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
(19505, 1019, 21618, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Received the following message from : behavioralcontracting@cigna.com  Sub: You have successfully submitted your application  Our application has been received, your CBP ID is CBP-0000207301. A recruiter will process your application and provide onboarding instructions within 20 business days. The process to join the Cigna Network can take up to 90 days. To check the status of your application, please email behavioralcontracting@cigna.com.', NULL, NULL, '2021-04-01 17:14:05', '2021-04-01 17:14:05'),
(19506, 1019, 21618, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com Sub: Enrollment Status || Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards, Alex', NULL, NULL, '2021-04-08 11:27:48', '2021-04-08 11:27:48'),
(19507, 1019, 21618, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received the following email from: BehavioralContracting@cigna.com SUB: Enrollment Status || Providers || SNBCARE || CIGNA   Hi, Please see below for the provider status update.  Justin Souliere- Received application will process shortly. Kerry Smith- Received application will process shortly. Rodesia Edmundson- Received application will process shortly. Carlee Rozell- Credentialing status  Kiara   Cigna Behavioral NCU   E: BehavioralContracting@cigna.com', NULL, NULL, '2021-04-14 07:22:18', '2021-04-14 07:22:18'),
(19508, 3040, 21618, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Email sent to: BehavioralContracting@cigna.com  Subject: Enrollment Status || Spectrum Neuro Behavioral Care || Providers || Cigna ||  Greetings,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers for our group Spectrum Neuro Behavioral Care under below locations.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI: Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thanks  ', NULL, NULL, '2021-04-19 10:07:20', '2021-04-19 10:07:20'),
(19509, 1019, 21618, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com SUB: Enrollment Status || Group & Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Secondary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Tertiary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Tawakol, Katie NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.      Hefti, Prisca NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 09:25:16', '2021-05-20 09:25:16'),
(19510, 1019, 21618, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Received the following email from julia.perkins@cigna.com SUB: MA 15087992 KERRY SMITH Cigna behavioral Contract BID  Thank you for your interest in becoming a part of our behavioral health care professional network. We are pleased to extend a Cigna Behavioral On-boarding Packet to you. Please review and complete the attached documents within the next 10 business days and submit them electronically via DocuSign with your signature. Once received, we will review your credentialing information via online source verification systems. Please note: You will not be considered in network until your credentials are verified and you receive notification from Cigna that your On-boarding is complete. If you have any questions, please contact me directly using the contact information located at the bottom of this email.  Thank you,  Julia Perkins ', NULL, NULL, '2021-05-25 08:00:30', '2021-05-25 08:00:30'),
(19511, 1019, 21618, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Signed the On Boarding Packet online thru Doc Sign Attached is the copy for reference.', NULL, NULL, '2021-05-25 08:01:04', '2021-05-25 08:01:04'),
(19512, 1019, 21618, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:35:22', '2021-06-03 15:35:22'),
(19513, 1019, 21618, NULL, '2021-11-23 00:00:00.000', 'Not Eligible', 'Received the following email from Julia.Perkins@evernorth.com  KERRY SMITH holds a Licensed Certified Social Worker which is Not accepted in the state of ma.     Helena Halterman– provider is in que for credentialing at current time there is no action needed from the provider or your office.     Dina Filoteo Nichols-Packet sent – your assigned Evernorth Recruiter has reviewed your Provider Information Form and has sent your onboarding packet via DocuSign. Please review, and sign.     Eliza Rodrigues- I do not show an application on file.', NULL, NULL, '2021-11-16 15:10:16', '2021-11-16 15:10:16'),
(19514, 1006, 21619, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:37', '2021-03-16 10:30:37'),
(19515, 3040, 21619, NULL, '2021-04-26 00:00:00.000', 'Not Eligible', 'As per our discussion with Furquan, I\'ve notified him that trying to keep going forward with this might effect the enrollment for our other LCSW providers after Cigna has been notified of their enrollment. Rejecting this task.  ', NULL, NULL, '2021-04-19 16:03:04', '2021-04-19 16:03:04'),
(19516, 1006, 21620, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:38', '2021-03-16 10:30:38'),
(19517, 1019, 21620, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to :BehavioralContAdmin@cigna.com Sub: Location Addition || Group and Providers || SNBCARE || CIGNA  ATTN: Behavioral Provider Contract Administration Please find the attached Clinic Location Changes For Existing Clinic Contracts form to Add new location under our group and to add providers as well. All providers are listed in the form accordingly.   Regards, Alex G.', NULL, NULL, '2021-04-21 07:38:20', '2021-04-21 07:38:20'),
(19518, 1019, 21620, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com SUB: Enrollment Status || Group & Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Secondary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Tertiary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Tawakol, Katie NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.      Hefti, Prisca NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 09:27:03', '2021-05-20 09:27:03'),
(19519, 1019, 21620, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:35:15', '2021-06-03 15:35:15'),
(19520, 1019, 21620, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Provider added under new location effective date 04/13/2021. Attached is the group roster for ref. ', NULL, NULL, '2021-07-15 07:53:34', '2021-07-15 07:53:34'),
(19521, 1006, 21621, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:40', '2021-03-16 10:30:40'),
(19522, 1019, 21621, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to :BehavioralContAdmin@cigna.com Sub: Location Addition || Group and Providers || SNBCARE || CIGNA  ATTN: Behavioral Provider Contract Administration Please find the attached Clinic Location Changes For Existing Clinic Contracts form to Add new location under our group and to add providers as well. All providers are listed in the form accordingly.   Regards, Alex G.', NULL, NULL, '2021-04-21 07:37:45', '2021-04-21 07:37:45'),
(19523, 1019, 21621, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com SUB: Enrollment Status || Group & Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Secondary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Tertiary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Tawakol, Katie NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.      Hefti, Prisca NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 09:27:37', '2021-05-20 09:27:37'),
(19524, 1019, 21621, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:35:08', '2021-06-03 15:35:08'),
(19525, 1019, 21621, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Provider added under new location effective date 0/06/2020. Attached is the group roster for ref. ', NULL, NULL, '2021-07-15 07:54:35', '2021-07-15 07:54:35'),
(19526, 1006, 21622, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:41', '2021-03-16 10:30:41'),
(19527, 1019, 21622, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to :BehavioralContAdmin@cigna.com Sub: Location Addition || Group and Providers || SNBCARE || CIGNA  ATTN: Behavioral Provider Contract Administration Please find the attached Clinic Location Changes For Existing Clinic Contracts form to Add new location under our group and to add providers as well. All providers are listed in the form accordingly.   Regards, Alex G.', NULL, NULL, '2021-04-21 07:36:44', '2021-04-21 07:36:44'),
(19528, 1019, 21622, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com SUB: Enrollment Status || Group & Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Secondary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Tertiary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Tawakol, Katie NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.      Hefti, Prisca NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 09:27:14', '2021-05-20 09:27:14'),
(19529, 1019, 21622, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:35:00', '2021-06-03 15:35:00'),
(19530, 1019, 21622, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Provider added under new location effective date 04/15/2020. Attached is the group roster for ref. ', NULL, NULL, '2021-07-15 07:55:32', '2021-07-15 07:55:32'),
(19531, 1006, 21623, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:43', '2021-03-16 10:30:43'),
(19532, 1019, 21623, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to :BehavioralContAdmin@cigna.com Sub: Location Addition || Group and Providers || SNBCARE || CIGNA  ATTN: Behavioral Provider Contract Administration Please find the attached Clinic Location Changes For Existing Clinic Contracts form to Add new location under our group and to add providers as well. All providers are listed in the form accordingly.   Regards, Alex G.', NULL, NULL, '2021-04-21 07:35:51', '2021-04-21 07:35:51'),
(19533, 1019, 21623, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com SUB: Enrollment Status || Group & Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Secondary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Tertiary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Tawakol, Katie NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.      Hefti, Prisca NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 09:26:52', '2021-05-20 09:26:52'),
(19534, 1019, 21623, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:34:31', '2021-06-03 15:34:31'),
(19535, 1019, 21623, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Provider added under new location effective date 02/07/2018. Attached is the group roster for ref. ', NULL, NULL, '2021-07-15 07:56:47', '2021-07-15 07:56:47'),
(19536, 1006, 21624, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:44', '2021-03-16 10:30:44'),
(19537, 1019, 21624, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to :BehavioralContAdmin@cigna.com Sub: Location Addition || Group and Providers || SNBCARE || CIGNA  ATTN: Behavioral Provider Contract Administration Please find the attached Clinic Location Changes For Existing Clinic Contracts form to Add new location under our group and to add providers as well. All providers are listed in the form accordingly.   Regards, Alex G.', NULL, NULL, '2021-04-21 07:34:59', '2021-04-21 07:34:59'),
(19538, 1019, 21624, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com SUB: Enrollment Status || Group & Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Secondary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Tertiary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Tawakol, Katie NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.      Hefti, Prisca NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 09:27:48', '2021-05-20 09:27:48'),
(19539, 1019, 21624, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:34:22', '2021-06-03 15:34:22'),
(19540, 1019, 21624, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Provider added under new location effective date 12/27/2017. Attached is the group roster for ref. ', NULL, NULL, '2021-07-15 07:57:54', '2021-07-15 07:57:54'),
(19541, 3040, 21625, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:44', '2021-03-16 10:30:44'),
(19542, 3040, 21625, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject:Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group Long Point Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-02 14:18:06', '2021-06-02 14:18:06'),
(19543, 3040, 21625, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Can you please advise what I need to link the providers with First Health. If the given tin is not linked with First Health then how come the providers are participating.    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-21 16:18:31', '2021-06-21 16:18:31'),
(19544, 11056, 21625, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:39:57', '2021-06-22 13:39:57'),
(19545, 11056, 21625, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:59:04', '2021-06-22 13:59:04'),
(19546, 3040, 21625, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-09 15:11:23', '2021-07-09 15:11:23'),
(19547, 3040, 21625, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 14:03:55', '2021-08-30 14:03:55'),
(19548, 10057, 21625, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani ', NULL, NULL, '2021-10-18 10:44:01', '2021-10-18 10:44:01'),
(19549, 10057, 21625, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:58:01', '2021-11-23 13:58:01'),
(19550, 10057, 21625, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Hope this email finds you in good health. Could you please provide me with the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:55:51', '2021-12-03 14:55:51'),
(19551, 10057, 21625, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-10 11:38:11', '2021-12-10 11:38:11'),
(19552, 10057, 21625, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:11:51', '2021-12-20 13:11:51'),
(19553, 10057, 21625, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:20:29', '2021-12-27 11:20:29'),
(19554, 20067, 21625, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to:  MadirajuP@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good afternoon, Hope you are doing well. Any updates on the below-mentioned request?  Kindly respond promptly, Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 16:03:29', '2022-01-11 16:03:29'),
(19555, 20067, 21625, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:25:12', '2022-01-20 10:25:12'),
(19556, 20067, 21625, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:29:19', '2022-01-20 10:29:19'),
(19557, 20067, 21625, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to:  pccdocsub@mitchell.com,MadirajuP@aetna.com  Sub: Re: Enrollment status || LONGPOINT MEDICAL CENTER || Group & Providers || First Health ||  Good Afternoon!  I would like to know the enrollment status of the below-mentioned providers.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 SIGI PAUL	1033623616 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Ani Stephen	1588959118 Jeena Abraham	1467901587 Glory Abraham	1194206490 James Piccione JR	1356321509 Mini Chennemkara	1841755956 Odette Korouma	1134525868 Abdur Rauf	1497726202 Jeemol George	1497219067  Thanks & Regards! Syed Ahad.', NULL, NULL, '2022-01-28 14:23:35', '2022-01-28 14:23:35'),
(19558, 20067, 21625, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:12:44', '2022-03-08 17:12:44'),
(19559, 1006, 21626, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:46', '2021-03-16 10:30:46'),
(19560, 1019, 21626, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to :BehavioralContAdmin@cigna.com Sub: Location Addition || Group and Providers || SNBCARE || CIGNA  ATTN: Behavioral Provider Contract Administration Please find the attached Clinic Location Changes For Existing Clinic Contracts form to Add new location under our group and to add providers as well. All providers are listed in the form accordingly.   Regards, Alex G.', NULL, NULL, '2021-04-21 07:34:24', '2021-04-21 07:34:24'),
(19561, 1019, 21626, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com SUB: Enrollment Status || Group & Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Secondary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Tertiary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Tawakol, Katie NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.      Hefti, Prisca NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 09:26:40', '2021-05-20 09:26:40'),
(19562, 1019, 21626, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:34:13', '2021-06-03 15:34:13'),
(19563, 1019, 21626, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Provider added under new location effective date 02/13/2020. Attached is the group roster for ref. ', NULL, NULL, '2021-07-15 07:59:03', '2021-07-15 07:59:03'),
(19564, 1006, 21627, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:47', '2021-03-16 10:30:47'),
(19565, 1019, 21627, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to :BehavioralContAdmin@cigna.com Sub: Location Addition || Group and Providers || SNBCARE || CIGNA  ATTN: Behavioral Provider Contract Administration Please find the attached Clinic Location Changes For Existing Clinic Contracts form to Add new location under our group and to add providers as well. All providers are listed in the form accordingly.   Regards, Alex G.', NULL, NULL, '2021-04-21 07:32:55', '2021-04-21 07:32:55');
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
(19566, 1019, 21627, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com SUB: Enrollment Status || Group & Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Secondary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Tertiary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Tawakol, Katie NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.      Hefti, Prisca NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 09:27:59', '2021-05-20 09:27:59'),
(19567, 1019, 21627, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:34:07', '2021-06-03 15:34:07'),
(19568, 1019, 21627, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Provider added under new location effective date 05/20/2020. Attached is the group roster for ref. ', NULL, NULL, '2021-07-15 08:00:20', '2021-07-15 08:00:20'),
(19569, 1006, 21628, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:49', '2021-03-16 10:30:49'),
(19570, 1019, 21628, NULL, '2021-04-13 00:00:00.000', 'Initiated', 'Thank you for your interest in joining the Cigna Behavioral Health network. We have received your application. A Cigna Recruiter will process your application and provide onboarding instructions within 20 business days. Please notate the confirmation number. If you have any questions or concerns, please email us at BehavioralContracting@cigna.com or call Provider Services at 1.800.926.2273. ', NULL, NULL, '2021-04-06 09:10:36', '2021-04-06 09:10:36'),
(19571, 1019, 21628, NULL, '2021-04-13 00:00:00.000', 'Initiated', 'Your application has been received, your CBP ID is CBP-0000207830. A recruiter will process your application and provide onboarding instructions within 20 business days. The process to join the Cigna Network can take up to 90 days. To check the status of your application, please email behavioralcontracting@cigna.com. ', NULL, NULL, '2021-04-06 09:12:15', '2021-04-06 09:12:15'),
(19572, 1019, 21628, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com Sub: Enrollment Status || Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards, Alex', NULL, NULL, '2021-04-08 11:28:11', '2021-04-08 11:28:11'),
(19573, 1019, 21628, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received the following email from: BehavioralContracting@cigna.com SUB: Enrollment Status || Providers || SNBCARE || CIGNA   Hi, Please see below for the provider status update.  Justin Souliere- Received application will process shortly. Kerry Smith- Received application will process shortly. Rodesia Edmundson- Received application will process shortly. Carlee Rozell- Credentialing status  Kiara   Cigna Behavioral NCU   E: BehavioralContracting@cigna.com', NULL, NULL, '2021-04-14 07:22:06', '2021-04-14 07:22:06'),
(19574, 3040, 21628, NULL, '2021-04-26 00:00:00.000', 'In Process', 'Email sent to: BehavioralContracting@cigna.com  Subject: Enrollment Status || Spectrum Neuro Behavioral Care || Providers || Cigna ||  Greetings,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers for our group Spectrum Neuro Behavioral Care under below locations.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI: Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thanks  ', NULL, NULL, '2021-04-19 10:07:08', '2021-04-19 10:07:08'),
(19575, 1019, 21628, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com SUB: Enrollment Status || Group & Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Secondary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Tertiary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Tawakol, Katie NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.      Hefti, Prisca NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 09:24:53', '2021-05-20 09:24:53'),
(19576, 1019, 21628, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:34:00', '2021-06-03 15:34:00'),
(19577, 1019, 21628, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Provider enrolled with Cigna effective date 07/13/2021. Attached is the Welcome Letter for Ref.  ', NULL, NULL, '2021-07-15 08:15:06', '2021-07-15 08:15:06'),
(19578, 1006, 21629, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:51', '2021-03-16 10:30:51'),
(19579, 1019, 21629, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Sent the following email to : BehavioralContracting@cigna.com Sub:  Enrollment Status || Providers || SNBCARE || CIGNA   Hello Kiara, We need to add a new Location to our group and also we want to add the mentioned provider under the new location for our group. Let us know what will be the process for that.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.  Regards, Alex ', NULL, NULL, '2021-04-14 15:16:56', '2021-04-14 15:16:56'),
(19580, 1019, 21629, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com SUB: Enrollment Status || Group & Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Secondary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Tertiary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Tawakol, Katie NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.      Hefti, Prisca NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 09:28:51', '2021-05-20 09:28:51'),
(19581, 1019, 21629, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Received the Updated contract with all servicing addresses linked under group, effective 05/20/2021 attached is the Contract Amendment', NULL, NULL, '2021-05-21 08:20:24', '2021-05-21 08:20:24'),
(19582, 3040, 21630, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:30:57', '2021-03-16 10:30:57'),
(19583, 3040, 21630, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject:Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group Long Point Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-02 14:18:11', '2021-06-02 14:18:11'),
(19584, 3040, 21630, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Can you please advise what I need to link the providers with First Health. If the given tin is not linked with First Health then how come the providers are participating.    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-21 16:18:35', '2021-06-21 16:18:35'),
(19585, 11056, 21630, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:40:43', '2021-06-22 13:40:43'),
(19586, 11056, 21630, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:59:19', '2021-06-22 13:59:19'),
(19587, 3040, 21630, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-09 15:11:23', '2021-07-09 15:11:23'),
(19588, 3040, 21630, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 14:03:58', '2021-08-30 14:03:58'),
(19589, 10057, 21630, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in First Health.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Abraham, Jeena	1467901587 John, Jeny	1073019493  Please feel free to reach out to me, if you need any other information. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 16:45:58', '2021-10-11 16:45:58'),
(19590, 10057, 21630, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:57:55', '2021-11-23 13:57:55'),
(19591, 10057, 21630, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Hope this email finds you in good health. Could you please provide me with the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:55:45', '2021-12-03 14:55:45'),
(19592, 10057, 21630, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-10 11:38:02', '2021-12-10 11:38:02'),
(19593, 10057, 21630, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:11:45', '2021-12-20 13:11:45'),
(19594, 10057, 21630, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:20:23', '2021-12-27 11:20:23'),
(19595, 20067, 21630, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to:  MadirajuP@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good afternoon, Hope you are doing well. Any updates on the below-mentioned request?  Kindly respond promptly, Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 16:03:22', '2022-01-11 16:03:22'),
(19596, 20067, 21630, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:25:03', '2022-01-20 10:25:03'),
(19597, 20067, 21630, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:29:13', '2022-01-20 10:29:13'),
(19598, 20067, 21630, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to:  pccdocsub@mitchell.com,MadirajuP@aetna.com  Sub: Re: Enrollment status || LONGPOINT MEDICAL CENTER || Group & Providers || First Health ||  Good Afternoon!  I would like to know the enrollment status of the below-mentioned providers.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 SIGI PAUL	1033623616 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Ani Stephen	1588959118 Jeena Abraham	1467901587 Glory Abraham	1194206490 James Piccione JR	1356321509 Mini Chennemkara	1841755956 Odette Korouma	1134525868 Abdur Rauf	1497726202 Jeemol George	1497219067  Thanks & Regards! Syed Ahad.', NULL, NULL, '2022-01-28 14:23:29', '2022-01-28 14:23:29'),
(19599, 20067, 21630, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:12:38', '2022-03-08 17:12:38'),
(19600, 3040, 21631, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:31:18', '2021-03-16 10:31:18'),
(19601, 3040, 21631, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject:Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group Long Point Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-02 14:18:15', '2021-06-02 14:18:15'),
(19602, 3040, 21631, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Can you please advise what I need to link the providers with First Health. If the given tin is not linked with First Health then how come the providers are participating.    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-21 16:18:38', '2021-06-21 16:18:38'),
(19603, 11056, 21631, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:41:05', '2021-06-22 13:41:05'),
(19604, 11056, 21631, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:59:29', '2021-06-22 13:59:29'),
(19605, 3040, 21631, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-09 15:11:22', '2021-07-09 15:11:22'),
(19606, 3040, 21631, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 14:04:01', '2021-08-30 14:04:01'),
(19607, 10057, 21631, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in First Health.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Abraham, Jeena	1467901587 John, Jeny	1073019493  Please feel free to reach out to me, if you need any other information. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 16:45:51', '2021-10-11 16:45:51'),
(19608, 10057, 21631, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani ', NULL, NULL, '2021-10-18 10:43:43', '2021-10-18 10:43:43'),
(19609, 10057, 21631, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:57:49', '2021-11-23 13:57:49'),
(19610, 10057, 21631, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Hope this email finds you in good health. Could you please provide me with the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:55:40', '2021-12-03 14:55:40'),
(19611, 10057, 21631, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-10 11:37:53', '2021-12-10 11:37:53'),
(19612, 10057, 21631, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:11:39', '2021-12-20 13:11:39'),
(19613, 10057, 21631, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:20:18', '2021-12-27 11:20:18'),
(19614, 20067, 21631, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||   Good afternoon, Hope you are doing well. Any updates on the below-mentioned request?  Kindly respond promptly, Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 14:27:48', '2022-01-14 14:27:48'),
(19615, 20067, 21631, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:24:57', '2022-01-20 10:24:57'),
(19616, 20067, 21631, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:29:07', '2022-01-20 10:29:07'),
(19617, 20067, 21631, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to:  pccdocsub@mitchell.com,MadirajuP@aetna.com  Sub: Re: Enrollment status || LONGPOINT MEDICAL CENTER || Group & Providers || First Health ||  Good Afternoon!  I would like to know the enrollment status of the below-mentioned providers.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 SIGI PAUL	1033623616 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Ani Stephen	1588959118 Jeena Abraham	1467901587 Glory Abraham	1194206490 James Piccione JR	1356321509 Mini Chennemkara	1841755956 Odette Korouma	1134525868 Abdur Rauf	1497726202 Jeemol George	1497219067  Thanks & Regards! Syed Ahad.', NULL, NULL, '2022-01-28 14:23:23', '2022-01-28 14:23:23'),
(19618, 20067, 21631, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:12:32', '2022-03-08 17:12:32'),
(19619, 1006, 21632, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:31:55', '2021-03-16 10:31:55'),
(19620, 1019, 21632, NULL, '2021-04-22 00:00:00.000', 'Initiated', 'Sent the following email to : PNMDepartment@commonwealthcare.org,; arines@commonwealthcare.org,; Credentialing@commonwealthcare.org  Hello, Attached are the HCAS forms for location addition for our group and providers. Let us know if you have any questions.   Regards, Alex', NULL, NULL, '2021-04-15 10:46:49', '2021-04-15 10:46:49'),
(19621, 1019, 21632, NULL, '2021-06-22 00:00:00.000', 'Initiated', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:07:37', '2021-06-03 16:07:37');
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
(19622, 1019, 21632, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Good Morning Alex,  The additional location of 100 New State Hwy was added for the below providers effective 04/15/2021.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.  Please clarify the request for a copy of their contracts if they’re linked or credentialed. The contract is with Spectrum Neuro Behavioral Care not the individual providers.  Many Thanks, Yesenia', NULL, NULL, '2021-07-13 10:17:48', '2021-07-13 10:17:48'),
(19623, 1006, 21633, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:31:57', '2021-03-16 10:31:57'),
(19624, 1019, 21633, NULL, '2021-04-22 00:00:00.000', 'Initiated', 'Sent the following email to : PNMDepartment@commonwealthcare.org,; arines@commonwealthcare.org,; Credentialing@commonwealthcare.org  Hello, Attached are the HCAS forms for location addition for our group and providers. Let us know if you have any questions.   Regards, Alex', NULL, NULL, '2021-04-15 10:48:22', '2021-04-15 10:48:22'),
(19625, 1019, 21633, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:07:24', '2021-06-03 16:07:24'),
(19626, 1019, 21633, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Good Morning Alex,  The additional location of 100 New State Hwy was added for the below providers effective 04/15/2021.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.  Please clarify the request for a copy of their contracts if they’re linked or credentialed. The contract is with Spectrum Neuro Behavioral Care not the individual providers.  Many Thanks, Yesenia', NULL, NULL, '2021-07-13 10:17:35', '2021-07-13 10:17:35'),
(19627, 1006, 21634, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:31:59', '2021-03-16 10:31:59'),
(19628, 1019, 21634, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Sent following email to PNMDepartment@commonwealthcare.org, Credentialing@commonwealthcare.org  Sub: HCAS Provider Enrollment - Kerry Smith - CCA - SNBCARE Hello,   Please find the attached enrollment form for our provider and expedite the enrollment process as much as possible. Do let me know how long it will take to get her added to our group.     Regards, Alex G.', NULL, NULL, '2021-03-30 13:20:58', '2021-03-30 13:20:58'),
(19629, 1019, 21634, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Received the following email from PNMDepartment@commonwealthcare.org  Hello, The Provider Kerry Smith, LCSW is effective from  03/30/2021 at 61 Lincoln St Suite 203, Framingham and 100 New State Hwy, Raynham  under  Spectrum Neuro Behavioral Care LLC  Thank you, Aravindrajan Bangaru Provider Network Management', NULL, NULL, '2021-04-23 07:00:42', '2021-04-23 07:00:42'),
(19630, 1019, 21634, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Sent the following email to PNMDepartment@commonwealthcare.org  Hello Aravindrajan, Can you please send me the copy of the contract for the following provider, under our group, as she is not showing on the provider directory.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Provider Name: Kerry Smith NPI: 1275083230  Regards, Alex', NULL, NULL, '2021-04-23 07:06:00', '2021-04-23 07:06:00'),
(19631, 1019, 21634, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Called CCA @ (866) 610-2273 Spoken with Rep Valarie conversation is mentioned below  Spoke with Valerie as per her Kerry is showing In Network in there systems with effective date 03/30/2021 for both locations.  Ref# 04/23/2021 - Valarie', NULL, NULL, '2021-04-23 08:52:40', '2021-04-23 08:52:40'),
(19632, 1019, 21634, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:08:08', '2021-06-03 16:08:08'),
(19633, 1019, 21634, NULL, '2021-06-28 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Hello,  The Provider Kerry Smith, LCSW is effective from  03/30/2021 at 61 Lincoln St Suite 203, Framingham and 100 New State Hwy, Raynham  under  Spectrum Neuro Behavioral Care LLC  Thank you, Aravindrajan Bangaru Provider Network Management Commonwealth Care Alliance 2 Avenue De Lafayette 5th Floor Boston MA 02111', NULL, NULL, '2021-06-21 09:07:07', '2021-06-21 09:07:07'),
(19634, 1006, 21635, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:32:01', '2021-03-16 10:32:01'),
(19635, 1019, 21635, NULL, '2021-04-22 00:00:00.000', 'Initiated', 'Sent the following email to : PNMDepartment@commonwealthcare.org,; arines@commonwealthcare.org,; Credentialing@commonwealthcare.org  Hello, Attached are the HCAS forms for location addition for our group and providers. Let us know if you have any questions.   Regards, Alex', NULL, NULL, '2021-04-15 10:49:14', '2021-04-15 10:49:14'),
(19636, 1019, 21635, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:07:18', '2021-06-03 16:07:18'),
(19637, 1019, 21635, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Good Morning Alex,  The additional location of 100 New State Hwy was added for the below providers effective 04/15/2021.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.  Please clarify the request for a copy of their contracts if they’re linked or credentialed. The contract is with Spectrum Neuro Behavioral Care not the individual providers.  Many Thanks, Yesenia', NULL, NULL, '2021-07-13 10:17:14', '2021-07-13 10:17:14'),
(19638, 1006, 21636, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:32:03', '2021-03-16 10:32:03'),
(19639, 1019, 21636, NULL, '2021-04-22 00:00:00.000', 'Initiated', 'Sent the following email to : PNMDepartment@commonwealthcare.org,; arines@commonwealthcare.org,; Credentialing@commonwealthcare.org  Hello, Attached are the HCAS forms for location addition for our group and providers. Let us know if you have any questions.   Regards, Alex', NULL, NULL, '2021-04-15 10:50:12', '2021-04-15 10:50:12'),
(19640, 1019, 21636, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:07:11', '2021-06-03 16:07:11'),
(19641, 1019, 21636, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Good Morning Alex,  The additional location of 100 New State Hwy was added for the below providers effective 04/15/2021.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.  Please clarify the request for a copy of their contracts if they’re linked or credentialed. The contract is with Spectrum Neuro Behavioral Care not the individual providers.  Many Thanks, Yesenia', NULL, NULL, '2021-07-13 10:16:52', '2021-07-13 10:16:52'),
(19642, 1006, 21637, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:32:16', '2021-03-16 10:32:16'),
(19643, 1019, 21637, NULL, '2021-04-22 00:00:00.000', 'Initiated', 'Sent the following email to : PNMDepartment@commonwealthcare.org,; arines@commonwealthcare.org,; Credentialing@commonwealthcare.org  Hello, Attached are the HCAS forms for location addition for our group and providers. Let us know if you have any questions.   Regards, Alex', NULL, NULL, '2021-04-15 10:52:48', '2021-04-15 10:52:48'),
(19644, 1019, 21637, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:07:01', '2021-06-03 16:07:01'),
(19645, 1019, 21637, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Good Morning Alex,  The additional location of 100 New State Hwy was added for the below providers effective 04/15/2021.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.  Please clarify the request for a copy of their contracts if they’re linked or credentialed. The contract is with Spectrum Neuro Behavioral Care not the individual providers.  Many Thanks, Yesenia', NULL, NULL, '2021-07-13 10:16:32', '2021-07-13 10:16:32'),
(19646, 1006, 21638, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:32:17', '2021-03-16 10:32:17'),
(19647, 1019, 21638, NULL, '2021-04-22 00:00:00.000', 'Initiated', 'Sent the following email to : PNMDepartment@commonwealthcare.org,; arines@commonwealthcare.org,; Credentialing@commonwealthcare.org  Hello, Attached are the HCAS forms for location addition for our group and providers. Let us know if you have any questions.   Regards, Alex', NULL, NULL, '2021-04-15 10:53:28', '2021-04-15 10:53:28'),
(19648, 1019, 21638, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:06:53', '2021-06-03 16:06:53'),
(19649, 1019, 21638, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Good Morning Alex,  The additional location of 100 New State Hwy was added for the below providers effective 04/15/2021.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.  Please clarify the request for a copy of their contracts if they’re linked or credentialed. The contract is with Spectrum Neuro Behavioral Care not the individual providers.  Many Thanks, Yesenia', NULL, NULL, '2021-07-13 10:16:15', '2021-07-13 10:16:15'),
(19650, 1006, 21639, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:32:19', '2021-03-16 10:32:19'),
(19651, 1019, 21639, NULL, '2021-04-22 00:00:00.000', 'Initiated', 'Sent the following email to : PNMDepartment@commonwealthcare.org,; arines@commonwealthcare.org,; Credentialing@commonwealthcare.org  Hello, Attached are the HCAS forms for location addition for our group and providers. Let us know if you have any questions.   Regards, Alex', NULL, NULL, '2021-04-15 10:54:05', '2021-04-15 10:54:05'),
(19652, 1019, 21639, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:06:24', '2021-06-03 16:06:24'),
(19653, 1019, 21639, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Good Morning Alex,  The additional location of 100 New State Hwy was added for the below providers effective 04/15/2021.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.  Please clarify the request for a copy of their contracts if they’re linked or credentialed. The contract is with Spectrum Neuro Behavioral Care not the individual providers.  Many Thanks, Yesenia', NULL, NULL, '2021-07-13 10:15:50', '2021-07-13 10:15:50'),
(19654, 1006, 21640, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:32:20', '2021-03-16 10:32:20'),
(19655, 1019, 21640, NULL, '2021-04-22 00:00:00.000', 'Initiated', 'Sent the following email to : PNMDepartment@commonwealthcare.org,; arines@commonwealthcare.org,; Credentialing@commonwealthcare.org  Hello, Attached are the HCAS forms for location addition for our group and providers. Let us know if you have any questions.   Regards, Alex', NULL, NULL, '2021-04-15 10:54:43', '2021-04-15 10:54:43'),
(19656, 1019, 21640, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:06:14', '2021-06-03 16:06:14'),
(19657, 1019, 21640, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Good Morning Alex,  The additional location of 100 New State Hwy was added for the below providers effective 04/15/2021.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.  Please clarify the request for a copy of their contracts if they’re linked or credentialed. The contract is with Spectrum Neuro Behavioral Care not the individual providers.  Many Thanks, Yesenia', NULL, NULL, '2021-07-13 10:15:09', '2021-07-13 10:15:09'),
(19658, 1006, 21641, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:32:23', '2021-03-16 10:32:23'),
(19659, 1019, 21641, NULL, '2021-04-22 00:00:00.000', 'Initiated', 'Sent the following email to : PNMDepartment@commonwealthcare.org,; arines@commonwealthcare.org,; Credentialing@commonwealthcare.org  Hello, Attached are the HCAS forms for location addition for our group and providers. Let us know if you have any questions.   Regards, Alex', NULL, NULL, '2021-04-15 10:56:06', '2021-04-15 10:56:06'),
(19660, 1019, 21641, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:06:07', '2021-06-03 16:06:07'),
(19661, 1019, 21641, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Good Morning Alex,  The additional location of 100 New State Hwy was added for the below providers effective 04/15/2021.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.  Please clarify the request for a copy of their contracts if they’re linked or credentialed. The contract is with Spectrum Neuro Behavioral Care not the individual providers.  Many Thanks, Yesenia', NULL, NULL, '2021-07-13 10:14:45', '2021-07-13 10:14:45'),
(19662, 1006, 21642, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:32:26', '2021-03-16 10:32:26'),
(19663, 1019, 21642, NULL, '2021-04-22 00:00:00.000', 'Initiated', 'Sent the following email to : PNMDepartment@commonwealthcare.org,; arines@commonwealthcare.org,; Credentialing@commonwealthcare.org  Hello, Attached are the HCAS forms for location addition for our group and providers. Let us know if you have any questions.   Regards, Alex', NULL, NULL, '2021-04-15 10:56:42', '2021-04-15 10:56:42'),
(19664, 1019, 21642, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:05:59', '2021-06-03 16:05:59');
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
(19665, 1019, 21642, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Good Morning Alex,  The additional location of 100 New State Hwy was added for the below providers effective 04/15/2021.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.  Please clarify the request for a copy of their contracts if they’re linked or credentialed. The contract is with Spectrum Neuro Behavioral Care not the individual providers.  Many Thanks, Yesenia', NULL, NULL, '2021-07-13 10:13:35', '2021-07-13 10:13:35'),
(19666, 1006, 21643, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:32:28', '2021-03-16 10:32:28'),
(19667, 1019, 21643, NULL, '2021-04-13 00:00:00.000', 'Initiated', 'Sent following email to PNMDepartment@commonwealthcare.org, Credentialing@commonwealthcare.org  Sub: HCAS Provider Enrollment - Rodesia Edmundson - CCA - SNBCARE Hello,   Please find the attached enrollment form for our provider and expedite the enrollment process as much as possible. Do let me know how long it will take to get her added to our group.   Alex G.', NULL, NULL, '2021-04-06 09:41:02', '2021-04-06 09:41:02'),
(19668, 1019, 21643, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:05:52', '2021-06-03 16:05:52'),
(19669, 1019, 21643, NULL, '2021-06-28 00:00:00.000', 'Approved', 'See Attached for the email SS received from CCA for Approval Confirmation.  Also spoken with Rep Gilsen F, as per rep the provider is linked under both (Framingham & Raynham) locations.  Call ref #: Gislen F - 06/21/2021 ', NULL, NULL, '2021-06-21 08:51:05', '2021-06-21 08:51:05'),
(19670, 1006, 21644, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:32:29', '2021-03-16 10:32:29'),
(19671, 1019, 21644, NULL, '2021-04-22 00:00:00.000', 'Initiated', 'Sent the following email to: PNMDepartment@commonwealthcare.org ; arines@commonwealthcare.org SUB: Location Addition || Providers || SNBCARE || CCA  Hello, We need to add a new Location to our group and also we want to add the mentioned provider under the new location for our group. Let us know what will be the process for that.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 New Location: 100 New State Highway, Raynham, MA, 02767.    Individual Providers:  Jennifer Ullrich NPI:1710489760 New Location: 100 New State Highway, Raynham, MA, 02767.   Katie Tawakol NPI; 1609222116 New Location: 100 New State Highway, Raynham, MA, 02767.   Jonathan Schubert NPI: 1235755505 New Location: 100 New State Highway, Raynham, MA, 02767.   Carlee Rozell NPI: 1225645393 New Location: 100 New State Highway, Raynham, MA, 02767.   Mahreen Rashid NPI: 1396393146 New Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 New Location: 100 New State Highway, Raynham, MA, 02767.   Lynetta Loveland NPI: 1598163602 New Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali  Khan NPI: 1699761965 New Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite NPI: 1982617262 New Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182 New Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-04-15 07:22:11', '2021-04-15 07:22:11'),
(19672, 1019, 21644, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:05:24', '2021-06-03 16:05:24'),
(19673, 1019, 21644, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Good Morning Alex,  The additional location of 100 New State Hwy was added for the below providers effective 04/15/2021. Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.  Please clarify the request for a copy of their contracts if they’re linked or credentialed. The contract is with Spectrum Neuro Behavioral Care not the individual providers.  Many Thanks, Yesenia', NULL, NULL, '2021-07-13 10:12:19', '2021-07-13 10:12:19'),
(19674, 3040, 21645, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:32:38', '2021-03-16 10:32:38'),
(19675, 3040, 21645, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject:Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group Long Point Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-02 14:18:19', '2021-06-02 14:18:19'),
(19676, 3040, 21645, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Can you please advise what I need to link the providers with First Health. If the given tin is not linked with First Health then how come the providers are participating.    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-21 16:18:41', '2021-06-21 16:18:41'),
(19677, 11056, 21645, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:41:24', '2021-06-22 13:41:24'),
(19678, 11056, 21645, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:59:42', '2021-06-22 13:59:42'),
(19679, 3040, 21645, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-09 15:11:21', '2021-07-09 15:11:21'),
(19680, 3040, 21645, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 14:04:03', '2021-08-30 14:04:03'),
(19681, 10057, 21645, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in First Health.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Abraham, Jeena	1467901587 John, Jeny	1073019493  Please feel free to reach out to me, if you need any other information. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 16:45:43', '2021-10-11 16:45:43'),
(19682, 10057, 21645, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani ', NULL, NULL, '2021-10-18 10:43:34', '2021-10-18 10:43:34'),
(19683, 10057, 21645, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:57:44', '2021-11-23 13:57:44'),
(19684, 10057, 21645, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Hope this email finds you in good health. Could you please provide me with the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:55:34', '2021-12-03 14:55:34'),
(19685, 10057, 21645, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-10 11:37:45', '2021-12-10 11:37:45'),
(19686, 10057, 21645, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:11:31', '2021-12-20 13:11:31'),
(19687, 10057, 21645, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:20:12', '2021-12-27 11:20:12'),
(19688, 20067, 21645, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to:  MadirajuP@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good afternoon, Hope you are doing well. Any updates on the below-mentioned request?  Kindly respond promptly, Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 16:02:05', '2022-01-11 16:02:05'),
(19689, 20067, 21645, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:24:50', '2022-01-20 10:24:50'),
(19690, 20067, 21645, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:29:01', '2022-01-20 10:29:01'),
(19691, 20067, 21645, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to:  pccdocsub@mitchell.com,MadirajuP@aetna.com  Sub: Re: Enrollment status || LONGPOINT MEDICAL CENTER || Group & Providers || First Health ||  Good Afternoon!  I would like to know the enrollment status of the below-mentioned providers.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 SIGI PAUL	1033623616 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Ani Stephen	1588959118 Jeena Abraham	1467901587 Glory Abraham	1194206490 James Piccione JR	1356321509 Mini Chennemkara	1841755956 Odette Korouma	1134525868 Abdur Rauf	1497726202 Jeemol George	1497219067  Thanks & Regards! Syed Ahad.', NULL, NULL, '2022-01-28 14:23:17', '2022-01-28 14:23:17'),
(19692, 20067, 21645, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:12:26', '2022-03-08 17:12:26'),
(19693, 3040, 21646, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:33:01', '2021-03-16 10:33:01'),
(19694, 3040, 21646, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject:Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group Long Point Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-02 14:18:23', '2021-06-02 14:18:23'),
(19695, 3040, 21646, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Can you please advise what I need to link the providers with First Health. If the given tin is not linked with First Health then how come the providers are participating.    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-21 16:18:44', '2021-06-21 16:18:44'),
(19696, 11056, 21646, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:41:38', '2021-06-22 13:41:38'),
(19697, 11056, 21646, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:59:57', '2021-06-22 13:59:57'),
(19698, 3040, 21646, NULL, '2021-07-16 00:00:00.000', 'Approved', 'Email rcvd from: MadirajuP@aetna.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You, Phani', NULL, NULL, '2021-07-09 15:02:44', '2021-07-09 15:02:44'),
(19699, 3040, 21647, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:33:15', '2021-03-16 10:33:15'),
(19700, 3040, 21647, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject:Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group Long Point Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-02 14:18:26', '2021-06-02 14:18:26'),
(19701, 3040, 21647, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Can you please advise what I need to link the providers with First Health. If the given tin is not linked with First Health then how come the providers are participating.    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-21 16:18:48', '2021-06-21 16:18:48'),
(19702, 11056, 21647, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:41:56', '2021-06-22 13:41:56'),
(19703, 11056, 21647, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:57:47', '2021-06-22 13:57:47'),
(19704, 3040, 21647, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-09 15:11:20', '2021-07-09 15:11:20'),
(19705, 3040, 21647, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 14:04:06', '2021-08-30 14:04:06'),
(19706, 10057, 21647, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in First Health.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Abraham, Jeena	1467901587 John, Jeny	1073019493  Please feel free to reach out to me, if you need any other information. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 16:45:34', '2021-10-11 16:45:34'),
(19707, 10057, 21647, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani ', NULL, NULL, '2021-10-18 10:43:23', '2021-10-18 10:43:23'),
(19708, 10057, 21647, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:57:37', '2021-11-23 13:57:37'),
(19709, 10057, 21647, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Hope this email finds you in good health. Could you please provide me with the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:55:28', '2021-12-03 14:55:28'),
(19710, 10057, 21647, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-10 11:37:36', '2021-12-10 11:37:36'),
(19711, 10057, 21647, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:11:25', '2021-12-20 13:11:25'),
(19712, 10057, 21647, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:20:06', '2021-12-27 11:20:06'),
(19713, 20067, 21647, NULL, '2022-01-18 00:00:00.000', 'In Process', '', NULL, NULL, '2022-01-11 16:01:58', '2022-01-11 16:01:58'),
(19714, 20067, 21647, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to:  MadirajuP@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good afternoon, Hope you are doing well. Any updates on the below-mentioned request?  Kindly respond promptly, Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 16:02:21', '2022-01-11 16:02:21'),
(19715, 20067, 21647, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:24:43', '2022-01-20 10:24:43'),
(19716, 20067, 21647, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:28:56', '2022-01-20 10:28:56'),
(19717, 20067, 21647, NULL, '2022-02-04 00:00:00.000', 'In Process', '', NULL, NULL, '2022-01-28 14:23:11', '2022-01-28 14:23:11'),
(19718, 20067, 21647, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:12:19', '2022-03-08 17:12:19'),
(19719, 3040, 21648, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:33:31', '2021-03-16 10:33:31');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(19720, 3040, 21648, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject:Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group Long Point Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-02 14:18:30', '2021-06-02 14:18:30'),
(19721, 3040, 21648, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Can you please advise what I need to link the providers with First Health. If the given tin is not linked with First Health then how come the providers are participating.    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-21 16:18:51', '2021-06-21 16:18:51'),
(19722, 11056, 21648, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:42:11', '2021-06-22 13:42:11'),
(19723, 11056, 21648, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:54:27', '2021-06-22 13:54:27'),
(19724, 3040, 21648, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-09 15:11:20', '2021-07-09 15:11:20'),
(19725, 3040, 21648, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 14:04:08', '2021-08-30 14:04:08'),
(19726, 10057, 21648, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in First Health.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Abraham, Jeena	1467901587 John, Jeny	1073019493  Please feel free to reach out to me, if you need any other information. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 16:45:27', '2021-10-11 16:45:27'),
(19727, 10057, 21648, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani ', NULL, NULL, '2021-10-18 10:43:11', '2021-10-18 10:43:11'),
(19728, 10057, 21648, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:57:31', '2021-11-23 13:57:31'),
(19729, 10057, 21648, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-14 10:59:10', '2021-12-14 10:59:10'),
(19730, 10057, 21648, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:11:19', '2021-12-20 13:11:19'),
(19731, 10057, 21648, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:20:00', '2021-12-27 11:20:00'),
(19732, 20067, 21648, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to:  MadirajuP@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good afternoon, Hope you are doing well. Any updates on the below-mentioned request?  Kindly respond promptly, Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 16:01:53', '2022-01-11 16:01:53'),
(19733, 20067, 21648, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:24:35', '2022-01-20 10:24:35'),
(19734, 20067, 21648, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:28:50', '2022-01-20 10:28:50'),
(19735, 20067, 21648, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to:  pccdocsub@mitchell.com,MadirajuP@aetna.com  Sub: Re: Enrollment status || LONGPOINT MEDICAL CENTER || Group & Providers || First Health ||  Good Afternoon!  I would like to know the enrollment status of the below-mentioned providers.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 SIGI PAUL	1033623616 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Ani Stephen	1588959118 Jeena Abraham	1467901587 Glory Abraham	1194206490 James Piccione JR	1356321509 Mini Chennemkara	1841755956 Odette Korouma	1134525868 Abdur Rauf	1497726202 Jeemol George	1497219067  Thanks & Regards! Syed Ahad.', NULL, NULL, '2022-01-28 14:23:06', '2022-01-28 14:23:06'),
(19736, 20067, 21648, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:12:12', '2022-03-08 17:12:12'),
(19737, 3040, 21649, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:33:46', '2021-03-16 10:33:46'),
(19738, 3040, 21649, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject:Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group Long Point Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-02 14:18:34', '2021-06-02 14:18:34'),
(19739, 3040, 21649, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Can you please advise what I need to link the providers with First Health. If the given tin is not linked with First Health then how come the providers are participating.    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-21 16:18:54', '2021-06-21 16:18:54'),
(19740, 11056, 21649, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:42:28', '2021-06-22 13:42:28'),
(19741, 11056, 21649, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:54:05', '2021-06-22 13:54:05'),
(19742, 3040, 21649, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-09 15:11:19', '2021-07-09 15:11:19'),
(19743, 3040, 21649, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 14:04:10', '2021-08-30 14:04:10'),
(19744, 10057, 21649, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in First Health.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Abraham, Jeena	1467901587 John, Jeny	1073019493  Please feel free to reach out to me, if you need any other information. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 16:45:16', '2021-10-11 16:45:16'),
(19745, 10057, 21649, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani ', NULL, NULL, '2021-10-18 10:42:17', '2021-10-18 10:42:17'),
(19746, 10057, 21649, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:57:25', '2021-11-23 13:57:25'),
(19747, 10057, 21649, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Hope this email finds you in good health. Could you please provide me with the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:55:21', '2021-12-03 14:55:21'),
(19748, 10057, 21649, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-10 11:37:27', '2021-12-10 11:37:27'),
(19749, 10057, 21649, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:11:13', '2021-12-20 13:11:13'),
(19750, 10057, 21649, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:19:55', '2021-12-27 11:19:55'),
(19751, 20067, 21649, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to:  MadirajuP@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good afternoon, Hope you are doing well. Any updates on the below-mentioned request?  Kindly respond promptly, Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 16:01:47', '2022-01-11 16:01:47'),
(19752, 20067, 21649, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:24:29', '2022-01-20 10:24:29'),
(19753, 20067, 21649, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:28:42', '2022-01-20 10:28:42'),
(19754, 20067, 21649, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to:  pccdocsub@mitchell.com,MadirajuP@aetna.com  Sub: Re: Enrollment status || LONGPOINT MEDICAL CENTER || Group & Providers || First Health ||  Good Afternoon!  I would like to know the enrollment status of the below-mentioned providers.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 SIGI PAUL	1033623616 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Ani Stephen	1588959118 Jeena Abraham	1467901587 Glory Abraham	1194206490 James Piccione JR	1356321509 Mini Chennemkara	1841755956 Odette Korouma	1134525868 Abdur Rauf	1497726202 Jeemol George	1497219067  Thanks & Regards! Syed Ahad.', NULL, NULL, '2022-01-28 14:23:00', '2022-01-28 14:23:00'),
(19755, 20067, 21649, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:12:06', '2022-03-08 17:12:06'),
(19756, 3040, 21650, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:34:00', '2021-03-16 10:34:00'),
(19757, 1005, 21650, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:58:26', '2021-06-01 12:58:26'),
(19758, 3040, 21651, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:34:15', '2021-03-16 10:34:15'),
(19759, 3040, 21651, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject:Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group Long Point Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-02 14:18:38', '2021-06-02 14:18:38'),
(19760, 3040, 21651, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Can you please advise what I need to link the providers with First Health. If the given tin is not linked with First Health then how come the providers are participating.    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-21 16:18:58', '2021-06-21 16:18:58'),
(19761, 11056, 21651, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:43:01', '2021-06-22 13:43:01'),
(19762, 11056, 21651, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:53:32', '2021-06-22 13:53:32'),
(19763, 3040, 21651, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-09 15:11:19', '2021-07-09 15:11:19'),
(19764, 3040, 21651, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 14:04:13', '2021-08-30 14:04:13'),
(19765, 10057, 21651, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in First Health.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Abraham, Jeena	1467901587 John, Jeny	1073019493  Please feel free to reach out to me, if you need any other information. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 16:45:08', '2021-10-11 16:45:08'),
(19766, 10057, 21651, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani ', NULL, NULL, '2021-10-18 10:42:07', '2021-10-18 10:42:07'),
(19767, 10057, 21651, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:57:19', '2021-11-23 13:57:19'),
(19768, 10057, 21651, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Hope this email finds you in good health. Could you please provide me with the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:55:16', '2021-12-03 14:55:16'),
(19769, 10057, 21651, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-10 11:37:19', '2021-12-10 11:37:19'),
(19770, 10057, 21651, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:11:08', '2021-12-20 13:11:08'),
(19771, 10057, 21651, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:19:49', '2021-12-27 11:19:49'),
(19772, 20067, 21651, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to:  MadirajuP@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good afternoon, Hope you are doing well. Any updates on the below-mentioned request?  Kindly respond promptly, Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 16:01:41', '2022-01-11 16:01:41'),
(19773, 20067, 21651, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:24:22', '2022-01-20 10:24:22'),
(19774, 20067, 21651, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:28:35', '2022-01-20 10:28:35'),
(19775, 20067, 21651, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to:  pccdocsub@mitchell.com,MadirajuP@aetna.com  Sub: Re: Enrollment status || LONGPOINT MEDICAL CENTER || Group & Providers || First Health ||  Good Afternoon!  I would like to know the enrollment status of the below-mentioned providers.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 SIGI PAUL	1033623616 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Ani Stephen	1588959118 Jeena Abraham	1467901587 Glory Abraham	1194206490 James Piccione JR	1356321509 Mini Chennemkara	1841755956 Odette Korouma	1134525868 Abdur Rauf	1497726202 Jeemol George	1497219067  Thanks & Regards! Syed Ahad.', NULL, NULL, '2022-01-28 14:22:54', '2022-01-28 14:22:54'),
(19776, 20067, 21651, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:11:58', '2022-03-08 17:11:58'),
(19777, 3040, 21652, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:34:26', '2021-03-16 10:34:26');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(19778, 3040, 21652, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject:Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group Long Point Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-02 14:18:41', '2021-06-02 14:18:41'),
(19779, 3040, 21652, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Can you please advise what I need to link the providers with First Health. If the given tin is not linked with First Health then how come the providers are participating.    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-21 16:19:02', '2021-06-21 16:19:02'),
(19780, 11056, 21652, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:43:14', '2021-06-22 13:43:14'),
(19781, 11056, 21652, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:53:17', '2021-06-22 13:53:17'),
(19782, 3040, 21652, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-09 15:11:18', '2021-07-09 15:11:18'),
(19783, 3040, 21652, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 14:04:15', '2021-08-30 14:04:15'),
(19784, 10057, 21652, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in First Health.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Abraham, Jeena	1467901587 John, Jeny	1073019493  Please feel free to reach out to me, if you need any other information. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 16:45:00', '2021-10-11 16:45:00'),
(19785, 10057, 21652, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani ', NULL, NULL, '2021-10-18 10:41:57', '2021-10-18 10:41:57'),
(19786, 10057, 21652, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:57:13', '2021-11-23 13:57:13'),
(19787, 10057, 21652, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Hope this email finds you in good health. Could you please provide me with the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:55:10', '2021-12-03 14:55:10'),
(19788, 10057, 21652, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-10 11:37:11', '2021-12-10 11:37:11'),
(19789, 10057, 21652, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:11:03', '2021-12-20 13:11:03'),
(19790, 10057, 21652, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:19:43', '2021-12-27 11:19:43'),
(19791, 20067, 21652, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to:  MadirajuP@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good afternoon, Hope you are doing well. Any updates on the below-mentioned request?  Kindly respond promptly, Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 16:01:35', '2022-01-11 16:01:35'),
(19792, 20067, 21652, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:24:04', '2022-01-20 10:24:04'),
(19793, 20067, 21652, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:28:25', '2022-01-20 10:28:25'),
(19794, 20067, 21652, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to:  pccdocsub@mitchell.com,MadirajuP@aetna.com  Sub: Re: Enrollment status || LONGPOINT MEDICAL CENTER || Group & Providers || First Health ||  Good Afternoon!  I would like to know the enrollment status of the below-mentioned providers.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 SIGI PAUL	1033623616 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Ani Stephen	1588959118 Jeena Abraham	1467901587 Glory Abraham	1194206490 James Piccione JR	1356321509 Mini Chennemkara	1841755956 Odette Korouma	1134525868 Abdur Rauf	1497726202 Jeemol George	1497219067  Thanks & Regards! Syed Ahad.', NULL, NULL, '2022-01-28 14:22:47', '2022-01-28 14:22:47'),
(19795, 20067, 21652, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:11:50', '2022-03-08 17:11:50'),
(19796, 3040, 21653, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:34:39', '2021-03-16 10:34:39'),
(19797, 3040, 21653, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject:Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group Long Point Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-02 14:18:45', '2021-06-02 14:18:45'),
(19798, 3040, 21653, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Can you please advise what I need to link the providers with First Health. If the given tin is not linked with First Health then how come the providers are participating.    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-21 16:19:05', '2021-06-21 16:19:05'),
(19799, 11056, 21653, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:43:25', '2021-06-22 13:43:25'),
(19800, 11056, 21653, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:52:57', '2021-06-22 13:52:57'),
(19801, 3040, 21653, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-09 15:11:18', '2021-07-09 15:11:18'),
(19802, 3040, 21653, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 14:04:17', '2021-08-30 14:04:17'),
(19803, 10057, 21653, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in First Health.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Abraham, Jeena	1467901587 John, Jeny	1073019493  Please feel free to reach out to me, if you need any other information. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 16:44:30', '2021-10-11 16:44:30'),
(19804, 10057, 21653, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani ', NULL, NULL, '2021-10-18 10:41:46', '2021-10-18 10:41:46'),
(19805, 10057, 21653, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:57:08', '2021-11-23 13:57:08'),
(19806, 10057, 21653, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Hope this email finds you in good health. Could you please provide me with the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:55:03', '2021-12-03 14:55:03'),
(19807, 10057, 21653, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-10 11:37:03', '2021-12-10 11:37:03'),
(19808, 10057, 21653, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:10:57', '2021-12-20 13:10:57'),
(19809, 10057, 21653, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:19:37', '2021-12-27 11:19:37'),
(19810, 20067, 21653, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to:  MadirajuP@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good afternoon, Hope you are doing well. Any updates on the below-mentioned request?  Kindly respond promptly, Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 16:01:29', '2022-01-11 16:01:29'),
(19811, 20067, 21653, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:23:57', '2022-01-20 10:23:57'),
(19812, 20067, 21653, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:28:18', '2022-01-20 10:28:18'),
(19813, 20067, 21653, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to:  pccdocsub@mitchell.com,MadirajuP@aetna.com  Sub: Re: Enrollment status || LONGPOINT MEDICAL CENTER || Group & Providers || First Health ||  Good Afternoon!  I would like to know the enrollment status of the below-mentioned providers.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 SIGI PAUL	1033623616 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Ani Stephen	1588959118 Jeena Abraham	1467901587 Glory Abraham	1194206490 James Piccione JR	1356321509 Mini Chennemkara	1841755956 Odette Korouma	1134525868 Abdur Rauf	1497726202 Jeemol George	1497219067  Thanks & Regards! Syed Ahad.', NULL, NULL, '2022-01-28 14:22:42', '2022-01-28 14:22:42'),
(19814, 20067, 21653, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:11:41', '2022-03-08 17:11:41'),
(19815, 3040, 21654, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:34:51', '2021-03-16 10:34:51'),
(19816, 3040, 21654, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject:Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group Long Point Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-02 14:18:49', '2021-06-02 14:18:49'),
(19817, 3040, 21654, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Can you please advise what I need to link the providers with First Health. If the given tin is not linked with First Health then how come the providers are participating.    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-21 16:19:08', '2021-06-21 16:19:08'),
(19818, 11056, 21654, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com>  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,     Good Evening!     Given request is to add Providers, However Provider’s DOB, Location, Phone & Fax#, Billing location Phone & Fax#, are missing, Please provider the missing information to process further.     Thank You,  Phani.', NULL, NULL, '2021-06-22 13:43:36', '2021-06-22 13:43:36'),
(19819, 11056, 21654, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub:  Enrollment Information of the Providers - LPMC - First Health  Good Morning, Phani,  Hope you are doing well. Here is the information you need about the providers of the group enlisted below :-  Practice Info Practice Name : Longpoint Medical Center Practice NPI #  : 1770763815 Practice TIN #  :  76-0612416 Main Address   :  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Providers Info: Main & Billing Address :  9504 LONG POINT RD STE E, Houston , TX 77055-4226  Main & Billing Fax # :  713-461-3518 Main & Billing Phone # :  (713) 461-3535  Provider 1:  Provider Name: George, Jeemol  Provider DOB: 04/13/1983  Provider NPI# 1497219067   Provider 2:    Provider Name: Jose, Julie  Provider DOB: 08/31/1977  Provider NPI# 1447883061    Provider 3:    Provider Name: Stephen, Ani  Provider DOB: 01/30/1980  Provider NPI# 1588959118    Provider 4:    Provider Name: Piccione JR, James M  Provider DOB: 09/01/1959  Provider NPI# 1356321509    Provider 5:    Provider Name: Brown, Brittany  Provider DOB: 05/10/1988  Provider NPI# 1275163537   Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider DOB: 05/25/1970  Provider NPI# 1841755956    Provider 7:    Provider Name: Abraham, Glory  Provider DOB: 10/24/1977  Provider NPI# 1194206490      Provider 8:    Provider Name: Fernandus, Limy  Provider DOB: 07/03/1985  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider DOB: 05/28/1952  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider DOB: 04/21/1981  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider DOB: 01/08/1982  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider DOB: 05/30/1974  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider DOB: 10/22/1979  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider DOB: 05/25/1973  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider DOB: 05/05/1973  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-06-22 13:52:04', '2021-06-22 13:52:04'),
(19820, 3040, 21654, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-09 15:11:17', '2021-07-09 15:11:17'),
(19821, 3040, 21654, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-08-30 14:04:20', '2021-08-30 14:04:20'),
(19822, 10057, 21654, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in First Health.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Abraham, Jeena	1467901587 John, Jeny	1073019493  Please feel free to reach out to me, if you need any other information. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 16:44:22', '2021-10-11 16:44:22'),
(19823, 10057, 21654, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani ', NULL, NULL, '2021-10-18 10:41:37', '2021-10-18 10:41:37'),
(19824, 10057, 21654, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:57:03', '2021-11-23 13:57:03'),
(19825, 10057, 21654, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Hope this email finds you in good health. Could you please provide me with the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:54:55', '2021-12-03 14:54:55'),
(19826, 10057, 21654, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-10 11:36:51', '2021-12-10 11:36:51'),
(19827, 10057, 21654, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:10:50', '2021-12-20 13:10:50'),
(19828, 10057, 21654, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:19:31', '2021-12-27 11:19:31'),
(19829, 20067, 21654, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to:  MadirajuP@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good afternoon, Hope you are doing well. Any updates on the below-mentioned request?  Kindly respond promptly, Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 16:01:23', '2022-01-11 16:01:23'),
(19830, 20067, 21654, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:23:49', '2022-01-20 10:23:49'),
(19831, 20067, 21654, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:28:11', '2022-01-20 10:28:11'),
(19832, 20067, 21654, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to:  pccdocsub@mitchell.com,MadirajuP@aetna.com  Sub: Re: Enrollment status || LONGPOINT MEDICAL CENTER || Group & Providers || First Health ||  Good Afternoon!  I would like to know the enrollment status of the below-mentioned providers.   Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 SIGI PAUL	1033623616 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Ani Stephen	1588959118 Jeena Abraham	1467901587 Glory Abraham	1194206490 James Piccione JR	1356321509 Mini Chennemkara	1841755956 Odette Korouma	1134525868 Abdur Rauf	1497726202 Jeemol George	1497219067  Thanks & Regards! Syed Ahad.', NULL, NULL, '2022-01-28 14:22:36', '2022-01-28 14:22:36'),
(19833, 20067, 21654, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:11:31', '2022-03-08 17:11:31'),
(19834, 3040, 21655, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:38:06', '2021-03-16 10:38:06');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(19835, 3040, 21655, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:57:26', '2021-05-27 12:57:26'),
(19836, 3040, 21655, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:58', '2021-06-15 14:30:58'),
(19837, 11056, 21655, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:05:05', '2021-07-01 14:05:05'),
(19838, 11056, 21655, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:59:46', '2021-07-09 16:59:46'),
(19839, 3040, 21655, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:58', '2021-07-30 14:55:58'),
(19840, 11056, 21655, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:54:05', '2021-08-12 14:54:05'),
(19841, 10057, 21655, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:46:45', '2021-10-08 10:46:45'),
(19842, 10057, 21655, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:27:50', '2021-11-23 17:27:50'),
(19843, 10057, 21655, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:02:53', '2021-12-03 15:02:53'),
(19844, 10057, 21655, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:15:07', '2021-12-10 13:15:07'),
(19845, 10057, 21655, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:51:32', '2021-12-17 10:51:32'),
(19846, 10057, 21655, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:43:33', '2021-12-23 10:43:33'),
(19847, 20067, 21655, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:41:43', '2022-01-11 15:41:43'),
(19848, 20067, 21655, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:42:59', '2022-01-20 10:42:59'),
(19849, 20067, 21655, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:32:22', '2022-01-28 14:32:22'),
(19850, 20067, 21655, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:59:16', '2022-02-18 13:59:16'),
(19851, 20067, 21655, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:17:03', '2022-03-08 10:17:03'),
(19852, 20067, 21655, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:30:59', '2022-03-08 14:30:59'),
(19853, 19067, 21655, NULL, '2022-04-08 00:00:00.000', 'In Process', 'The agreement has been faxed. See attachment for reference. ', NULL, NULL, '2022-04-01 16:55:34', '2022-04-01 16:55:34'),
(19854, 3040, 21656, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:38:26', '2021-03-16 10:38:26'),
(19855, 3040, 21656, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:57:30', '2021-05-27 12:57:30'),
(19856, 3040, 21656, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:54', '2021-06-15 14:30:54'),
(19857, 11056, 21656, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:05:17', '2021-07-01 14:05:17'),
(19858, 11056, 21656, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:53:35', '2021-07-09 16:53:35'),
(19859, 11056, 21656, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:53:48', '2021-07-09 16:53:48'),
(19860, 3040, 21656, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:57', '2021-07-30 14:55:57'),
(19861, 11056, 21656, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:58:21', '2021-08-12 14:58:21'),
(19862, 10057, 21656, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:46:35', '2021-10-08 10:46:35'),
(19863, 10057, 21656, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:27:44', '2021-11-23 17:27:44'),
(19864, 10057, 21656, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:02:48', '2021-12-03 15:02:48'),
(19865, 10057, 21656, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:15:01', '2021-12-10 13:15:01'),
(19866, 10057, 21656, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:51:25', '2021-12-17 10:51:25'),
(19867, 10057, 21656, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:43:25', '2021-12-23 10:43:25'),
(19868, 20067, 21656, NULL, '2022-01-18 00:00:00.000', 'In Process', '', NULL, NULL, '2022-01-11 15:41:02', '2022-01-11 15:41:02'),
(19869, 20067, 21656, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:41:35', '2022-01-11 15:41:35'),
(19870, 20067, 21656, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:42:53', '2022-01-20 10:42:53'),
(19871, 20067, 21656, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:32:15', '2022-01-28 14:32:15'),
(19872, 20067, 21656, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:59:10', '2022-02-18 13:59:10'),
(19873, 20067, 21656, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:16:57', '2022-03-08 10:16:57'),
(19874, 20067, 21656, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:30:35', '2022-03-08 14:30:35'),
(19875, 3040, 21657, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:38:40', '2021-03-16 10:38:40'),
(19876, 3040, 21657, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:57:34', '2021-05-27 12:57:34'),
(19877, 3040, 21657, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:50', '2021-06-15 14:30:50'),
(19878, 11056, 21657, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:05:26', '2021-07-01 14:05:26'),
(19879, 11056, 21657, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:51:48', '2021-07-09 16:51:48'),
(19880, 3040, 21657, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:57', '2021-07-30 14:55:57'),
(19881, 11056, 21657, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:58:13', '2021-08-12 14:58:13'),
(19882, 10057, 21657, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:46:20', '2021-10-08 10:46:20'),
(19883, 10057, 21657, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:27:38', '2021-11-23 17:27:38'),
(19884, 10057, 21657, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:02:42', '2021-12-03 15:02:42'),
(19885, 10057, 21657, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:14:55', '2021-12-10 13:14:55'),
(19886, 10057, 21657, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:51:18', '2021-12-17 10:51:18'),
(19887, 10057, 21657, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:43:17', '2021-12-23 10:43:17'),
(19888, 20067, 21657, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:40:54', '2022-01-11 15:40:54'),
(19889, 20067, 21657, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:42:45', '2022-01-20 10:42:45'),
(19890, 20067, 21657, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:32:08', '2022-01-28 14:32:08'),
(19891, 20067, 21657, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:59:03', '2022-02-18 13:59:03'),
(19892, 20067, 21657, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:16:51', '2022-03-08 10:16:51'),
(19893, 20067, 21657, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:30:29', '2022-03-08 14:30:29'),
(19894, 3040, 21658, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:38:54', '2021-03-16 10:38:54');
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
(19895, 3040, 21658, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:57:38', '2021-05-27 12:57:38'),
(19896, 3040, 21658, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:47', '2021-06-15 14:30:47'),
(19897, 11056, 21658, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:05:36', '2021-07-01 14:05:36'),
(19898, 11056, 21658, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:51:46', '2021-07-09 16:51:46'),
(19899, 3040, 21658, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:57', '2021-07-30 14:55:57'),
(19900, 11056, 21658, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:58:02', '2021-08-12 14:58:02'),
(19901, 10057, 21658, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:46:13', '2021-10-08 10:46:13'),
(19902, 10057, 21658, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:27:31', '2021-11-23 17:27:31'),
(19903, 10057, 21658, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:02:35', '2021-12-03 15:02:35'),
(19904, 10057, 21658, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:14:48', '2021-12-10 13:14:48'),
(19905, 10057, 21658, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:51:10', '2021-12-17 10:51:10'),
(19906, 10057, 21658, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:43:09', '2021-12-23 10:43:09'),
(19907, 20067, 21658, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:40:46', '2022-01-11 15:40:46'),
(19908, 20067, 21658, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:42:38', '2022-01-20 10:42:38'),
(19909, 20067, 21658, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:32:02', '2022-01-28 14:32:02'),
(19910, 20067, 21658, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:58:56', '2022-02-18 13:58:56'),
(19911, 20067, 21658, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:16:46', '2022-03-08 10:16:46'),
(19912, 20067, 21658, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:30:23', '2022-03-08 14:30:23'),
(19913, 3040, 21659, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:39:17', '2021-03-16 10:39:17'),
(19914, 3040, 21659, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:57:42', '2021-05-27 12:57:42'),
(19915, 3040, 21659, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:43', '2021-06-15 14:30:43'),
(19916, 11056, 21659, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:05:42', '2021-07-01 14:05:42'),
(19917, 11056, 21659, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:57:09', '2021-07-09 16:57:09'),
(19918, 3040, 21659, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:56', '2021-07-30 14:55:56'),
(19919, 11056, 21659, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:57:55', '2021-08-12 14:57:55'),
(19920, 10057, 21659, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:46:02', '2021-10-08 10:46:02'),
(19921, 10057, 21659, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:27:25', '2021-11-23 17:27:25'),
(19922, 10057, 21659, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:02:28', '2021-12-03 15:02:28'),
(19923, 10057, 21659, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:14:42', '2021-12-10 13:14:42'),
(19924, 10057, 21659, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:51:04', '2021-12-17 10:51:04'),
(19925, 10057, 21659, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:43:01', '2021-12-23 10:43:01'),
(19926, 20067, 21659, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:40:38', '2022-01-11 15:40:38'),
(19927, 20067, 21659, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:42:27', '2022-01-20 10:42:27'),
(19928, 20067, 21659, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:31:57', '2022-01-28 14:31:57'),
(19929, 20067, 21659, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:58:49', '2022-02-18 13:58:49'),
(19930, 20067, 21659, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:16:41', '2022-03-08 10:16:41'),
(19931, 20067, 21659, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:30:17', '2022-03-08 14:30:17'),
(19932, 3040, 21660, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:39:30', '2021-03-16 10:39:30'),
(19933, 3040, 21660, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:57:46', '2021-05-27 12:57:46'),
(19934, 3040, 21660, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:40', '2021-06-15 14:30:40'),
(19935, 11056, 21660, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Good Afternoon,  Hello Daniel,  Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 14:05:50', '2021-07-01 14:05:50'),
(19936, 11056, 21660, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:55:29', '2021-07-09 16:55:29'),
(19937, 3040, 21660, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:56', '2021-07-30 14:55:56'),
(19938, 11056, 21660, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:57:47', '2021-08-12 14:57:47'),
(19939, 10057, 21660, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:45:48', '2021-10-08 10:45:48'),
(19940, 10057, 21660, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:27:19', '2021-11-23 17:27:19'),
(19941, 10057, 21660, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:02:22', '2021-12-03 15:02:22'),
(19942, 10057, 21660, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:14:36', '2021-12-10 13:14:36'),
(19943, 10057, 21660, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:50:57', '2021-12-17 10:50:57'),
(19944, 10057, 21660, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:42:53', '2021-12-23 10:42:53'),
(19945, 20067, 21660, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:40:31', '2022-01-11 15:40:31'),
(19946, 20067, 21660, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:42:21', '2022-01-20 10:42:21'),
(19947, 20067, 21660, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:31:51', '2022-01-28 14:31:51'),
(19948, 20067, 21660, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:58:43', '2022-02-18 13:58:43'),
(19949, 20067, 21660, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:16:35', '2022-03-08 10:16:35'),
(19950, 20067, 21660, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:30:10', '2022-03-08 14:30:10'),
(19951, 3040, 21661, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:39:44', '2021-03-16 10:39:44'),
(19952, 3040, 21661, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:57:50', '2021-05-27 12:57:50'),
(19953, 3040, 21661, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. I am trying to reach you but I couldn\'t. Can you please advise we have 16 providers under our group Long point Medical Center. The agreement that you sent is for a group I wanted to enroll the providers under the group so advise the process on how we can enroll the providers?   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-15 14:30:35', '2021-06-15 14:30:35');
