', NULL, NULL, '2021-05-05 12:50:05', '2021-05-05 12:50:05'),
(9530, 3040, 13555, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-20 17:07:38', '2021-01-20 17:07:38'),
(9531, 3040, 13555, NULL, '2021-01-27 00:00:00.000', 'Initiated', 'Provider Application submitted online.  See attachments', NULL, NULL, '2021-01-20 17:07:44', '2021-01-20 17:07:44'),
(9532, 3040, 13555, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. Please find the attached Individual Provider Contracting form as per the email received from Superior Health Plan.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-22 17:12:27', '2021-01-22 17:12:27'),
(9533, 3040, 13555, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 13:14:51', '2021-01-29 13:14:51'),
(9534, 3040, 13555, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello,  We received your completed application on (1.22.21).  It is currently in credentialing.  Please note that we will notify you of acceptance and/or participation status within 90 days of receipt of completed application.  Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thanks  Felicia Napier', NULL, NULL, '2021-02-02 17:16:32', '2021-02-02 17:16:32'),
(9535, 3040, 13555, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-16 12:25:27', '2021-02-16 12:25:27'),
(9536, 3040, 13555, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  Waiting for your response.   Thanks', NULL, NULL, '2021-02-23 13:52:07', '2021-02-23 13:52:07'),
(9537, 3040, 13555, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || MOSES CAMPOS || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello  We received your completed application on 1/22/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan', NULL, NULL, '2021-03-02 14:34:10', '2021-03-02 14:34:10'),
(9538, 3040, 13555, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-12 15:51:48', '2021-03-12 15:51:48'),
(9539, 3040, 13555, NULL, '2021-05-12 00:00:00.000', 'Approved', 'Email rcvd from: ECMExecutionTeam@superiorhealthplan.com  Subject: MOSES CAMPOS WELCOME LETTER  MOSES CAMPOS VALLEY MED URGENT CARE PLLC VMUC@CLAIMSMEDINC.COM  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:   05/01/2021                                                  C/ 48009', NULL, NULL, '2021-05-05 12:50:08', '2021-05-05 12:50:08'),
(9540, 3040, 13556, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-20 17:30:07', '2021-01-20 17:30:07'),
(9541, 3040, 13556, NULL, '2021-01-27 00:00:00.000', 'Initiated', 'Application submitted online  See attachments', NULL, NULL, '2021-01-20 17:30:26', '2021-01-20 17:30:26'),
(9542, 3040, 13556, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. Please find the attached Individual Provider Contracting form as per the email received from Superior Health Plan.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-22 16:43:58', '2021-01-22 16:43:58');
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
(9543, 3040, 13556, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Deborah Potter  Provider NPI# 1861914053  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 13:17:57', '2021-01-29 13:17:57'),
(9544, 3040, 13556, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello,  We received your completed application on (1.22.21.) Your projected effective date is (3.1.21).  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thanks  Felicia Napier', NULL, NULL, '2021-02-02 17:18:10', '2021-02-02 17:18:10'),
(9545, 3040, 13556, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-16 12:25:33', '2021-02-16 12:25:33'),
(9546, 3040, 13556, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. I just wanted to follow up  regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Deborah Potter  Provider NPI# 1861914053  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-23 13:54:07', '2021-02-23 13:54:07'),
(9547, 3040, 13556, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||3  Hello  We received your completed application on 1/22/2021. It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan ', NULL, NULL, '2021-03-02 14:35:12', '2021-03-02 14:35:12'),
(9548, 3040, 13556, NULL, '2021-03-12 00:00:00.000', 'Approved', 'Provider in-network with effective date 03/01/2021.  Please see attachment.', NULL, NULL, '2021-03-05 18:02:41', '2021-03-05 18:02:41'),
(9549, 3040, 13557, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-20 17:30:42', '2021-01-20 17:30:42'),
(9550, 3040, 13557, NULL, '2021-01-27 00:00:00.000', 'Initiated', 'Application submitted online  See attachments', NULL, NULL, '2021-01-20 17:30:48', '2021-01-20 17:30:48'),
(9551, 3040, 13557, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. Please find the attached Individual Provider Contracting form as per the email received from Superior Health Plan.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-22 16:45:34', '2021-01-22 16:45:34'),
(9552, 3040, 13557, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Deborah Potter  Provider NPI# 1861914053  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 13:17:50', '2021-01-29 13:17:50'),
(9553, 3040, 13557, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello,  We received your completed application on (1.22.21.) Your projected effective date is (3.1.21).  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thanks  Felicia Napier', NULL, NULL, '2021-02-02 17:18:19', '2021-02-02 17:18:19'),
(9554, 3040, 13557, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-16 12:25:40', '2021-02-16 12:25:40'),
(9555, 3040, 13557, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. I just wanted to follow up  regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Deborah Potter  Provider NPI# 1861914053  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-23 13:54:00', '2021-02-23 13:54:00'),
(9556, 3040, 13557, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||3  Hello  We received your completed application on 1/22/2021. It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan  ', NULL, NULL, '2021-03-02 14:35:07', '2021-03-02 14:35:07'),
(9557, 3040, 13557, NULL, '2021-03-12 00:00:00.000', 'Approved', 'Provider in-network with effective date 03/01/2021.  Please see attachment.', NULL, NULL, '2021-03-05 18:02:46', '2021-03-05 18:02:46'),
(9558, 3040, 13558, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-20 17:30:57', '2021-01-20 17:30:57'),
(9559, 3040, 13558, NULL, '2021-01-27 00:00:00.000', 'Initiated', 'Application submitted online  See attachments', NULL, NULL, '2021-01-20 17:31:05', '2021-01-20 17:31:05'),
(9560, 3040, 13558, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. Please find the attached Individual Provider Contracting form as per the email received from Superior Health Plan.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-22 16:45:42', '2021-01-22 16:45:42'),
(9561, 3040, 13558, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Deborah Potter  Provider NPI# 1861914053  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 13:18:05', '2021-01-29 13:18:05'),
(9562, 3040, 13558, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||  Hello,  We received your completed application on (1.22.21.) Your projected effective date is (3.1.21).  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.  Thanks  Felicia Napier', NULL, NULL, '2021-02-02 17:18:28', '2021-02-02 17:18:28'),
(9563, 3040, 13558, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-16 12:25:45', '2021-02-16 12:25:45'),
(9564, 3040, 13558, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||  Greetings,  Hope you are doing well. I just wanted to follow up  regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Deborah Potter  Provider NPI# 1861914053  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-23 13:54:12', '2021-02-23 13:54:12'),
(9565, 3040, 13558, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email rcvd from: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Individual Provider Contracting || DEBORAH POTTER || Valley Med Urgent Care PLLC || Superior Health Plan ||3  Hello  We received your completed application on 1/22/2021. It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management Superior HealthPlan ', NULL, NULL, '2021-03-02 14:35:18', '2021-03-02 14:35:18'),
(9566, 3040, 13558, NULL, '2021-03-12 00:00:00.000', 'Approved', 'Provider in-network with effective date 03/01/2021.  Please see attachment.', NULL, NULL, '2021-03-05 18:02:52', '2021-03-05 18:02:52'),
(9567, 1006, 13559, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-20 18:12:27', '2021-01-20 18:12:27'),
(9568, 1006, 13559, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Request initiated:  \"Applicant Name: KERRY SMITH  Tracking ID: T012020210003497  Reassignment Tracking ID: T012020210003513  Submitted Date: WED - JANUARY 20 2021 06:09:19 PM EST  Submitted By: Kerry Smith  Contact Email(s): KERRYTOMATO@GMAIL.COM SNBC@CLAIMSMEDINC.COM\"', NULL, NULL, '2021-01-20 18:12:39', '2021-01-20 18:12:39'),
(9569, 1006, 13559, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Your Medicare enrollment application(s) was received on January 20, 2021. We are closing this request and returning your application(s) for the following reason(s):  The CMS-855 application was sent to the wrong contractor.', NULL, NULL, '2021-01-28 16:53:26', '2021-01-28 16:53:26'),
(9570, 1006, 13559, NULL, '2021-02-04 00:00:00.000', 'In Process', '855I/R application resent: Enrollment Tracking Information Applicant Name: KERRY SMITH  Tracking ID: T012820210003659  Reassignment Tracking ID: T012820210003678  Submitted Date: THU - JANUARY 28 2021 05:08:39 PM EST  Submitted By: Kerry Smith  Contact Email(s): KERRYTOMATO@GMAIL.COM SNBC@CLAIMSMEDINC.COM Reason(s) for submission: A Medicare Part B practitioner is enrolling in the Medicare program for the first time to bill for Part B services. A reassignment of benefits may exist.', NULL, NULL, '2021-01-28 17:09:05', '2021-01-28 17:09:05'),
(9571, 1006, 13559, NULL, '2021-02-08 00:00:00.000', 'Approved', 'Application Tracking ID: T012820210003659   NPI ID: 1275083230   Medicare ID: S400720036   Name: KERRY SMITH  State: MA   Form Type: 855I  Date: 02/01/2021  Status: APPROVED', NULL, NULL, '2021-02-01 17:41:12', '2021-02-01 17:41:12'),
(9572, 3040, 13560, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 13:16:13', '2021-01-21 13:16:13'),
(9573, 3040, 13560, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter for our group Valley Med Urgent Care PLLC in all three locations.  Practice 1: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248     Provider 1: Provider Name: Larry Donald Wright Provider NPI# 1033769765  Provider 2: Provider Name: Deborah Potter Provider NPI# 1861914053  Provider 3: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 13:17:01', '2021-01-21 13:17:01'),
(9574, 3040, 13560, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Online application form submitted.  Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.', NULL, NULL, '2021-01-22 18:25:28', '2021-01-22 18:25:28'),
(9575, 3040, 13560, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  If you have an existing account please go to www.superiorhealthplan.com and click on the provider tab in the middle of the page, from there you will see Network Participation and options to add to an existing account or as a new provider.  Thank you, ', NULL, NULL, '2021-01-22 18:25:40', '2021-01-22 18:25:40'),
(9576, 3040, 13560, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 14:19:48', '2021-01-29 14:19:48'),
(9577, 3040, 13560, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-02-05 09:44:45', '2021-02-05 09:44:45'),
(9578, 3040, 13560, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Hi,  Larry Wright is currently in the credentialing cycle, please allow more time to complete the cycle.', NULL, NULL, '2021-02-12 12:13:32', '2021-02-12 12:13:32'),
(9579, 3040, 13560, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-02-19 16:46:00', '2021-02-19 16:46:00'),
(9580, 3040, 13560, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Hi,  I show you to be in the active credentialing cycle, please allow more time to complete.1', NULL, NULL, '2021-02-26 11:01:49', '2021-02-26 11:01:49'),
(9581, 3040, 13560, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-05 17:22:20', '2021-03-05 17:22:20'),
(9582, 3040, 13560, NULL, '2021-03-19 00:00:00.000', 'In Process', '	 Still in process. ', NULL, NULL, '2021-03-12 15:55:19', '2021-03-12 15:55:19'),
(9583, 3040, 13560, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Hello,  This is a follow up regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-04-21 15:46:49', '2021-04-21 15:46:49'),
(9584, 3040, 13560, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up regarding the enrollment status for the below mentioned provider for our group Valley Med Urgent Care PLLC under all locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-05-03 11:30:42', '2021-05-03 11:30:42'),
(9585, 3040, 13560, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: JACQUELINE.BATISTA@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  This is a follow up regarding the enrollment status for the below mentioned provider for our group Valley Med Urgent Care PLLC under all locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-27 09:36:09', '2021-05-27 09:36:09'),
(9586, 3040, 13560, NULL, '2021-06-23 00:00:00.000', 'Approved', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Good evening,                      Credentialing for this provider is complete, the re-credential date will be 04/30/2024. The effective date will be 05/01/2021.', NULL, NULL, '2021-06-16 09:26:26', '2021-06-16 09:26:26'),
(9587, 3040, 13561, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 13:17:22', '2021-01-21 13:17:22'),
(9588, 3040, 13561, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter for our group Valley Med Urgent Care PLLC in all three locations.  Practice 1: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248     Provider 1: Provider Name: Larry Donald Wright Provider NPI# 1033769765  Provider 2: Provider Name: Deborah Potter Provider NPI# 1861914053  Provider 3: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 13:17:35', '2021-01-21 13:17:35'),
(9589, 3040, 13561, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Online application form submitted.  Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.', NULL, NULL, '2021-01-22 18:25:26', '2021-01-22 18:25:26'),
(9590, 3040, 13561, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  If you have an existing account please go to www.superiorhealthplan.com and click on the provider tab in the middle of the page, from there you will see Network Participation and options to add to an existing account or as a new provider.  Thank you, ', NULL, NULL, '2021-01-22 18:25:46', '2021-01-22 18:25:46'),
(9591, 3040, 13561, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 14:19:36', '2021-01-29 14:19:36'),
(9592, 3040, 13561, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-02-05 09:44:51', '2021-02-05 09:44:51'),
(9593, 3040, 13561, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Hi,  Larry Wright is currently in the credentialing cycle, please allow more time to complete the cycle.', NULL, NULL, '2021-02-12 12:13:23', '2021-02-12 12:13:23'),
(9594, 3040, 13561, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-02-19 16:46:06', '2021-02-19 16:46:06'),
(9595, 3040, 13561, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Hi,  I show you to be in the active credentialing cycle, please allow more time to complete.1', NULL, NULL, '2021-02-26 11:01:42', '2021-02-26 11:01:42'),
(9596, 3040, 13561, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-05 17:22:12', '2021-03-05 17:22:12'),
(9597, 3040, 13561, NULL, '2021-03-19 00:00:00.000', 'In Process', '	 Still in process. ', NULL, NULL, '2021-03-12 15:55:23', '2021-03-12 15:55:23'),
(9598, 3040, 13561, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Hello,  This is a follow up regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-04-21 15:46:43', '2021-04-21 15:46:43'),
(9599, 3040, 13561, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up regarding the enrollment status for the below mentioned provider for our group Valley Med Urgent Care PLLC under all locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-05-03 11:30:36', '2021-05-03 11:30:36'),
(9600, 3040, 13561, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: JACQUELINE.BATISTA@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  This is a follow up regarding the enrollment status for the below mentioned provider for our group Valley Med Urgent Care PLLC under all locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-27 09:36:19', '2021-05-27 09:36:19'),
(9601, 3040, 13561, NULL, '2021-06-23 00:00:00.000', 'Approved', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Good evening,                      Credentialing for this provider is complete, the re-credential date will be 04/30/2024. The effective date will be 05/01/2021.', NULL, NULL, '2021-06-16 09:26:09', '2021-06-16 09:26:09'),
(9602, 3040, 13562, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 13:17:53', '2021-01-21 13:17:53'),
(9603, 3040, 13562, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter for our group Valley Med Urgent Care PLLC in all three locations.  Practice 1: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248     Provider 1: Provider Name: Larry Donald Wright Provider NPI# 1033769765  Provider 2: Provider Name: Deborah Potter Provider NPI# 1861914053  Provider 3: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 13:18:17', '2021-01-21 13:18:17'),
(9604, 3040, 13562, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Online application form submitted.  Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.', NULL, NULL, '2021-01-22 18:25:24', '2021-01-22 18:25:24'),
(9605, 3040, 13562, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  If you have an existing account please go to www.superiorhealthplan.com and click on the provider tab in the middle of the page, from there you will see Network Participation and options to add to an existing account or as a new provider.  Thank you, ', NULL, NULL, '2021-01-22 18:25:50', '2021-01-22 18:25:50'),
(9606, 3040, 13562, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 14:19:56', '2021-01-29 14:19:56'),
(9607, 3040, 13562, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-02-05 09:44:57', '2021-02-05 09:44:57'),
(9608, 3040, 13562, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Hi,  Larry Wright is currently in the credentialing cycle, please allow more time to complete the cycle.', NULL, NULL, '2021-02-12 12:13:44', '2021-02-12 12:13:44'),
(9609, 3040, 13562, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-02-19 16:46:15', '2021-02-19 16:46:15'),
(9610, 3040, 13562, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Hi,  I show you to be in the active credentialing cycle, please allow more time to complete.1', NULL, NULL, '2021-02-26 11:01:54', '2021-02-26 11:01:54'),
(9611, 3040, 13562, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-05 17:22:26', '2021-03-05 17:22:26'),
(9612, 3040, 13562, NULL, '2021-03-19 00:00:00.000', 'In Process', '	 Still in process. ', NULL, NULL, '2021-03-12 15:55:28', '2021-03-12 15:55:28'),
(9613, 3040, 13562, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Hello,  This is a follow up regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-04-21 15:46:37', '2021-04-21 15:46:37'),
(9614, 3040, 13562, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up regarding the enrollment status for the below mentioned provider for our group Valley Med Urgent Care PLLC under all locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-05-03 11:30:33', '2021-05-03 11:30:33'),
(9615, 3040, 13562, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: JACQUELINE.BATISTA@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Greetings,  This is a follow up regarding the enrollment status for the below mentioned provider for our group Valley Med Urgent Care PLLC under all locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name:  Larry Donald Wright Provider NPI# 1033769765  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-27 09:36:14', '2021-05-27 09:36:14'),
(9616, 3040, 13562, NULL, '2021-06-23 00:00:00.000', 'Approved', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Wright, Larry Donald || Ambetter ||  Good evening,                      Credentialing for this provider is complete, the re-credential date will be 04/30/2024. The effective date will be 05/01/2021.', NULL, NULL, '2021-06-16 09:25:54', '2021-06-16 09:25:54'),
(9617, 3040, 13563, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 13:19:22', '2021-01-21 13:19:22'),
(9618, 3040, 13563, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter for our group Valley Med Urgent Care PLLC in all three locations.  Practice 1: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248     Provider 1: Provider Name: Larry Donald Wright Provider NPI# 1033769765  Provider 2: Provider Name: Deborah Potter Provider NPI# 1861914053  Provider 3: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 13:19:37', '2021-01-21 13:19:37'),
(9619, 3040, 13563, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Online application form submitted.  Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.', NULL, NULL, '2021-01-22 18:27:52', '2021-01-22 18:27:52'),
(9620, 3040, 13563, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  If you have an existing account please go to www.superiorhealthplan.com and click on the provider tab in the middle of the page, from there you will see Network Participation and options to add to an existing account or as a new provider.  Thank you,', NULL, NULL, '2021-01-22 18:28:13', '2021-01-22 18:28:13'),
(9621, 3040, 13563, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Deborah Potter  Provider NPI# 1861914053  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 14:22:51', '2021-01-29 14:22:51'),
(9622, 3040, 13563, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-02-05 09:46:59', '2021-02-05 09:46:59'),
(9623, 3040, 13563, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. Can you please send me the welcome letter I still didn\'t get?  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-12 12:50:25', '2021-02-12 12:50:25'),
(9624, 3040, 13563, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter |  Hi,  That comes from another team, it should be there shortly.', NULL, NULL, '2021-02-12 12:50:36', '2021-02-12 12:50:36'),
(9625, 3040, 13563, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email Sent to:  Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter |  Greetings,  I really appreciate your prompt response. Could you please send me the copy of the welcome letter.   Waiting for your response.  Thanks', NULL, NULL, '2021-02-12 12:50:47', '2021-02-12 12:50:47'),
(9626, 3040, 13563, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from:  Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter |  Hi,  I show that Deborah Potter was approved by Committee 01-12-2021 giving her an effective date of 02-01-2021.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com ', NULL, NULL, '2021-02-12 12:50:58', '2021-02-12 12:50:58'),
(9627, 3040, 13563, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Good Afternoon,  I sent an email to the contracting team to confirm DEBORAH POTTER TIN 815123542 NPI 1861914053 Ambetter effective date.  Upon receiving notification I will communicate, please feel free to request status update.  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA', NULL, NULL, '2021-02-19 16:49:32', '2021-02-19 16:49:32'),
(9628, 3040, 13563, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  It is usually within 30 days of the credentialing completion date.  ', NULL, NULL, '2021-02-19 16:50:49', '2021-02-19 16:50:49'),
(9629, 3040, 13563, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Hello!  Can you please let me know the time frame is?  Thanks', NULL, NULL, '2021-02-19 16:52:14', '2021-02-19 16:52:14'),
(9630, 3040, 13563, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Hi,   It doesn’t come from Credentialing it comes from our Contract Execution team, I will forward this their way.', NULL, NULL, '2021-02-19 16:53:17', '2021-02-19 16:53:17'),
(9631, 3040, 13563, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Please note that I didn\'t receive the welcome yet. Kindly send me the welcome letter.  Thanks', NULL, NULL, '2021-02-19 16:54:33', '2021-02-19 16:54:33'),
(9632, 3040, 13563, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Hi,  The effective date is based on the Cred Policy however if your Welcome Letter indicates another effective date it will be the effective date on the Welcome Letter.', NULL, NULL, '2021-02-19 16:55:42', '2021-02-19 16:55:42'),
(9633, 3040, 13563, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to:  Daniel.Velez@superiorhealthplan.com Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. I had a word with Ambetter representative and she advised me the effective date for the provider is 03/01/2021 but as per credentialing department the effective date 02/01/2021. Can you please double check and advise which effective date is correct.  .  Waiting for your response.  Thanks', NULL, NULL, '2021-02-19 16:57:50', '2021-02-19 16:57:50'),
(9634, 3040, 13563, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Good Afternoon,  I sent a follow up email to confirm effective date.  Please allow additional time to clarify, please feel free to request status update.', NULL, NULL, '2021-02-26 11:27:04', '2021-02-26 11:27:04');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(9635, 3040, 13563, NULL, '2021-03-12 00:00:00.000', 'Approved', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Good Morning,  Thank you for your patience.  I received notification, Deborah Potter NPI 1861914053 TIN 815123542 “This record was processed with 03/01/2020 eff date”.  If you require any further information, feel free to contact me.', NULL, NULL, '2021-03-05 17:59:37', '2021-03-05 17:59:37'),
(9636, 3040, 13564, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 13:20:01', '2021-01-21 13:20:01'),
(9637, 3040, 13564, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter for our group Valley Med Urgent Care PLLC in all three locations.  Practice 1: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248     Provider 1: Provider Name: Larry Donald Wright Provider NPI# 1033769765  Provider 2: Provider Name: Deborah Potter Provider NPI# 1861914053  Provider 3: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 13:20:21', '2021-01-21 13:20:21'),
(9638, 3040, 13564, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Online application form submitted.  Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.', NULL, NULL, '2021-01-22 18:27:57', '2021-01-22 18:27:57'),
(9639, 3040, 13564, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  If you have an existing account please go to www.superiorhealthplan.com and click on the provider tab in the middle of the page, from there you will see Network Participation and options to add to an existing account or as a new provider.  Thank you,', NULL, NULL, '2021-01-22 18:28:19', '2021-01-22 18:28:19'),
(9640, 3040, 13564, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Deborah Potter  Provider NPI# 1861914053  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 14:22:45', '2021-01-29 14:22:45'),
(9641, 3040, 13564, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-02-05 09:46:53', '2021-02-05 09:46:53'),
(9642, 3040, 13564, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. Can you please send me the welcome letter I still didn\'t get?  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-12 12:46:26', '2021-02-12 12:46:26'),
(9643, 3040, 13564, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter |  Hi,  That comes from another team, it should be there shortly.', NULL, NULL, '2021-02-12 12:47:21', '2021-02-12 12:47:21'),
(9644, 3040, 13564, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email Sent to:  Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter |  Greetings,  I really appreciate your prompt response. Could you please send me the copy of the welcome letter.   Waiting for your response.  Thanks', NULL, NULL, '2021-02-12 12:48:17', '2021-02-12 12:48:17'),
(9645, 3040, 13564, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from:  Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter |  Hi,  I show that Deborah Potter was approved by Committee 01-12-2021 giving her an effective date of 02-01-2021.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com   ', NULL, NULL, '2021-02-12 12:49:13', '2021-02-12 12:49:13'),
(9646, 3040, 13564, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Good Afternoon,  I sent an email to the contracting team to confirm DEBORAH POTTER TIN 815123542 NPI 1861914053 Ambetter effective date.  Upon receiving notification I will communicate, please feel free to request status update.  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA', NULL, NULL, '2021-02-19 16:49:17', '2021-02-19 16:49:17'),
(9647, 3040, 13564, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  It is usually within 30 days of the credentialing completion date.  ', NULL, NULL, '2021-02-19 16:50:36', '2021-02-19 16:50:36'),
(9648, 3040, 13564, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Hello!  Can you please let me know the time frame is?  Thanks', NULL, NULL, '2021-02-19 16:52:03', '2021-02-19 16:52:03'),
(9649, 3040, 13564, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Hi,   It doesn’t come from Credentialing it comes from our Contract Execution team, I will forward this their way.', NULL, NULL, '2021-02-19 16:53:04', '2021-02-19 16:53:04'),
(9650, 3040, 13564, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Please note that I didn\'t receive the welcome yet. Kindly send me the welcome letter.  Thanks', NULL, NULL, '2021-02-19 16:54:21', '2021-02-19 16:54:21'),
(9651, 3040, 13564, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Hi,  The effective date is based on the Cred Policy however if your Welcome Letter indicates another effective date it will be the effective date on the Welcome Letter.', NULL, NULL, '2021-02-19 16:55:29', '2021-02-19 16:55:29'),
(9652, 3040, 13564, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to:  Daniel.Velez@superiorhealthplan.com Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. I had a word with Ambetter representative and she advised me the effective date for the provider is 03/01/2021 but as per credentialing department the effective date 02/01/2021. Can you please double check and advise which effective date is correct.  .  Waiting for your response.  Thanks', NULL, NULL, '2021-02-19 16:57:39', '2021-02-19 16:57:39'),
(9653, 3040, 13564, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Good Afternoon,  I sent a follow up email to confirm effective date.  Please allow additional time to clarify, please feel free to request status update.', NULL, NULL, '2021-02-26 11:26:58', '2021-02-26 11:26:58'),
(9654, 3040, 13564, NULL, '2021-03-12 00:00:00.000', 'Approved', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Good Morning,  Thank you for your patience.  I received notification, Deborah Potter NPI 1861914053 TIN 815123542 “This record was processed with 03/01/2020 eff date”.  If you require any further information, feel free to contact me.', NULL, NULL, '2021-03-05 17:59:31', '2021-03-05 17:59:31'),
(9655, 3040, 13565, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 13:20:38', '2021-01-21 13:20:38'),
(9656, 3040, 13565, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter for our group Valley Med Urgent Care PLLC in all three locations.  Practice 1: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248     Provider 1: Provider Name: Larry Donald Wright Provider NPI# 1033769765  Provider 2: Provider Name: Deborah Potter Provider NPI# 1861914053  Provider 3: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 13:20:48', '2021-01-21 13:20:48'),
(9657, 3040, 13565, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Online application form submitted.  Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.', NULL, NULL, '2021-01-22 18:28:02', '2021-01-22 18:28:02'),
(9658, 3040, 13565, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  If you have an existing account please go to www.superiorhealthplan.com and click on the provider tab in the middle of the page, from there you will see Network Participation and options to add to an existing account or as a new provider.  Thank you,', NULL, NULL, '2021-01-22 18:28:24', '2021-01-22 18:28:24'),
(9659, 3040, 13565, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Deborah Potter  Provider NPI# 1861914053  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-01-29 14:22:57', '2021-01-29 14:22:57'),
(9660, 3040, 13565, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-02-05 09:47:04', '2021-02-05 09:47:04'),
(9661, 3040, 13565, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. Can you please send me the welcome letter I still didn\'t get?  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-12 12:52:59', '2021-02-12 12:52:59'),
(9662, 3040, 13565, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter |  Hi,  That comes from another team, it should be there shortly.', NULL, NULL, '2021-02-12 12:53:11', '2021-02-12 12:53:11'),
(9663, 3040, 13565, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email Sent to:  Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter |  Greetings,  I really appreciate your prompt response. Could you please send me the copy of the welcome letter.   Waiting for your response.  Thanks', NULL, NULL, '2021-02-12 12:53:21', '2021-02-12 12:53:21'),
(9664, 3040, 13565, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from:  Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter |  Hi,  I show that Deborah Potter was approved by Committee 01-12-2021 giving her an effective date of 02-01-2021.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com', NULL, NULL, '2021-02-12 12:53:31', '2021-02-12 12:53:31'),
(9665, 3040, 13565, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Good Afternoon,  I sent an email to the contracting team to confirm DEBORAH POTTER TIN 815123542 NPI 1861914053 Ambetter effective date.  Upon receiving notification I will communicate, please feel free to request status update.  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA', NULL, NULL, '2021-02-19 16:49:23', '2021-02-19 16:49:23'),
(9666, 3040, 13565, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  It is usually within 30 days of the credentialing completion date.  ', NULL, NULL, '2021-02-19 16:50:42', '2021-02-19 16:50:42'),
(9667, 3040, 13565, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Hello!  Can you please let me know the time frame is?  Thanks', NULL, NULL, '2021-02-19 16:52:09', '2021-02-19 16:52:09'),
(9668, 3040, 13565, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Hi,   It doesn’t come from Credentialing it comes from our Contract Execution team, I will forward this their way.', NULL, NULL, '2021-02-19 16:53:10', '2021-02-19 16:53:10'),
(9669, 3040, 13565, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Please note that I didn\'t receive the welcome yet. Kindly send me the welcome letter.  Thanks', NULL, NULL, '2021-02-19 16:54:27', '2021-02-19 16:54:27'),
(9670, 3040, 13565, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject:  Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Hi,  The effective date is based on the Cred Policy however if your Welcome Letter indicates another effective date it will be the effective date on the Welcome Letter.', NULL, NULL, '2021-02-19 16:55:37', '2021-02-19 16:55:37'),
(9671, 3040, 13565, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to:  Daniel.Velez@superiorhealthplan.com Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. I had a word with Ambetter representative and she advised me the effective date for the provider is 03/01/2021 but as per credentialing department the effective date 02/01/2021. Can you please double check and advise which effective date is correct.  .  Waiting for your response.  Thanks', NULL, NULL, '2021-02-19 16:57:45', '2021-02-19 16:57:45'),
(9672, 3040, 13565, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Good Afternoon,  I sent a follow up email to confirm effective date.  Please allow additional time to clarify, please feel free to request status update.', NULL, NULL, '2021-02-26 11:27:10', '2021-02-26 11:27:10'),
(9673, 3040, 13565, NULL, '2021-03-12 00:00:00.000', 'Approved', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Good Morning,  Thank you for your patience.  I received notification, Deborah Potter NPI 1861914053 TIN 815123542 “This record was processed with 03/01/2020 eff date”.  If you require any further information, feel free to contact me.', NULL, NULL, '2021-03-05 18:00:03', '2021-03-05 18:00:03'),
(9674, 3040, 13566, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 13:21:32', '2021-01-21 13:21:32'),
(9675, 3040, 13566, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter for our group Valley Med Urgent Care PLLC in all three locations.  Practice 1: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248     Provider 1: Provider Name: Larry Donald Wright Provider NPI# 1033769765  Provider 2: Provider Name: Deborah Potter Provider NPI# 1861914053  Provider 3: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 13:21:52', '2021-01-21 13:21:52'),
(9676, 3040, 13566, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Online application form submitted.  Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.', NULL, NULL, '2021-01-22 18:21:18', '2021-01-22 18:21:18'),
(9677, 3040, 13566, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  If you have an existing account please go to www.superiorhealthplan.com and click on the provider tab in the middle of the page, from there you will see Network Participation and options to add to an existing account or as a new provider.  Thank you,   ', NULL, NULL, '2021-01-22 18:22:37', '2021-01-22 18:22:37'),
(9678, 3040, 13566, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-01-29 14:27:21', '2021-01-29 14:27:21'),
(9679, 3040, 13566, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-02-05 09:50:57', '2021-02-05 09:50:57'),
(9680, 3040, 13566, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  Moses is still in the credentialing cycle, please allow more time to complete the cycle.  Thank you', NULL, NULL, '2021-02-12 12:21:37', '2021-02-12 12:21:37'),
(9681, 3040, 13566, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  Please get back to me as soon as you can get a chance. Waiting for your response.  Thanks', NULL, NULL, '2021-02-19 17:01:35', '2021-02-19 17:01:35'),
(9682, 3040, 13566, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject:  Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  He is in the credentialing cycle, please allow more time to complete.  ', NULL, NULL, '2021-02-26 11:28:09', '2021-02-26 11:28:09'),
(9683, 3040, 13566, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-05 18:05:05', '2021-03-05 18:05:05'),
(9684, 3040, 13566, NULL, '2021-03-19 00:00:00.000', 'In Process', '	 Still in process. ', NULL, NULL, '2021-03-12 15:55:32', '2021-03-12 15:55:32'),
(9685, 3040, 13566, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hello,   I wanted to follow up regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you', NULL, NULL, '2021-04-21 15:42:54', '2021-04-21 15:42:54'),
(9686, 3040, 13566, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under all locations.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-05-03 11:27:05', '2021-05-03 11:27:05'),
(9687, 1005, 13566, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'The provider Moses Campos is no longer with Valley Med Urgent Care', NULL, NULL, '2021-06-01 14:33:13', '2021-06-01 14:33:13'),
(9688, 3040, 13567, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 13:22:04', '2021-01-21 13:22:04'),
(9689, 3040, 13567, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter for our group Valley Med Urgent Care PLLC in all three locations.  Practice 1: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248     Provider 1: Provider Name: Larry Donald Wright Provider NPI# 1033769765  Provider 2: Provider Name: Deborah Potter Provider NPI# 1861914053  Provider 3: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 13:22:18', '2021-01-21 13:22:18'),
(9690, 3040, 13567, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Online application form submitted.  Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.', NULL, NULL, '2021-01-22 18:21:29', '2021-01-22 18:21:29'),
(9691, 3040, 13567, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  If you have an existing account please go to www.superiorhealthplan.com and click on the provider tab in the middle of the page, from there you will see Network Participation and options to add to an existing account or as a new provider.  Thank you,   ', NULL, NULL, '2021-01-22 18:22:36', '2021-01-22 18:22:36'),
(9692, 3040, 13567, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-01-29 14:27:16', '2021-01-29 14:27:16'),
(9693, 3040, 13567, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-02-05 09:50:52', '2021-02-05 09:50:52'),
(9694, 3040, 13567, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  Moses is still in the credentialing cycle, please allow more time to complete the cycle.  Thank you', NULL, NULL, '2021-02-12 12:21:32', '2021-02-12 12:21:32'),
(9695, 3040, 13567, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  Please get back to me as soon as you can get a chance. Waiting for your response.  Thanks', NULL, NULL, '2021-02-19 17:01:20', '2021-02-19 17:01:20'),
(9696, 3040, 13567, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject:  Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  He is in the credentialing cycle, please allow more time to complete.  ', NULL, NULL, '2021-02-26 11:28:04', '2021-02-26 11:28:04'),
(9697, 3040, 13567, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-05 18:04:59', '2021-03-05 18:04:59'),
(9698, 3040, 13567, NULL, '2021-03-19 00:00:00.000', 'In Process', '	 Still in process. ', NULL, NULL, '2021-03-12 15:55:36', '2021-03-12 15:55:36'),
(9699, 3040, 13567, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hello,   I wanted to follow up regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you', NULL, NULL, '2021-04-21 15:42:50', '2021-04-21 15:42:50'),
(9700, 3040, 13567, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under all locations.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-05-03 11:27:10', '2021-05-03 11:27:10'),
(9701, 1005, 13567, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'The provider Moses Campos is no longer with Valley Med Urgent Care', NULL, NULL, '2021-06-01 14:33:42', '2021-06-01 14:33:42'),
(9702, 3040, 13568, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 13:22:38', '2021-01-21 13:22:38'),
(9703, 3040, 13568, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter for our group Valley Med Urgent Care PLLC in all three locations.  Practice 1: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248     Provider 1: Provider Name: Larry Donald Wright Provider NPI# 1033769765  Provider 2: Provider Name: Deborah Potter Provider NPI# 1861914053  Provider 3: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-21 13:22:52', '2021-01-21 13:22:52'),
(9704, 3040, 13568, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Online application form submitted.  Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.', NULL, NULL, '2021-01-22 18:21:34', '2021-01-22 18:21:34'),
(9705, 3040, 13568, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll || Wright, Larry Donald, Potter, Deborah, Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  If you have an existing account please go to www.superiorhealthplan.com and click on the provider tab in the middle of the page, from there you will see Network Participation and options to add to an existing account or as a new provider.  Thank you,   ', NULL, NULL, '2021-01-22 18:22:41', '2021-01-22 18:22:41'),
(9706, 3040, 13568, NULL, '2021-02-05 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Potter, Deborah || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please let me know. Waiting for your response.  Thanks ', NULL, NULL, '2021-01-29 14:27:27', '2021-01-29 14:27:27'),
(9707, 3040, 13568, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Follow up email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please let me know. Waiting for your response.  Thanks', NULL, NULL, '2021-02-05 09:51:04', '2021-02-05 09:51:04'),
(9708, 3040, 13568, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  Moses is still in the credentialing cycle, please allow more time to complete the cycle.  Thank you', NULL, NULL, '2021-02-12 12:21:43', '2021-02-12 12:21:43'),
(9709, 3040, 13568, NULL, '2021-02-26 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  Please get back to me as soon as you can get a chance. Waiting for your response.  Thanks', NULL, NULL, '2021-02-19 17:01:28', '2021-02-19 17:01:28'),
(9710, 3040, 13568, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject:  Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hi,  He is in the credentialing cycle, please allow more time to complete.  ', NULL, NULL, '2021-02-26 11:28:15', '2021-02-26 11:28:15'),
(9711, 3040, 13568, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-05 18:05:10', '2021-03-05 18:05:10'),
(9712, 3040, 13568, NULL, '2021-03-19 00:00:00.000', 'In Process', '	 Still in process. ', NULL, NULL, '2021-03-12 15:55:44', '2021-03-12 15:55:44'),
(9713, 3040, 13568, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Hello,   I wanted to follow up regarding the enrollment status for the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you', NULL, NULL, '2021-04-21 15:42:44', '2021-04-21 15:42:44'),
(9714, 3040, 13568, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Campos, Moses || Valley Med Urgent Care PLLC || Ambetter ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider in our group Valley Med Urgent Care PLLC under all locations.   Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-05-03 11:27:15', '2021-05-03 11:27:15'),
(9715, 1005, 13568, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'The provider Moses Campos is no longer with Valley Med Urgent Care', NULL, NULL, '2021-06-01 14:34:05', '2021-06-01 14:34:05'),
(9716, 3040, 13569, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 15:16:33', '2021-01-21 15:16:33'),
(9717, 3040, 13569, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Campos, Moses || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for Moses Campos for our group Valley Med Urgent Care PLLC under all three locations.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-21 15:17:11', '2021-01-21 15:17:11'),
(9718, 3040, 13569, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Campos, Moses || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,  Hope you are doing well. I just wanted to know that you received the application of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-28 09:53:23', '2021-01-28 09:53:23'),
(9719, 3040, 13569, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Campos, Moses || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process. Please follow up directly with Aperture    to assure any requesting information has been received.  Thanks  Melinda', NULL, NULL, '2021-01-28 14:30:01', '2021-01-28 14:30:01'),
(9720, 3040, 13569, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Campos, Moses || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process. Please follow up directly with Aperture    to assure any requesting information has been received.  Thanks  Melinda', NULL, NULL, '2021-02-04 10:09:59', '2021-02-04 10:09:59'),
(9721, 3040, 13569, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: outreachsupport@aperturecvo.com  Subject: Campos, Moses || NPI# 1558680009 || Ref: 7FWH6 ||  Greetings,  Hope you are doing well. Please find the attached DEA certificate (Supervising Physician Teresa Saavedra) as per the request from (Michelle) Aperture representative for the below mentioned provider.    Practice Details:  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-11 16:37:51', '2021-02-11 16:37:51'),
(9722, 3040, 13569, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Follow up email sent to: outreachsupport@aperturecvo.com  Subject: Campos, Moses || NPI# 1558680009 || Ref: 7FWH6 ||  Greetings,  Hope you are doing well. Can you please advise me that you received the requested document for the below mentioned provider?   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider: Provider Name: Moses Campos Provider NPI# 1558680009  Please get back to me as soon as you can get a chance. Waiting for your response.  Thanks', NULL, NULL, '2021-02-18 13:59:40', '2021-02-18 13:59:40'),
(9723, 3040, 13569, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Campos, Moses || NPI# 1558680009 || Ref: 7FWH6 ||  Greetings.  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-25 14:46:26', '2021-02-25 14:46:26'),
(9724, 3040, 13569, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: 	ibarra.vmuc@outlook.com  Subject: Need References From M Campos PA  Greetings, Hope you are doing well. I received an email from Driscoll and they requested me to send the references from Moses Campos. Can you please send me at least 03 peer references. For your reference I attached the document.  Thanks ', NULL, NULL, '2021-03-04 16:40:33', '2021-03-04 16:40:33'),
(9725, 3040, 13569, NULL, '2021-04-19 00:00:00.000', 'In Process', 'Provider has left the group 03/06/2021.', NULL, NULL, '2021-03-12 16:03:31', '2021-03-12 16:03:31'),
(9726, 3040, 13569, NULL, '2021-04-20 00:00:00.000', 'On Hold', 'Email rcvd from: Patricia.Garcia@dchstx.org  Subject: Withdraw letter - M Campos PA  Dear Mr Campos:  Your application has been withdrawn, notice received that Moses Campos, PA has left group (Valley Med Urgent Care).', NULL, NULL, '2021-04-13 15:44:48', '2021-04-13 15:44:48'),
(9727, 1005, 13569, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'The provider Moses Campos is no longer with Valley Med Urgent Care', NULL, NULL, '2021-06-01 14:35:58', '2021-06-01 14:35:58');
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
(9728, 3040, 13570, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 15:17:14', '2021-01-21 15:17:14'),
(9729, 3040, 13570, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Campos, Moses || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for Moses Campos for our group Valley Med Urgent Care PLLC under all three locations.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-21 15:17:27', '2021-01-21 15:17:27'),
(9730, 3040, 13570, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Campos, Moses || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,  Hope you are doing well. I just wanted to know that you received the application of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-28 09:53:28', '2021-01-28 09:53:28'),
(9731, 3040, 13570, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Campos, Moses || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process. Please follow up directly with Aperture    to assure any requesting information has been received.  Thanks  Melinda', NULL, NULL, '2021-01-28 14:30:08', '2021-01-28 14:30:08'),
(9732, 3040, 13570, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Campos, Moses || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process. Please follow up directly with Aperture    to assure any requesting information has been received.  Thanks  Melinda', NULL, NULL, '2021-02-04 10:10:06', '2021-02-04 10:10:06'),
(9733, 3040, 13570, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: outreachsupport@aperturecvo.com  Subject: Campos, Moses || NPI# 1558680009 || Ref: 7FWH6 ||  Greetings,  Hope you are doing well. Please find the attached DEA certificate (Supervising Physician Teresa Saavedra) as per the request from (Michelle) Aperture representative for the below mentioned provider.    Practice Details:  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-11 16:37:57', '2021-02-11 16:37:57'),
(9734, 3040, 13570, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Follow up email sent to: outreachsupport@aperturecvo.com  Subject: Campos, Moses || NPI# 1558680009 || Ref: 7FWH6 ||  Greetings,  Hope you are doing well. Can you please advise me that you received the requested document for the below mentioned provider?   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider: Provider Name: Moses Campos Provider NPI# 1558680009  Please get back to me as soon as you can get a chance. Waiting for your response.  Thanks', NULL, NULL, '2021-02-18 13:59:34', '2021-02-18 13:59:34'),
(9735, 3040, 13570, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Campos, Moses || NPI# 1558680009 || Ref: 7FWH6 ||  Greetings.  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-25 14:46:21', '2021-02-25 14:46:21'),
(9736, 3040, 13570, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: 	ibarra.vmuc@outlook.com  Subject: Need References From M Campos PA  Greetings, Hope you are doing well. I received an email from Driscoll and they requested me to send the references from Moses Campos. Can you please send me at least 03 peer references. For your reference I attached the document.  Thanks ', NULL, NULL, '2021-03-04 16:40:29', '2021-03-04 16:40:29'),
(9737, 3040, 13570, NULL, '2021-04-19 00:00:00.000', 'In Process', 'Provider has left the group 03/06/2021.', NULL, NULL, '2021-03-12 16:03:54', '2021-03-12 16:03:54'),
(9738, 3040, 13570, NULL, '2021-04-20 00:00:00.000', 'On Hold', 'Email rcvd from: Patricia.Garcia@dchstx.org  Subject: Withdraw letter - M Campos PA  Dear Mr Campos:  Your application has been withdrawn, notice received that Moses Campos, PA has left group (Valley Med Urgent Care).', NULL, NULL, '2021-04-13 15:44:52', '2021-04-13 15:44:52'),
(9739, 1005, 13570, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'The provider Moses Campos is no longer with Valley Med Urgent Care', NULL, NULL, '2021-06-01 14:36:25', '2021-06-01 14:36:25'),
(9740, 3040, 13571, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 15:17:29', '2021-01-21 15:17:29'),
(9741, 3040, 13571, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Campos, Moses || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for Moses Campos for our group Valley Med Urgent Care PLLC under all three locations.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-21 15:17:43', '2021-01-21 15:17:43'),
(9742, 3040, 13571, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Campos, Moses || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,  Hope you are doing well. I just wanted to know that you received the application of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-28 09:53:34', '2021-01-28 09:53:34'),
(9743, 3040, 13571, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Campos, Moses || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process. Please follow up directly with Aperture    to assure any requesting information has been received.  Thanks  Melinda', NULL, NULL, '2021-01-28 14:30:16', '2021-01-28 14:30:16'),
(9744, 3040, 13571, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Campos, Moses || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process. Please follow up directly with Aperture    to assure any requesting information has been received.  Thanks  Melinda', NULL, NULL, '2021-02-04 10:10:13', '2021-02-04 10:10:13'),
(9745, 3040, 13571, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: outreachsupport@aperturecvo.com  Subject: Campos, Moses || NPI# 1558680009 || Ref: 7FWH6 ||  Greetings,  Hope you are doing well. Please find the attached DEA certificate (Supervising Physician Teresa Saavedra) as per the request from (Michelle) Aperture representative for the below mentioned provider.    Practice Details:  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-11 16:38:03', '2021-02-11 16:38:03'),
(9746, 3040, 13571, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Follow up email sent to: outreachsupport@aperturecvo.com  Subject: Campos, Moses || NPI# 1558680009 || Ref: 7FWH6 ||  Greetings,  Hope you are doing well. Can you please advise me that you received the requested document for the below mentioned provider?   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider: Provider Name: Moses Campos Provider NPI# 1558680009  Please get back to me as soon as you can get a chance. Waiting for your response.  Thanks', NULL, NULL, '2021-02-18 13:59:45', '2021-02-18 13:59:45'),
(9747, 3040, 13571, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Campos, Moses || NPI# 1558680009 || Ref: 7FWH6 ||  Greetings.  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider: Provider Name: Moses Campos Provider NPI# 1558680009  If you need any additional information please feel free to call or email me. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-25 14:46:30', '2021-02-25 14:46:30'),
(9748, 3040, 13571, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: 	ibarra.vmuc@outlook.com  Subject: Need References From M Campos PA  Greetings, Hope you are doing well. I received an email from Driscoll and they requested me to send the references from Moses Campos. Can you please send me at least 03 peer references. For your reference I attached the document.  Thanks ', NULL, NULL, '2021-03-04 16:40:45', '2021-03-04 16:40:45'),
(9749, 3040, 13571, NULL, '2021-04-19 00:00:00.000', 'In Process', 'Provider has left the group 03/06/2021.', NULL, NULL, '2021-03-12 16:03:42', '2021-03-12 16:03:42'),
(9750, 3040, 13571, NULL, '2021-04-20 00:00:00.000', 'On Hold', 'Email rcvd from: Patricia.Garcia@dchstx.org  Subject: Withdraw letter - M Campos PA  Dear Mr Campos:  Your application has been withdrawn, notice received that Moses Campos, PA has left group (Valley Med Urgent Care).', NULL, NULL, '2021-04-13 15:44:58', '2021-04-13 15:44:58'),
(9751, 1005, 13571, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'The provider Moses Campos is no longer with Valley Med Urgent Care', NULL, NULL, '2021-06-01 14:36:52', '2021-06-01 14:36:52'),
(9752, 3040, 13572, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 15:20:54', '2021-01-21 15:20:54'),
(9753, 3040, 13572, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for Deborah Potter for our group Valley Med Urgent Care PLLC under all three locations.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-21 15:21:34', '2021-01-21 15:21:34'),
(9754, 3040, 13572, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,  Hope you are doing well. I just wanted to know that you received the application of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-28 09:55:55', '2021-01-28 09:55:55'),
(9755, 3040, 13572, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from:  Melinda.Lopez@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process.  Thanks  Melinda', NULL, NULL, '2021-01-28 14:28:22', '2021-01-28 14:28:22'),
(9756, 3040, 13572, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process.  Thanks  Melinda', NULL, NULL, '2021-02-04 10:08:33', '2021-02-04 10:08:33'),
(9757, 3040, 13572, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,  Hope you are doing well. Please note that I had a word with (Michelle) Aperture representative and she advised the application return back to Driscoll for Committee review.   If you need any additional information from my side please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-11 12:38:00', '2021-02-11 12:38:00'),
(9758, 3040, 13572, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject:  Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Hello, just wanted to let you know that the verification file for Deborah Potter NPI 1861914053 is in our queue for review and completion of the credentialing process. Please allow 60-90 days to complete this final process.', NULL, NULL, '2021-02-18 14:04:17', '2021-02-18 14:04:17'),
(9759, 3040, 13572, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-25 14:48:40', '2021-02-25 14:48:40'),
(9760, 3040, 13572, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-04 16:41:53', '2021-03-04 16:41:53'),
(9761, 3040, 13572, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-12 16:34:35', '2021-03-12 16:34:35'),
(9762, 3040, 13572, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Hello Melinda,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053  Waiting for your response.   Thank you  ', NULL, NULL, '2021-04-13 08:59:49', '2021-04-13 08:59:49'),
(9763, 3040, 13572, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject:  Potter, Deborah, FNP  Hello Karla,  I wanted to add a location for the below mentioned provider in Driscoll Health plan for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Additional Location: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248   If you need any additional information please let me know. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-03 15:04:41', '2021-05-03 15:04:41'),
(9764, 3040, 13572, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Potter, Deborah, FNP  Good morning,  Please find the attached Welcome letter for this provider effective 05/01/2021.  Karla Claunch, C.M.A. Driscoll Health Plan Provider Contracting and Credentialing Intake Specialist 4525 Ayers St Corpus Christi TX 78415-1401 Phone: 361-694-6554 Fax: 361-808-2182 Email: karla.claunch@dchstx.org   ', NULL, NULL, '2021-05-04 13:37:56', '2021-05-04 13:37:56'),
(9765, 3040, 13573, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 15:21:37', '2021-01-21 15:21:37'),
(9766, 3040, 13573, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for Deborah Potter for our group Valley Med Urgent Care PLLC under all three locations.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-21 15:21:44', '2021-01-21 15:21:44'),
(9767, 3040, 13573, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,  Hope you are doing well. I just wanted to know that you received the application of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-28 09:56:02', '2021-01-28 09:56:02'),
(9768, 3040, 13573, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,  Hope you are doing well. I just wanted to know that you received the application of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-28 09:56:02', '2021-01-28 09:56:02'),
(9769, 3040, 13573, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from:  Melinda.Lopez@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process.  Thanks  Melinda', NULL, NULL, '2021-01-28 14:28:28', '2021-01-28 14:28:28'),
(9770, 3040, 13573, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from:  Melinda.Lopez@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process.  Thanks  Melinda', NULL, NULL, '2021-01-28 14:28:28', '2021-01-28 14:28:28'),
(9771, 3040, 13573, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process.  Thanks  Melinda', NULL, NULL, '2021-02-04 10:08:40', '2021-02-04 10:08:40'),
(9772, 3040, 13573, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,  Hope you are doing well. Please note that I had a word with (Michelle) Aperture representative and she advised the application return back to Driscoll for Committee review.   If you need any additional information from my side please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-11 12:37:54', '2021-02-11 12:37:54'),
(9773, 3040, 13573, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject:  Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Hello, just wanted to let you know that the verification file for Deborah Potter NPI 1861914053 is in our queue for review and completion of the credentialing process. Please allow 60-90 days to complete this final process.', NULL, NULL, '2021-02-18 14:04:08', '2021-02-18 14:04:08'),
(9774, 3040, 13573, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-25 14:48:35', '2021-02-25 14:48:35'),
(9775, 3040, 13573, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-04 16:41:49', '2021-03-04 16:41:49'),
(9776, 3040, 13573, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-12 16:34:45', '2021-03-12 16:34:45'),
(9777, 3040, 13573, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Hello Melinda,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053  Waiting for your response.   Thank you  ', NULL, NULL, '2021-04-13 08:59:53', '2021-04-13 08:59:53'),
(9778, 3040, 13573, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject:  Potter, Deborah, FNP  Hello Karla,  I wanted to add a location for the below mentioned provider in Driscoll Health plan for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Additional Location: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248   If you need any additional information please let me know. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-03 15:04:45', '2021-05-03 15:04:45'),
(9779, 3040, 13573, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Potter, Deborah, FNP  Good Morning Karla,  I wanted to add the locations for the below mentioned provider in Driscoll Health plan for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Additional Location: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248    Waiting for you response.   Thanks   ', NULL, NULL, '2021-05-28 09:02:20', '2021-05-28 09:02:20'),
(9780, 3040, 13573, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject:Potter, Deborah, FNP  This requested location was effective on the date of the request 05/03/2021  Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248     Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 her originally requested practice location effective date 05/01/2021  ', NULL, NULL, '2021-06-03 15:49:07', '2021-06-03 15:49:07'),
(9781, 3040, 13574, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 15:21:46', '2021-01-21 15:21:46'),
(9782, 3040, 13574, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for Deborah Potter for our group Valley Med Urgent Care PLLC under all three locations.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-21 15:21:51', '2021-01-21 15:21:51'),
(9783, 3040, 13574, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,  Hope you are doing well. I just wanted to know that you received the application of the below mentioned provider.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-28 09:56:08', '2021-01-28 09:56:08'),
(9784, 3040, 13574, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from:  Melinda.Lopez@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process.  Thanks  Melinda', NULL, NULL, '2021-01-28 14:28:35', '2021-01-28 14:28:35'),
(9785, 3040, 13574, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process.  Thanks  Melinda', NULL, NULL, '2021-02-04 10:08:49', '2021-02-04 10:08:49'),
(9786, 3040, 13574, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,  Hope you are doing well. Please note that I had a word with (Michelle) Aperture representative and she advised the application return back to Driscoll for Committee review.   If you need any additional information from my side please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-11 12:38:07', '2021-02-11 12:38:07'),
(9787, 3040, 13574, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject:  Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Hello, just wanted to let you know that the verification file for Deborah Potter NPI 1861914053 is in our queue for review and completion of the credentialing process. Please allow 60-90 days to complete this final process.', NULL, NULL, '2021-02-18 14:04:23', '2021-02-18 14:04:23'),
(9788, 3040, 13574, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-25 14:48:45', '2021-02-25 14:48:45'),
(9789, 3040, 13574, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-04 16:41:57', '2021-03-04 16:41:57'),
(9790, 3040, 13574, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process', NULL, NULL, '2021-03-12 16:34:40', '2021-03-12 16:34:40'),
(9791, 3040, 13574, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Enrollment || Potter, Deborah || Valley Med Urgent Care PLLC || Driscoll ||  Hello Melinda,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053  Waiting for your response.   Thank you  ', NULL, NULL, '2021-04-13 09:00:00', '2021-04-13 09:00:00'),
(9792, 3040, 13574, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject:  Potter, Deborah, FNP  Hello Karla,  I wanted to add a location for the below mentioned provider in Driscoll Health plan for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Additional Location: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248   If you need any additional information please let me know. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-05-03 15:04:49', '2021-05-03 15:04:49'),
(9793, 3040, 13574, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Potter, Deborah, FNP  Good Morning Karla,  I wanted to add the locations for the below mentioned provider in Driscoll Health plan for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Deborah Potter Provider NPI# 1861914053 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Additional Location: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248    Waiting for you response.   Thanks   ', NULL, NULL, '2021-05-28 09:02:15', '2021-05-28 09:02:15'),
(9794, 3040, 13574, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject:Potter, Deborah, FNP  This requested location was effective on the date of the request 05/03/2021  Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248     Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 her originally requested practice location effective date 05/01/2021  ', NULL, NULL, '2021-06-03 15:49:08', '2021-06-03 15:49:08'),
(9795, 3040, 13575, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 15:25:02', '2021-01-21 15:25:02'),
(9796, 3040, 13575, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for Larry Donald Wright for our group Valley Med Urgent Care PLLC under all three locations.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-21 15:25:42', '2021-01-21 15:25:42'),
(9797, 3040, 13575, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: 	DHPContracting@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||   Greetings,  Hope you are doing well. I just wanted to know that you received the application of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-28 09:49:44', '2021-01-28 09:49:44'),
(9798, 3040, 13575, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process.  Please follow up directly with Aperture to assure any requesting information has been received.  Thanks  Melinda', NULL, NULL, '2021-01-28 14:31:11', '2021-01-28 14:31:11'),
(9799, 3040, 13575, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process.  Please follow up directly with Aperture to assure any requesting information has been received.  Thanks  Melinda', NULL, NULL, '2021-02-04 10:03:59', '2021-02-04 10:03:59'),
(9800, 3040, 13575, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,  Hope you are doing well. Please note that I had a word with (Michelle) Aperture representative and she advised the application return back to Driscoll for Committee review.   If you need any additional information from my side please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-11 12:36:22', '2021-02-11 12:36:22'),
(9801, 3040, 13575, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Hello, just wanted to let you know that the verification file for Larry Donald Wright  NPI 1033769765 is in our queue for review and completion of the credentialing process. Please allow 60-90 days to complete this final process.', NULL, NULL, '2021-02-18 14:05:30', '2021-02-18 14:05:30'),
(9802, 3040, 13575, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-25 14:49:16', '2021-02-25 14:49:16'),
(9803, 3040, 13575, NULL, '2021-03-11 00:00:00.000', 'In Process', '	 Still in process. ', NULL, NULL, '2021-03-04 16:42:21', '2021-03-04 16:42:21'),
(9804, 3040, 13575, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-12 16:35:16', '2021-03-12 16:35:16'),
(9805, 3040, 13575, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject:  Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Hello Melinda,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Larry Donald Wright Provider NPI# 1033769765  Waiting for your response.  Thank you ', NULL, NULL, '2021-04-13 08:50:42', '2021-04-13 08:50:42'),
(9806, 3040, 13575, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Good Afternoon Melinda,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned provider. Is there any good news for me?  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Larry Donald Wright Provider NPI# 1033769765  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-05-04 13:48:13', '2021-05-04 13:48:13'),
(9807, 3040, 13575, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Adil, the credentialing file for Larry Donald Wright has been completed and should be reviewed for approval by our credentialing committee on 5/26/2021.  Thanks  Melinda   ', NULL, NULL, '2021-05-28 08:36:00', '2021-05-28 08:36:00'),
(9808, 3040, 13575, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Wright, Larry D., NP  May 26, 2021  Valley Med Urgent Care PLLC Larry D. Wright, NP 2534 Boca Chica Blvd Brownsville, TX 78521-3496  Good morning,  Please find the attached Welcome Letter for this provider effective 06/01/2021.  If you need any further assistance, please let me know.', NULL, NULL, '2021-06-03 16:02:23', '2021-06-03 16:02:23'),
(9809, 3040, 13576, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 15:25:45', '2021-01-21 15:25:45'),
(9810, 3040, 13576, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for Larry Donald Wright for our group Valley Med Urgent Care PLLC under all three locations.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-21 15:25:52', '2021-01-21 15:25:52'),
(9811, 3040, 13576, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: 	DHPContracting@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||   Greetings,  Hope you are doing well. I just wanted to know that you received the application of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-28 09:49:53', '2021-01-28 09:49:53');
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
(9812, 3040, 13576, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process.  Please follow up directly with Aperture to assure any requesting information has been received.  Thanks  Melinda', NULL, NULL, '2021-01-28 14:31:19', '2021-01-28 14:31:19'),
(9813, 3040, 13576, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process.  Please follow up directly with Aperture to assure any requesting information has been received.  Thanks  Melinda', NULL, NULL, '2021-02-04 10:04:07', '2021-02-04 10:04:07'),
(9814, 3040, 13576, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,  Hope you are doing well. Please note that I had a word with (Michelle) Aperture representative and she advised the application return back to Driscoll for Committee review.   If you need any additional information from my side please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-11 12:36:33', '2021-02-11 12:36:33'),
(9815, 3040, 13576, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Hello, just wanted to let you know that the verification file for Larry Donald Wright  NPI 1033769765 is in our queue for review and completion of the credentialing process. Please allow 60-90 days to complete this final process.', NULL, NULL, '2021-02-18 14:05:24', '2021-02-18 14:05:24'),
(9816, 3040, 13576, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-25 14:48:59', '2021-02-25 14:48:59'),
(9817, 3040, 13576, NULL, '2021-03-11 00:00:00.000', 'In Process', '	 Still in process. ', NULL, NULL, '2021-03-04 16:42:17', '2021-03-04 16:42:17'),
(9818, 3040, 13576, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-12 16:35:20', '2021-03-12 16:35:20'),
(9819, 3040, 13576, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject:  Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Hello Melinda,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Larry Donald Wright Provider NPI# 1033769765  Waiting for your response.  Thank you ', NULL, NULL, '2021-04-13 08:50:49', '2021-04-13 08:50:49'),
(9820, 3040, 13576, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Good Afternoon Melinda,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned provider. Is there any good news for me?  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Larry Donald Wright Provider NPI# 1033769765  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-05-04 13:48:18', '2021-05-04 13:48:18'),
(9821, 3040, 13576, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Adil, the credentialing file for Larry Donald Wright has been completed and should be reviewed for approval by our credentialing committee on 5/26/2021.  Thanks  Melinda   ', NULL, NULL, '2021-05-28 08:38:11', '2021-05-28 08:38:11'),
(9822, 3040, 13576, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Re: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Hello Melinda,  Hope you are doing well. Please update regarding the additional location request for the below mentioned provider. Provider is already enrolled with Driscoll on 06/01/2021.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider 1: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Additional Location: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Waiting for your response.   Thank you ', NULL, NULL, '2021-06-16 12:53:14', '2021-06-16 12:53:14'),
(9823, 3040, 13576, NULL, '2021-07-12 00:00:00.000', 'Approved', 'Provider enrolled in Driscoll. Please see attachment. ', NULL, NULL, '2021-07-05 14:15:10', '2021-07-05 14:15:10'),
(9824, 3040, 13577, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 15:25:54', '2021-01-21 15:25:54'),
(9825, 3040, 13577, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Email sent to: DHPContracting@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for Larry Donald Wright for our group Valley Med Urgent Care PLLC under all three locations.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-21 15:25:59', '2021-01-21 15:25:59'),
(9826, 3040, 13577, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: 	DHPContracting@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||   Greetings,  Hope you are doing well. I just wanted to know that you received the application of the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Larry Donald Wright Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-28 09:49:59', '2021-01-28 09:49:59'),
(9827, 3040, 13577, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process.  Please follow up directly with Aperture to assure any requesting information has been received.  Thanks  Melinda', NULL, NULL, '2021-01-28 14:31:24', '2021-01-28 14:31:24'),
(9828, 3040, 13577, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Adil, this provider has been sent to Aperture to initiate the verification process please assure that this provider has a fully completed Texas Standardized Credentialing Application posted on CAQH with all required credentialing information and documents.  Aperture will reach out to you directly for any missing information, we encourage our providers to respond as quickly as possible to any requests from Aperture to avoid any delays in the verification process.  Please follow up directly with Aperture to assure any requesting information has been received.  Thanks  Melinda', NULL, NULL, '2021-02-04 10:04:14', '2021-02-04 10:04:14'),
(9829, 3040, 13577, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Greetings,  Hope you are doing well. Please note that I had a word with (Michelle) Aperture representative and she advised the application return back to Driscoll for Committee review.   If you need any additional information from my side please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-11 12:36:28', '2021-02-11 12:36:28'),
(9830, 3040, 13577, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Hello, just wanted to let you know that the verification file for Larry Donald Wright  NPI 1033769765 is in our queue for review and completion of the credentialing process. Please allow 60-90 days to complete this final process.', NULL, NULL, '2021-02-18 14:05:36', '2021-02-18 14:05:36'),
(9831, 3040, 13577, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-02-25 14:49:23', '2021-02-25 14:49:23'),
(9832, 3040, 13577, NULL, '2021-03-11 00:00:00.000', 'In Process', '	 Still in process. ', NULL, NULL, '2021-03-04 16:42:27', '2021-03-04 16:42:27'),
(9833, 3040, 13577, NULL, '2021-03-19 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-12 16:35:12', '2021-03-12 16:35:12'),
(9834, 3040, 13577, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject:  Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Hello Melinda,  Hope you are doing well. Please advise me the enrollment status for the below mentioned provider.   Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Larry Donald Wright Provider NPI# 1033769765  Waiting for your response.  Thank you ', NULL, NULL, '2021-04-13 08:50:54', '2021-04-13 08:50:54'),
(9835, 3040, 13577, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Good Afternoon Melinda,  Hope you are doing well. This is a follow up email regarding the enrollment status for the below mentioned provider. Is there any good news for me?  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider Name: Larry Donald Wright Provider NPI# 1033769765  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-05-04 13:48:22', '2021-05-04 13:48:22'),
(9836, 3040, 13577, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email rcvd from: Melinda.Lopez@dchstx.org  Subject: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Adil, the credentialing file for Larry Donald Wright has been completed and should be reviewed for approval by our credentialing committee on 5/26/2021.  Thanks  Melinda   ', NULL, NULL, '2021-05-28 08:36:58', '2021-05-28 08:36:58'),
(9837, 3040, 13577, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: Melinda.Lopez@dchstx.org  Subject: Re: Enrollment || Wright, larry Donald || Valley Med Urgent Care PLLC || Driscoll ||  Hello Melinda,  Hope you are doing well. Please update regarding the additional location request for the below mentioned provider. Provider is already enrolled with Driscoll on 06/01/2021.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd  Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Provider 1: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Additional Location: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248  Waiting for your response.   Thank you ', NULL, NULL, '2021-06-16 12:53:08', '2021-06-16 12:53:08'),
(9838, 3040, 13577, NULL, '2021-07-12 00:00:00.000', 'Approved', 'Provider enrolled in Driscoll. Please see attachment. ', NULL, NULL, '2021-07-05 14:15:03', '2021-07-05 14:15:03'),
(9839, 3040, 13578, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 15:59:28', '2021-01-21 15:59:28'),
(9840, 3040, 13578, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Application submitted online through Aetna website.  See attachment.', NULL, NULL, '2021-01-21 16:00:11', '2021-01-21 16:00:11'),
(9841, 3040, 13578, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Application submitted online through Aetna website.  See attachment.', NULL, NULL, '2021-01-21 16:00:14', '2021-01-21 16:00:14'),
(9842, 3040, 13578, NULL, '2021-02-04 00:00:00.000', 'Approved', 'Urgent Care Contract.   See Attachments.', NULL, NULL, '2021-01-28 11:12:10', '2021-01-28 11:12:10'),
(9843, 3040, 13579, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 16:00:18', '2021-01-21 16:00:18'),
(9844, 3040, 13579, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Application submitted online through Aetna website.  See attachment.', NULL, NULL, '2021-01-21 16:00:23', '2021-01-21 16:00:23'),
(9845, 3040, 13579, NULL, '2021-02-04 00:00:00.000', 'Approved', 'Urgent Care Contract.   See Attachments.', NULL, NULL, '2021-01-28 11:11:59', '2021-01-28 11:11:59'),
(9846, 3040, 13580, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-21 16:00:26', '2021-01-21 16:00:26'),
(9847, 3040, 13580, NULL, '2021-01-28 00:00:00.000', 'Initiated', 'Application submitted online through Aetna website.  See attachment.', NULL, NULL, '2021-01-21 16:00:31', '2021-01-21 16:00:31'),
(9848, 3040, 13580, NULL, '2021-02-04 00:00:00.000', 'Approved', 'Urgent Care Contract.   See Attachments.', NULL, NULL, '2021-01-28 11:12:04', '2021-01-28 11:12:04'),
(9849, 1006, 13581, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-22 14:42:16', '2021-01-22 14:42:16'),
(9850, 1006, 13581, NULL, '2021-01-29 00:00:00.000', 'Initiated', 'Sent link letter @ pec@maximus.com. Attached. ', NULL, NULL, '2021-01-22 14:42:35', '2021-01-22 14:42:35'),
(9851, 1006, 13581, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Sent a followup email @ pec@maximus.com', NULL, NULL, '2021-01-28 10:04:13', '2021-01-28 10:04:13'),
(9852, 1006, 13581, NULL, '2021-02-12 00:00:00.000', 'Approved', 'Good morning Brad,  Thank you for your email.   PID# 110087898A- RAVEENDRAN , PANDEESWARI-  Group link: 110159328A             1356906572             SNBCARE,           10/01/2020    12/31/2299\"', NULL, NULL, '2021-02-05 10:43:54', '2021-02-05 10:43:54'),
(9853, 3040, 13582, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-27 15:42:42', '2021-01-27 15:42:42'),
(9854, 3040, 13582, NULL, '2021-02-03 00:00:00.000', 'Initiated', 'Email sent to: MDuffee@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers under the In-network existing Tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-27 15:44:02', '2021-01-27 15:44:02'),
(9855, 3040, 13582, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers under the In-network existing Tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-03 09:28:25', '2021-02-03 09:28:25'),
(9856, 3040, 13582, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com, MDuffee@humana.com, KMoten4@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Good Afternoon,  I wanted to enroll the below mentioned provider under the In-network existing tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  Waiting for your response.   Thanks', NULL, NULL, '2021-02-10 13:00:23', '2021-02-10 13:00:23'),
(9857, 3040, 13582, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Effective Date: 11/01/2017  Group has an ancillary contract.', NULL, NULL, '2021-02-12 17:20:40', '2021-02-12 17:20:40'),
(9858, 3040, 13582, NULL, NULL, 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you', NULL, NULL, '2021-03-25 10:00:06', '2021-03-25 10:00:06'),
(9859, 3040, 13582, NULL, '2021-06-23 00:00:00.000', 'Revalidation', 'Email rcvd from: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Your request was received and is in the queue to be worked.  You will receive an email notification once your request has been completed.  Thank you', NULL, NULL, '2021-06-16 15:05:48', '2021-06-16 15:05:48'),
(9860, 3040, 13582, NULL, '2021-06-29 00:00:00.000', 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:47:46', '2021-06-22 11:47:46'),
(9861, 3040, 13582, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Group has an ancillary contract. No need to add individual providers. We already sent the request for location addition once the location under the contract we gonna update the providers task. ', NULL, NULL, '2021-07-09 12:02:19', '2021-07-09 12:02:19'),
(9862, 3040, 13582, NULL, '2021-07-27 00:00:00.000', 'Revalidated', 'Group has an ancillary contract. No need to add individual providers.', NULL, NULL, '2021-07-20 11:50:31', '2021-07-20 11:50:31'),
(9863, 3040, 13583, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-27 15:42:50', '2021-01-27 15:42:50'),
(9864, 3040, 13583, NULL, '2021-02-03 00:00:00.000', 'Initiated', 'Email sent to: MDuffee@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers under the In-network existing Tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-27 15:43:49', '2021-01-27 15:43:49'),
(9865, 3040, 13583, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers under the In-network existing Tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-03 09:28:31', '2021-02-03 09:28:31'),
(9866, 3040, 13583, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com, MDuffee@humana.com, KMoten4@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Good Afternoon,  I wanted to enroll the below mentioned provider under the In-network existing tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  Waiting for your response.   Thanks', NULL, NULL, '2021-02-11 17:18:27', '2021-02-11 17:18:27'),
(9867, 3040, 13583, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Effective Date: 11/01/2017  Group has an ancillary contract.', NULL, NULL, '2021-02-12 17:20:41', '2021-02-12 17:20:41'),
(9868, 3040, 13584, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-27 15:44:07', '2021-01-27 15:44:07'),
(9869, 3040, 13584, NULL, '2021-02-03 00:00:00.000', 'Initiated', 'Email sent to: MDuffee@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers under the In-network existing Tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-27 15:44:31', '2021-01-27 15:44:31'),
(9870, 3040, 13584, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers under the In-network existing Tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-03 09:28:40', '2021-02-03 09:28:40'),
(9871, 3040, 13584, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com, MDuffee@humana.com, KMoten4@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Good Afternoon,  I wanted to enroll the below mentioned provider under the In-network existing tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  Waiting for your response.   Thanks', NULL, NULL, '2021-02-10 13:00:29', '2021-02-10 13:00:29'),
(9872, 3040, 13584, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Effective Date: 11/01/2017  Group has an ancillary contract.', NULL, NULL, '2021-02-12 17:20:42', '2021-02-12 17:20:42'),
(9873, 3040, 13585, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-27 15:50:00', '2021-01-27 15:50:00'),
(9874, 3040, 13585, NULL, '2021-02-03 00:00:00.000', 'Initiated', 'Email sent to: MDuffee@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers under the In-network existing Tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-27 15:50:29', '2021-01-27 15:50:29'),
(9875, 3040, 13585, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers under the In-network existing Tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-03 09:29:14', '2021-02-03 09:29:14'),
(9876, 3040, 13585, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com, MDuffee@humana.com, KMoten4@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Good Afternoon,  I wanted to enroll the below mentioned provider under the In-network existing tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  Waiting for your response.   Thanks', NULL, NULL, '2021-02-10 13:00:41', '2021-02-10 13:00:41'),
(9877, 3040, 13585, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Effective Date: 11/01/2017  Group has an ancillary contract.', NULL, NULL, '2021-02-12 17:20:35', '2021-02-12 17:20:35'),
(9878, 3040, 13586, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-27 15:50:32', '2021-01-27 15:50:32'),
(9879, 3040, 13586, NULL, '2021-02-03 00:00:00.000', 'Initiated', 'Email sent to: MDuffee@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers under the In-network existing Tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-27 15:50:58', '2021-01-27 15:50:58'),
(9880, 3040, 13586, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers under the In-network existing Tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-03 09:29:20', '2021-02-03 09:29:20'),
(9881, 3040, 13586, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com, MDuffee@humana.com, KMoten4@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Good Afternoon,  I wanted to enroll the below mentioned provider under the In-network existing tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  Waiting for your response.   Thanks', NULL, NULL, '2021-02-10 13:00:35', '2021-02-10 13:00:35'),
(9882, 3040, 13586, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Effective Date: 11/01/2017  Group has an ancillary contract.', NULL, NULL, '2021-02-12 17:20:36', '2021-02-12 17:20:36'),
(9883, 3040, 13586, NULL, NULL, 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you', NULL, NULL, '2021-03-25 09:59:26', '2021-03-25 09:59:26'),
(9884, 3040, 13586, NULL, '2021-06-23 00:00:00.000', 'Revalidation', 'Email rcvd from: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Your request was received and is in the queue to be worked.  You will receive an email notification once your request has been completed.  Thank you', NULL, NULL, '2021-06-16 15:05:43', '2021-06-16 15:05:43'),
(9885, 3040, 13586, NULL, '2021-06-29 00:00:00.000', 'Revalidation', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:47:46', '2021-06-22 11:47:46'),
(9886, 3040, 13586, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Group has an ancillary contract. No need to add individual providers. We already sent the request for location addition once the location under the contract we gonna update the providers task. ', NULL, NULL, '2021-07-09 12:02:20', '2021-07-09 12:02:20'),
(9887, 3040, 13586, NULL, '2021-07-27 00:00:00.000', 'Revalidated', 'Group has an ancillary contract. No need to add individual providers.', NULL, NULL, '2021-07-20 11:50:32', '2021-07-20 11:50:32'),
(9888, 3040, 13587, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-27 15:51:04', '2021-01-27 15:51:04'),
(9889, 3040, 13587, NULL, '2021-02-03 00:00:00.000', 'Initiated', 'Email sent to: MDuffee@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers under the In-network existing Tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-27 15:51:29', '2021-01-27 15:51:29'),
(9890, 3040, 13587, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers under the In-network existing Tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  If you need any additional information please call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-03 09:29:27', '2021-02-03 09:29:27'),
(9891, 3040, 13587, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com, MDuffee@humana.com, KMoten4@humana.com  Subject: Need Enroll || Potter, Deborah, Wright, Larry Donald || Valley Med Urgent Care PLLC || Humana ||  Good Afternoon,  I wanted to enroll the below mentioned provider under the In-network existing tax ID.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address:2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Deborah Potter, Provider NPI# 1861914053  Provider 2:   Provider Name: Larry Donald Wright, Provider NPI# 1033769765  Waiting for your response.   Thanks', NULL, NULL, '2021-02-10 13:00:47', '2021-02-10 13:00:47'),
(9892, 3040, 13587, NULL, '2021-02-19 00:00:00.000', 'Approved', 'Effective Date: 11/01/2017  Group has an ancillary contract.', NULL, NULL, '2021-02-12 17:20:38', '2021-02-12 17:20:38'),
(9893, 3040, 13588, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-27 16:32:12', '2021-01-27 16:32:12'),
(9894, 3040, 13588, NULL, '2021-02-03 00:00:00.000', 'Initiated', 'Email sent to: MDuffee@humana.com  Subject: Need Enroll || Fernandus, Limy || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider under the In-network existing Tax ID. The provider should be In-network with Humana.   Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2:   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Information: Provider Name: Limy Fernandus Provider NPI# 1972005189  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-27 16:33:15', '2021-01-27 16:33:15'),
(9895, 3040, 13588, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Humana Market Roaster || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Fernandus, Limy || Humana ||  Greetings,  Hope you are doing well. Please find the attached the Humana market roster to enroll the provider under the In-network existing Tax ID. The provider is already In-network with Humana as well.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-28 14:23:24', '2021-01-28 14:23:24'),
(9896, 3040, 13588, NULL, '2021-02-05 00:00:00.000', 'Approved', 'From: HumanaHoustonPD@humana.com  We can bill under the group TIN.', NULL, NULL, '2021-01-29 17:07:01', '2021-01-29 17:07:01'),
(9897, 3040, 13589, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-27 16:33:23', '2021-01-27 16:33:23'),
(9898, 3040, 13589, NULL, '2021-02-03 00:00:00.000', 'Initiated', 'Email sent to: MDuffee@humana.com  Subject: Need Enroll || Fernandus, Limy || Valley Med Urgent Care PLLC || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider under the In-network existing Tax ID. The provider should be In-network with Humana.   Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice 2:   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Information: Provider Name: Limy Fernandus Provider NPI# 1972005189  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-27 16:33:44', '2021-01-27 16:33:44'),
(9899, 3040, 13589, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Humana Market Roaster || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Fernandus, Limy || Humana ||  Greetings,  Hope you are doing well. Please find the attached the Humana market roster to enroll the provider under the In-network existing Tax ID. The provider is already In-network with Humana as well.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-28 14:23:34', '2021-01-28 14:23:34'),
(9900, 3040, 13589, NULL, '2021-02-05 00:00:00.000', 'Approved', 'From: HumanaHoustonPD@humana.com  We can bill under the group TIN.', NULL, NULL, '2021-01-29 17:06:59', '2021-01-29 17:06:59'),
(9901, 3040, 13590, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-27 16:40:41', '2021-01-27 16:40:41'),
(9902, 3040, 13590, NULL, '2021-02-03 00:00:00.000', 'Initiated', 'Email sent to: MDuffee@humana.com  Subject: Need Enroll || Fernandus, Limy || Longpoint Medical Center || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider under the In-network existing Tax ID. The provider should be In-network with Humana.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice Tax ID# 76-0612416 Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Information: Provider Name: Limy Fernandus Provider NPI# 1972005189  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-27 16:41:55', '2021-01-27 16:41:55'),
(9903, 3040, 13590, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Humana Market Roaster || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Fernandus, Limy || Humana ||  Greetings,  Hope you are doing well. Please find the attached the Humana market roster to enroll the provider under the In-network existing Tax ID. The provider is already In-network with Humana as well.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-28 14:23:43', '2021-01-28 14:23:43'),
(9904, 3040, 13590, NULL, '2021-02-05 00:00:00.000', 'Approved', 'From: HumanaHoustonPD@humana.com  We can bill under the group TIN.', NULL, NULL, '2021-01-29 17:06:57', '2021-01-29 17:06:57'),
(9905, 3040, 13591, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-01-27 16:42:06', '2021-01-27 16:42:06'),
(9906, 3040, 13591, NULL, '2021-02-03 00:00:00.000', 'Initiated', 'Email sent to: MDuffee@humana.com  Subject: Need Enroll || Fernandus, Limy || Columbus Urgent Care PA || Humana ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider under the In-network existing Tax ID. The provider should be In-network with Humana.   Practice Details: Practice Name: Columbus Urgent Care PA Practice NPI# 1215330501 Practice Tax ID# 47-1914151 Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Information: Provider Name: Limy Fernandus Provider NPI# 1972005189  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-27 16:42:56', '2021-01-27 16:42:56'),
(9907, 3040, 13591, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Humana Market Roaster || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Fernandus, Limy || Humana ||  Greetings,  Hope you are doing well. Please find the attached the Humana market roster to enroll the provider under the In-network existing Tax ID. The provider is already In-network with Humana as well.  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-01-28 14:23:59', '2021-01-28 14:23:59'),
(9908, 3040, 13591, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Humana Market Roaster || Columbus Urgent Care PA || Fernandus, Limy || Humana ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned provider.    Practice Details: Practice Name: Columbus Urgent Care PA Practice NPI# 1215330501 Practice Tax ID# 47-1914151 Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Information: Provider Name: Limy Fernandus Provider NPI# 1972005189  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-04 13:28:28', '2021-02-04 13:28:28'),
(9909, 3040, 13591, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Need Enroll || Fernandus, Limy || Columbus Urgent Care PA || Humana ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status of the below mentioned provider. I already submitted the roster that you sent me.  Practice Details: Practice Name: Columbus Urgent Care PA Practice NPI# 1215330501 Practice Tax ID# 47-1914151 Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Information: Provider Name: Limy Fernandus Provider NPI# 1972005189  Please get back to me as soon as you get a chance. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-11 10:14:46', '2021-02-11 10:14:46'),
(9910, 3040, 13591, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: mduffee@humana.com  Subject: Need Enroll || Fernandus, Limy || Columbus Urgent Care PA || Humana ||  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-02-18 09:54:11', '2021-02-18 09:54:11');
