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
(23374, 3040, 22300, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com, Provider_Relations_South_Texas@bcbstx.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 08:37:27', '2021-03-30 08:37:27'),
(23375, 1006, 22300, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Sent f/u @ TX NM South Texas Provider_Relations_South_Texas@bcbstx.com: Sub: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Group || BCBS ||  \"Hello,   I wanted to get an update regarding a demographic update request we submitted last month for the following group:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 168992490  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2021-04-15 08:43:23', '2021-04-15 08:43:23'),
(23376, 1006, 22300, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Received following email from: Valerie_Martinez@bcbstx.com  Sub: BCBSTX PROVIDER UPDATE JUAN CAPUPUS APN  Good afternoon,   The following provider is showing to be in network.   Thank you,  Valerie Martinez | Internal Network Support Rep II – Southwest Region  \"Hello,  I reviewed the account and it looks like all the updates have been completed for the group and providers except for one (TREVINO, FRANCISCO A, APN). It is still processing and would take 7 to 10 to show up in the directory. Please let me know if you need any additional assistance.  Thank you,  Angela Alanis Norman | Data Entry Operator III – Southwest Region Blue Cross Blue Shield of Texas 4444 Corona Dr. Ste. 148, Corpus Christi, TX 78411 phone 361-878-1614 | fax 361-852-0624 | email Angela_Norman@BCBSTX.com', NULL, NULL, '2021-04-27 07:48:14', '2021-04-27 07:48:14'),
(23377, 3040, 22301, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:45:36', '2021-03-16 15:45:36'),
(23378, 3040, 22301, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in First Health under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-01 16:03:15', '2021-04-01 16:03:15'),
(23379, 3040, 22301, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject: Enroll Group & Provider || Ladot Healthcare LLC || Group & Providers || First Health ||  Hello,   Please advise me the enrollment process for the below mentioned group and providers.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  Waiting for your response.   Thanks', NULL, NULL, '2021-04-30 12:54:06', '2021-04-30 12:54:06'),
(23380, 3040, 22301, NULL, '2021-06-01 00:00:00.000', 'In Process', 'I had a word with (Dona) First Health representative and she advised to fill out the First Health participation from submitted online.   Please see attachment.', NULL, NULL, '2021-05-25 15:00:29', '2021-05-25 15:00:29'),
(23381, 1006, 22301, NULL, '2021-06-03 00:00:00.000', 'In Process', 'The request was submitted for the providers, forms are attached in their individual tasks. ', NULL, NULL, '2021-05-27 09:47:33', '2021-05-27 09:47:33'),
(23382, 1006, 22301, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent f/u email @ pdsdallas@aetna.com:  Sub: Enrollment Status - LHC - First Health  \"Hello,  I hope you\'re doing well, we submitted enrollment forms for the following providers under our group and I wanted to get an update regarding their enrollment status, their information is as follows:  Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283Practice NPI# 1912502626  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  Please get back to me as soon as possible. Thank you.\"', NULL, NULL, '2021-06-11 12:02:37', '2021-06-11 12:02:37'),
(23383, 1006, 22301, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email received from: MadirajuP@aetna.com  Sub : Enrollment Status - LHC - First Health Hi,     Good Afternoon!   Please find the status of the below Providers.   PROVIDER NAME	    CPD ID    TAX ID	        NPI	            EFFECTIVE DATE     Status 1)Dada, Oladipo	2912147	  85-2432283	 1760700223	              -	                Given tin is not                                                                                                                        linked with First Health 2)Dada, Atinuke             -      85-2432283	   1154782720      -	           Provider not linked                                                                                                                               with First  Health   Thank You, Phani', NULL, NULL, '2021-06-30 14:04:51', '2021-06-30 14:04:51'),
(23384, 1006, 22301, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email received from: MadirajuP@aetna.com  Sub : Enrollment Status - LHC - First Health Hi,     Good Afternoon!   Please find the status of the below Providers.   PROVIDER NAME	    CPD ID    TAX ID	        NPI	            EFFECTIVE DATE     Status 1)Dada, Oladipo	2912147	  85-2432283	 1760700223	              -	                Given tin is not                                                                                                                        linked with First Health 2)Dada, Atinuke             -      85-2432283	   1154782720      -	           Provider not linked                                                                                                                               with First  Health   Thank You, Phani', NULL, NULL, '2021-06-30 14:04:52', '2021-06-30 14:04:52'),
(23385, 11056, 22301, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Good morning,  I hope you are doing well. Kindly tell us about how to link the provider and TIN with First Health. Guide us to the procedure soon.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Providers: Provider 1: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI # : 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-12 11:02:28', '2021-07-12 11:02:28'),
(23386, 11056, 22301, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to  : MadirajuP@aetna.com      &    pdsdallas@aetna.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Good Afternoon!  I hope you are doing well. Kindly tell us about how to link the provider and Tax I.D (TIN) with First Health. Guide us to the procedure as soon as possible. Eagerly waiting for your reply.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Providers: Provider 1: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI # : 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 13:58:24', '2021-07-19 13:58:24'),
(23387, 11056, 22301, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to  : MadirajuP@aetna.com      &    pdsdallas@aetna.com   &  SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Good Afternoon!  I hope you are doing well. Kindly tell us about how to link the provider and Tax I.D (TIN) with First Health. Guide us to the procedure as soon as possible. Eagerly waiting for your reply.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Providers: Provider 1: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI # : 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-30 14:07:30', '2021-07-30 14:07:30'),
(23388, 11056, 22301, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to :  BharathB@aetna.com,  &    MadirajuP@aetna.com, PDS Dallas pdsdallas@aetna.com  Sub :   Good Afternoon!  I hope you are doing well. It has been a long time since you haven\'t responded to our emails. Kindly tell us about how to link the provider and Tax I.D (TIN) with First Health. Guide us to the procedure as soon as possible.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Providers: Provider 1: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI # : 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 10:07:34', '2021-08-03 10:07:34'),
(23389, 11056, 22301, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Hello,     I hope that this email finds you well!     This TIN is still not participating within the First Health Network. The new group agreement sent over to email address adil@claimsmedinc.com on 7/3 is still out for review and has not yet been returned signed. I do show that it was viewed on 7/5, however, it is still in process and has not been completed on your signers side.     Please let me know if I need to redirect the agreement to a different email address for review/signature.     Additionally, please send over your most current roster of providers/locations that you would like to be linked to the new group agreement once signed.     Please do not hesitate to reach out if you have any questions or concerns.     Take care,     Jeanette Sidley  Network Relations Consultant', NULL, NULL, '2021-08-09 15:19:08', '2021-08-09 15:19:08'),
(23390, 11056, 22301, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Hey Jeanette!  Hope you are doing well. Yes please redirect the agreement to me at sta@claimsmedinc.com for review/signature. Here is the most current roster of location mentioned below. Please see the attachment.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Furthermore, If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-16 09:26:30', '2021-08-16 09:26:30'),
(23391, 11056, 22301, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Good morning,     You are most welcome! I have just re-assigned the agreement to your email address for review/signature.     Please do not hesitate to reach out if you have any questions or concerns when reviewing.     Take care,  Jeanette', NULL, NULL, '2021-08-23 09:26:31', '2021-08-23 09:26:31'),
(23392, 11056, 22301, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Hello!  I actually forwarded it over on Friday after I responded to your email. It will come over via Adobe EchoSign. I will send another link again through the system.   Please let me know if you do not get it by the end of today. I will send it multiple times.  Thank you! Jeanette', NULL, NULL, '2021-09-01 08:51:48', '2021-09-01 08:51:48'),
(23393, 11056, 22301, NULL, '2021-09-20 00:00:00.000', 'Approved', 'Approval Email received from : SidleyJ1@firsthealth.com  Sub : Ladot Healthcare LLC - First Health Network   Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  I would like to take a moment to share what to expect next and share important resources with you in order to allow a smooth process as your contract is implemented and beyond.  Please see welcome letter below. The contract will be fully in the systems by the effective date of 10/1.  The new group agreement/rates do not become effective until 10/1 so any claims before then will not price to the contracted rates.  Please feel free to forward this information to anyone that you feel would benefit.  Thank you, Jeanette Sidley  eff date is :  10/01/2021   confirmed by a call rep. too.  Agreement is attached. Please see the attachment.', NULL, NULL, '2021-09-13 16:10:32', '2021-09-13 16:10:32'),
(23394, 1006, 22302, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:45:45', '2021-03-16 15:45:45'),
(23395, 3040, 22302, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicare & Medicaid. ', NULL, NULL, '2021-04-05 10:36:47', '2021-04-05 10:36:47'),
(23396, 1006, 22302, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'The request is pending Medicaid enrollment.', NULL, NULL, '2021-05-25 10:19:51', '2021-05-25 10:19:51'),
(23397, 1006, 22302, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Sent enrollment request @ jointchp@texaschildrens.org:  Sub: Enrollment Request - RSM - TCHP  \"Hello,   Please find the attached LOI Questionnaire with the W9, do let me know if anything else is needed to proceed with the request for enrollment.   Thank you. \"', NULL, NULL, '2021-06-14 15:23:45', '2021-06-14 15:23:45'),
(23398, 1006, 22302, NULL, '2021-07-09 00:00:00.000', 'In Process', 'We received the following reply from jointchp@texaschildrens.org:  Sub: Enrollment Request - RSM - TCHP  \"Please resubmit your Letter of interest questionnaire with a w9.  Thank you\"  Sent W9: \"Hello,   Please find the attached form. let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-07-02 16:24:34', '2021-07-02 16:24:34'),
(23399, 1006, 22302, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Received the following reply from TCHP @ danisbet@texaschildrens.org: \"July 23, 2021 Ramegowda Belaker, MD Right Step Medical Center, LLC 11925 Southwest Freeway, Suite 12 Stafford, TX  Re: Participation in Texas Children’s Health Plan, Inc.  Dear Provider: Thank you for your interest in becoming a participating provider in Texas Children’s Health Plan, Inc. (TCHP).  In order to be considered for participation in TCHP, all providers must have a Texas Medicaid-attested National Provider Identifier (NPI). We regret to inform you that we are unable to accept your request for participation at this time for the following reason:  You do not have a Texas Medicaid-attested individual NPI for the Group or Physical Address listed on your letter  of interest questionnaire  Please contact Texas Medicaid & Healthcare Partnership online at www.tmhp.com., or by phone at 800-925-9126, (Option 3) to have the information corrected/updated. Once you have received confirmation that the information has been corrected/updated, you may re-apply for participation with Texas Children’s Health Plan.  Sincerely,  Contracts Administration Texas Children’s Health Plan\"  Replied with:  \"Hello Deborah,   I appreciate the update but as per my discussion with TMHP both the NPI of the group and the individual provider is attested. What exactly seems to be missing?  Thank you. \"', NULL, NULL, '2021-07-26 12:23:05', '2021-07-26 12:23:05'),
(23400, 1006, 22302, NULL, '2021-08-05 00:00:00.000', 'In Process', 'We received the following reply from danisbet@texaschildrens.org:  Sub: Ramegowda Belaker, MD  \"Hi Brad,  Please resubmit your application and I will have it submitted.  Thanks, Deb\"  Re-sent the application. ', NULL, NULL, '2021-07-29 14:29:22', '2021-07-29 14:29:22'),
(23401, 1006, 22302, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Sent f/u email @ \"Nisbet, Deborah A. (Deb)\" danisbet@texaschildrens.org:  Sub: Ramegowda Belaker, MD  \"Hello Deborah,   I hope you\'re doing well, I just wanted to get an update regarding this request. Has the LOI been processed yet?  Thank you. \"', NULL, NULL, '2021-08-11 17:07:18', '2021-08-11 17:07:18'),
(23402, 1006, 22302, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Sent f/u email @ danisbet@texaschildrens.org:  Sub: Ramegowda Belaker, MD  \"Hello Deb,   I wanted to get an update regarding the status of our request.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-31 15:58:33', '2021-08-31 15:58:33'),
(23403, 11056, 22302, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Email sent to : danisbet@texaschildrens.org  Sub : Re: Ramegowda Belaker, MD  Good Morning!  Hope this email finds you well. I want to know the enrollment status of the following providers and practice soon. Please update me soon.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-09-03 09:01:43', '2021-09-03 09:01:43'),
(23404, 11056, 22302, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email received from : bxgupta@texaschildrens.org  Sub : PIF & Roster  Good morning Alex,  Please see attached PIF & Roster for you to complete and return for next step in process for contracting team. Would appreciate it greatly.   Have a great day,  Kind regards,  Roster and and forms has been submitted. Please see the attachment.', NULL, NULL, '2021-09-17 08:37:33', '2021-09-17 08:37:33'),
(23405, 11056, 22302, NULL, '2021-10-04 00:00:00.000', 'In Process', 'I have words with Nuerez Liz. She demanded us the hospital admitting privileges and has been provided by our side.  She going to review and going to contact us back regarding that if anything else is needed.', NULL, NULL, '2021-09-27 16:48:45', '2021-09-27 16:48:45'),
(23406, 11056, 22302, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email received from : danisbet@texaschildrens.org  Sub : Ramegowda Belaker, MD  Greetings,  Please see the attached for important information regarding your recent application.  Thank you.  Seeing this matter. Trying to figure this out.', NULL, NULL, '2021-10-04 17:05:22', '2021-10-04 17:05:22'),
(23407, 11056, 22302, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep : Bharvi Gupta  Status: TCHP can\'t credential any practitioner if their Admitting privileges Hospital hasn\'t credentialed with THCP.  If we want to credential with TCHP we have to credential our Admitting Hospital too. Otherwise, we have to find a hospital already credentialed with THCP and have to link our MD to it.   Ref code : bharvi10212021', NULL, NULL, '2021-10-21 07:58:34', '2021-10-21 07:58:34'),
(23408, 11056, 22302, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to Mr Jobi :rightstepmedicalcenter@yahoo.com  Sub  :  TCHP In Network Hospitals  Good Morning Dr. Jobi,  Hope you are doing well, This is to inform you that TCHP is not covering the hospitals where Dr. Ram has Admitting Privileges, I have attached the list of Hospitals which are covered by TCHP so if Dr. Ram can have Admitting Privileges in one of them the Hospital should be within 10 miles radius of our location.  Let me know if you have any questions.   Regards,', NULL, NULL, '2021-11-11 09:17:14', '2021-11-11 09:17:14'),
(23409, 11056, 22302, NULL, '2021-11-25 00:00:00.000', 'On Hold', 'Waiting for the list  of TCHP In-Network Hospitals.', NULL, NULL, '2021-11-18 12:16:41', '2021-11-18 12:16:41'),
(23410, 19067, 22302, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from:  mdfouts@texaschildrens.org  Subject: RE: TCHP - RSM - GROUP & Providers Applications   Hello Alex,  I have passed this along to our contract specialists who work the LOIs when they come in. The contract specialist will send a Confidentiality Agreement to the signature authority for signature. Once we receive the NDA back, a contract agreement will be created by a Contract Administrator, who will be in touch with you.     Beginning March 10, I will be on leave so it’s best that you communicate directly with our team through the TCHP network management email:  tchpnetworkmanagement@texaschildrens.org.     I have enjoyed working with you and my best to you,  Melissa', NULL, NULL, '2022-03-01 11:51:47', '2022-03-01 11:51:47'),
(23411, 19067, 22302, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Email sent to: mdfouts@texaschildrens.org  Subject: TCHP - RSM - GROUP & Providers Applications    Good Morning Melissa,  Hope you\'re doing good, can you please get the attached application process as this will be a  new group, and the application was denied before due hospital privileges, which is nor sorted out and we have hospitals privileges for all 3 plans of TCHP. Let me knoe if you have any questions.    Regards, Alex', NULL, NULL, '2022-03-11 10:33:13', '2022-03-11 10:33:13'),
(23412, 1009, 22302, NULL, '2022-04-06 00:00:00.000', 'In Process', 'Received an Email from lekraus@texaschildrens.org  Good morning,     We received Provider Information Forms to join our network, but upon initial review we cannot locate a contract. Please submit an LOI to get the contracting process started for your group: http://www.tchp.us/sites/default/files/pdf/ND-2011-346%20LOI%20Questionnaire_Fillable_Update%204.06.pdf ', NULL, NULL, '2022-03-30 13:55:01', '2022-03-30 13:55:01'),
(23413, 1009, 22302, NULL, '2022-04-06 00:00:00.000', 'In Process', 'Email sent to lekraus@texaschildrens.org>, jointchp@texaschildrens.org Good Afternoon,  Please review the attached LOI with the updated W9 form.  Do let me know if you need anything else.  Thank you! ', NULL, NULL, '2022-03-30 13:56:34', '2022-03-30 13:56:34'),
(23414, 19067, 22302, NULL, '2022-04-13 00:00:00.000', 'In Process', 'Email received from: jointchp@texaschildrens.org  Subject: RE: PIF received for Right Step Medical Center LLC    Hello,     Thank you for your interest in our health plan’s network. Your LOI  has been received on for Ramegowda_Belaker_Right_Step_LOI  and communication will be sent out to you once the review has been completed.  Thank you     Contract Specialist  Texas Children’s Health Plan', NULL, NULL, '2022-04-06 08:32:05', '2022-04-06 08:32:05'),
(23415, 19067, 22302, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: TCHP - RSM - GROUP & Providers Applications    Hello Melissa,  We sent you the application for enrollment what is the update on that. We sent the applications on 03/01/2022.  Thanks, Hammad', NULL, NULL, '2022-04-27 07:28:01', '2022-04-27 07:28:01'),
(23416, 3040, 22303, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:45:46', '2021-03-16 15:45:46'),
(23417, 3040, 22303, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Email sent to: PDSDallas@aetna.com  Subject: Enroll Group & Provider || Ladot Healthcare LLC || Group & Providers || First Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in First Health under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-01 16:03:49', '2021-04-01 16:03:49'),
(23418, 3040, 22303, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject: Enroll Group & Provider || Ladot Healthcare LLC || Group & Providers || First Health ||  Hello,   Please advise me the enrollment process for the below mentioned group and providers.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  Waiting for your response.   Thanks', NULL, NULL, '2021-04-30 12:54:11', '2021-04-30 12:54:11'),
(23419, 3040, 22303, NULL, '2021-06-01 00:00:00.000', 'In Process', 'I had a word with (Dona) First Health representative and she advised to fill out the First Health participation from submitted online.   Please see attachment', NULL, NULL, '2021-05-25 15:00:10', '2021-05-25 15:00:10'),
(23420, 1006, 22303, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent f/u email @ pdsdallas@aetna.com:  Sub: Enrollment Status - LHC - First Health  \"Hello,  I hope you\'re doing well, we submitted enrollment forms for the following providers under our group and I wanted to get an update regarding their enrollment status, their information is as follows:  Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283Practice NPI# 1912502626  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  Please get back to me as soon as possible. Thank you.\"', NULL, NULL, '2021-06-11 12:02:44', '2021-06-11 12:02:44'),
(23421, 1006, 22303, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email received from: MadirajuP@aetna.com  Sub : Enrollment Status - LHC - First Health Hi,     Good Afternoon!   Please find the status of the below Providers.   PROVIDER NAME	    CPD ID    TAX ID	        NPI	            EFFECTIVE DATE     Status 1)Dada, Oladipo	2912147	  85-2432283	 1760700223	              -	                Given tin is not                                                                                                                        linked with First Health 2)Dada, Atinuke             -      85-2432283	   1154782720      -	           Provider not linked                                                                                                                               with First  Health   Thank You, Phani', NULL, NULL, '2021-06-30 14:03:56', '2021-06-30 14:03:56'),
(23422, 1006, 22303, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email received from: MadirajuP@aetna.com  Sub : Enrollment Status - LHC - First Health Hi,     Good Afternoon!   Please find the status of the below Providers.   PROVIDER NAME	    CPD ID    TAX ID	        NPI	            EFFECTIVE DATE     Status 1)Dada, Oladipo	2912147	  85-2432283	 1760700223	              -	                Given tin is not                                                                                                                        linked with First Health 2)Dada, Atinuke             -      85-2432283	   1154782720      -	           Provider not linked                                                                                                                               with First  Health   Thank You, Phani', NULL, NULL, '2021-06-30 14:03:58', '2021-06-30 14:03:58'),
(23423, 11056, 22303, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Good morning,  I hope you are doing well. Kindly tell us about how to link the provider and TIN with First Health. Guide us to the procedure soon.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Providers: Provider 1: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI # : 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-12 11:02:22', '2021-07-12 11:02:22'),
(23424, 11056, 22303, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to  : MadirajuP@aetna.com      &    pdsdallas@aetna.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Good Afternoon!  I hope you are doing well. Kindly tell us about how to link the provider and Tax I.D (TIN) with First Health. Guide us to the procedure as soon as possible. Eagerly waiting for your reply.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Providers: Provider 1: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI # : 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 13:58:16', '2021-07-19 13:58:16'),
(23425, 11056, 22303, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to  : MadirajuP@aetna.com      &    pdsdallas@aetna.com   &  SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Good Afternoon!  I hope you are doing well. Kindly tell us about how to link the provider and Tax I.D (TIN) with First Health. Guide us to the procedure as soon as possible. Eagerly waiting for your reply.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Providers: Provider 1: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI # : 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-30 14:07:07', '2021-07-30 14:07:07'),
(23426, 11056, 22303, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to :  BharathB@aetna.com,  &    MadirajuP@aetna.com, PDS Dallas pdsdallas@aetna.com  Sub :   Good Afternoon!  I hope you are doing well. It has been a long time since you haven\'t responded to our emails. Kindly tell us about how to link the provider and Tax I.D (TIN) with First Health. Guide us to the procedure as soon as possible.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Providers: Provider 1: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI # : 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 10:07:58', '2021-08-03 10:07:58'),
(23427, 11056, 22303, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Hello,     I hope that this email finds you well!     This TIN is still not participating within the First Health Network. The new group agreement sent over to email address adil@claimsmedinc.com on 7/3 is still out for review and has not yet been returned signed. I do show that it was viewed on 7/5, however, it is still in process and has not been completed on your signers side.     Please let me know if I need to redirect the agreement to a different email address for review/signature.     Additionally, please send over your most current roster of providers/locations that you would like to be linked to the new group agreement once signed.     Please do not hesitate to reach out if you have any questions or concerns.     Take care,     Jeanette Sidley  Network Relations Consultant', NULL, NULL, '2021-08-09 15:18:57', '2021-08-09 15:18:57'),
(23428, 11056, 22303, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Hey Jeanette!  Hope you are doing well. Yes please redirect the agreement to me at sta@claimsmedinc.com for review/signature. Here is the most current roster of location mentioned below. Please see the attachment.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Furthermore, If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-16 09:26:21', '2021-08-16 09:26:21'),
(23429, 11056, 22303, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Good morning,     You are most welcome! I have just re-assigned the agreement to your email address for review/signature.     Please do not hesitate to reach out if you have any questions or concerns when reviewing.     Take care,  Jeanette', NULL, NULL, '2021-08-23 09:26:58', '2021-08-23 09:26:58'),
(23430, 11056, 22303, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Hello!  I actually forwarded it over on Friday after I responded to your email. It will come over via Adobe EchoSign. I will send another link again through the system.   Please let me know if you do not get it by the end of today. I will send it multiple times.  Thank you! Jeanette', NULL, NULL, '2021-09-01 08:50:47', '2021-09-01 08:50:47'),
(23431, 11056, 22303, NULL, '2021-09-20 00:00:00.000', 'Approved', 'Approval Email received from : SidleyJ1@firsthealth.com  Sub : Ladot Healthcare LLC - First Health Network   Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  I would like to take a moment to share what to expect next and share important resources with you in order to allow a smooth process as your contract is implemented and beyond.  Please see welcome letter below. The contract will be fully in the systems by the effective date of 10/1.  The new group agreement/rates do not become effective until 10/1 so any claims before then will not price to the contracted rates.  Please feel free to forward this information to anyone that you feel would benefit.  Thank you, Jeanette Sidley  eff date is :  10/01/2021   confirmed by a call rep. too.  Agreement is attached. Please see the attachment.', NULL, NULL, '2021-09-13 16:10:22', '2021-09-13 16:10:22'),
(23432, 1006, 22304, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:45:47', '2021-03-16 15:45:47'),
(23433, 3040, 22304, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicare & Medicaid. ', NULL, NULL, '2021-04-05 10:36:46', '2021-04-05 10:36:46'),
(23434, 1006, 22304, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'The request is pending Medicaid enrollment.', NULL, NULL, '2021-05-25 10:19:55', '2021-05-25 10:19:55'),
(23435, 1006, 22304, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Sent enrollment request @ jointchp@texaschildrens.org:  Sub: Enrollment Request - RSM - TCHP  \"Hello,   Please find the attached LOI Questionnaire with the W9, do let me know if anything else is needed to proceed with the request for enrollment.   Thank you. \"  Enrollment form is attached in group task.', NULL, NULL, '2021-06-14 15:24:00', '2021-06-14 15:24:00'),
(23436, 1006, 22304, NULL, '2021-07-09 00:00:00.000', 'In Process', 'We received the following reply from jointchp@texaschildrens.org:  Sub: Enrollment Request - RSM - TCHP  \"Please resubmit your Letter of interest questionnaire with a w9.  Thank you\"  Sent W9: \"Hello,   Please find the attached form. let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-07-02 16:24:31', '2021-07-02 16:24:31'),
(23437, 1006, 22304, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Received the following reply from TCHP @ danisbet@texaschildrens.org: \"July 23, 2021 Ramegowda Belaker, MD Right Step Medical Center, LLC 11925 Southwest Freeway, Suite 12 Stafford, TX  Re: Participation in Texas Children’s Health Plan, Inc.  Dear Provider: Thank you for your interest in becoming a participating provider in Texas Children’s Health Plan, Inc. (TCHP).  In order to be considered for participation in TCHP, all providers must have a Texas Medicaid-attested National Provider Identifier (NPI). We regret to inform you that we are unable to accept your request for participation at this time for the following reason:  You do not have a Texas Medicaid-attested individual NPI for the Group or Physical Address listed on your letter  of interest questionnaire  Please contact Texas Medicaid & Healthcare Partnership online at www.tmhp.com., or by phone at 800-925-9126, (Option 3) to have the information corrected/updated. Once you have received confirmation that the information has been corrected/updated, you may re-apply for participation with Texas Children’s Health Plan.  Sincerely,  Contracts Administration Texas Children’s Health Plan\"  Replied with:  \"Hello Deborah,   I appreciate the update but as per my discussion with TMHP both the NPI of the group and the individual provider is attested. What exactly seems to be missing?  Thank you. \"', NULL, NULL, '2021-07-26 12:23:17', '2021-07-26 12:23:17'),
(23438, 1006, 22304, NULL, '2021-08-05 00:00:00.000', 'In Process', 'We received the following reply from danisbet@texaschildrens.org:  Sub: Ramegowda Belaker, MD  \"Hi Brad,  Please resubmit your application and I will have it submitted.  Thanks, Deb\"  Re-sent the application. ', NULL, NULL, '2021-07-29 14:29:19', '2021-07-29 14:29:19'),
(23439, 1006, 22304, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Sent f/u email @ \"Nisbet, Deborah A. (Deb)\" danisbet@texaschildrens.org:  Sub: Ramegowda Belaker, MD  \"Hello Deborah,   I hope you\'re doing well, I just wanted to get an update regarding this request. Has the LOI been processed yet?  Thank you. \"', NULL, NULL, '2021-08-11 17:07:13', '2021-08-11 17:07:13'),
(23440, 1006, 22304, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Sent f/u email @ danisbet@texaschildrens.org:  Sub: Ramegowda Belaker, MD  \"Hello Deb,   I wanted to get an update regarding the status of our request.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-31 15:58:30', '2021-08-31 15:58:30'),
(23441, 11056, 22304, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Email sent to : danisbet@texaschildrens.org  Sub : Re: Ramegowda Belaker, MD  Good Morning!  Hope this email finds you well. I want to know the enrollment status of the following providers and practice soon. Please update me soon.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-09-03 09:01:37', '2021-09-03 09:01:37'),
(23442, 11056, 22304, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email received from : bxgupta@texaschildrens.org  Sub : PIF & Roster  Good morning Alex,  Please see attached PIF & Roster for you to complete and return for next step in process for contracting team. Would appreciate it greatly.   Have a great day,  Kind regards,  Roster and and forms has been submitted. Please see the attachment.', NULL, NULL, '2021-09-17 08:37:22', '2021-09-17 08:37:22'),
(23443, 11056, 22304, NULL, '2021-10-04 00:00:00.000', 'In Process', 'I have words with Nuerez Liz. She demanded us the hospital admitting privileges and has been provided by our side.  She going to review and going to contact us back regarding that if anything else is needed.', NULL, NULL, '2021-09-27 16:48:34', '2021-09-27 16:48:34'),
(23444, 11056, 22304, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email received from : danisbet@texaschildrens.org  Sub : Ramegowda Belaker, MD  Greetings,  Please see the attached for important information regarding your recent application.  Thank you.  Seeing this matter. Trying to figure this out.', NULL, NULL, '2021-10-04 17:05:14', '2021-10-04 17:05:14'),
(23445, 11056, 22304, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep : Bharvi Gupta  Status: TCHP can\'t credential any practitioner if their Admitting privileges Hospital hasn\'t credentialed with THCP.  If we want to credential with TCHP we have to credential our Admitting Hospital too. Otherwise, we have to find a hospital already credentialed with THCP and have to link our MD to it.   Ref code : bharvi10212021', NULL, NULL, '2021-10-21 07:58:28', '2021-10-21 07:58:28'),
(23446, 11056, 22304, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to Mr Jobi :rightstepmedicalcenter@yahoo.com  Sub  :  TCHP In Network Hospitals  Good Morning Dr. Jobi,  Hope you are doing well, This is to inform you that TCHP is not covering the hospitals where Dr. Ram has Admitting Privileges, I have attached the list of Hospitals which are covered by TCHP so if Dr. Ram can have Admitting Privileges in one of them the Hospital should be within 10 miles radius of our location.  Let me know if you have any questions.   Regards,', NULL, NULL, '2021-11-11 09:17:08', '2021-11-11 09:17:08'),
(23447, 11056, 22304, NULL, '2021-11-25 00:00:00.000', 'On Hold', 'Waiting for the list  of TCHP In-Network Hospitals.', NULL, NULL, '2021-11-18 12:16:35', '2021-11-18 12:16:35'),
(23448, 19067, 22304, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from:  mdfouts@texaschildrens.org  Subject: RE: TCHP - RSM - GROUP & Providers Applications   Hello Alex,  I have passed this along to our contract specialists who work the LOIs when they come in. The contract specialist will send a Confidentiality Agreement to the signature authority for signature. Once we receive the NDA back, a contract agreement will be created by a Contract Administrator, who will be in touch with you.     Beginning March 10, I will be on leave so it’s best that you communicate directly with our team through the TCHP network management email:  tchpnetworkmanagement@texaschildrens.org.     I have enjoyed working with you and my best to you,  Melissa', NULL, NULL, '2022-03-01 11:51:52', '2022-03-01 11:51:52'),
(23449, 19067, 22304, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Email sent to: mdfouts@texaschildrens.org  Subject: TCHP - RSM - GROUP & Providers Applications    Good Morning Melissa,  Hope you\'re doing good, can you please get the attached application process as this will be a  new group, and the application was denied before due hospital privileges, which is nor sorted out and we have hospitals privileges for all 3 plans of TCHP. Let me knoe if you have any questions.    Regards, Alex', NULL, NULL, '2022-03-11 10:32:59', '2022-03-11 10:32:59'),
(23450, 19067, 22304, NULL, '2022-04-12 00:00:00.000', 'On Hold', 'Provider no longer practices @ RSM', NULL, NULL, '2022-04-05 13:05:18', '2022-04-05 13:05:18'),
(23451, 19067, 22304, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: TCHP - RSM - GROUP & Providers Applications    Hello Melissa,  We sent you the application for enrollment what is the update on that. We sent the applications on 03/01/2022.  Thanks, Hammad', NULL, NULL, '2022-04-27 07:27:56', '2022-04-27 07:27:56'),
(23452, 1006, 22305, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:45:48', '2021-03-16 15:45:48'),
(23453, 3040, 22305, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicare & Medicaid. ', NULL, NULL, '2021-04-05 10:36:45', '2021-04-05 10:36:45'),
(23454, 1006, 22305, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'The request is pending Medicaid enrollment.', NULL, NULL, '2021-05-25 10:19:59', '2021-05-25 10:19:59'),
(23455, 1006, 22305, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Sent enrollment request @ jointchp@texaschildrens.org:  Sub: Enrollment Request - RSM - TCHP  \"Hello,   Please find the attached LOI Questionnaire with the W9, do let me know if anything else is needed to proceed with the request for enrollment.   Thank you. \"  Enrollment form is attached in group task.', NULL, NULL, '2021-06-14 15:24:09', '2021-06-14 15:24:09'),
(23456, 1006, 22305, NULL, '2021-07-09 00:00:00.000', 'In Process', 'We received the following reply from jointchp@texaschildrens.org:  Sub: Enrollment Request - RSM - TCHP  \"Please resubmit your Letter of interest questionnaire with a w9.  Thank you\"  Sent W9: \"Hello,   Please find the attached form. let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-07-02 16:24:28', '2021-07-02 16:24:28');
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
(23457, 1006, 22305, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Received the following reply from TCHP @ danisbet@texaschildrens.org: \"July 23, 2021 Ramegowda Belaker, MD Right Step Medical Center, LLC 11925 Southwest Freeway, Suite 12 Stafford, TX  Re: Participation in Texas Children’s Health Plan, Inc.  Dear Provider: Thank you for your interest in becoming a participating provider in Texas Children’s Health Plan, Inc. (TCHP).  In order to be considered for participation in TCHP, all providers must have a Texas Medicaid-attested National Provider Identifier (NPI). We regret to inform you that we are unable to accept your request for participation at this time for the following reason:  You do not have a Texas Medicaid-attested individual NPI for the Group or Physical Address listed on your letter  of interest questionnaire  Please contact Texas Medicaid & Healthcare Partnership online at www.tmhp.com., or by phone at 800-925-9126, (Option 3) to have the information corrected/updated. Once you have received confirmation that the information has been corrected/updated, you may re-apply for participation with Texas Children’s Health Plan.  Sincerely,  Contracts Administration Texas Children’s Health Plan\"  Replied with:  \"Hello Deborah,   I appreciate the update but as per my discussion with TMHP both the NPI of the group and the individual provider is attested. What exactly seems to be missing?  Thank you. \"', NULL, NULL, '2021-07-26 12:23:20', '2021-07-26 12:23:20'),
(23458, 1006, 22305, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Received the following reply from TCHP @ danisbet@texaschildrens.org: \"July 23, 2021 Ramegowda Belaker, MD Right Step Medical Center, LLC 11925 Southwest Freeway, Suite 12 Stafford, TX  Re: Participation in Texas Children’s Health Plan, Inc.  Dear Provider: Thank you for your interest in becoming a participating provider in Texas Children’s Health Plan, Inc. (TCHP).  In order to be considered for participation in TCHP, all providers must have a Texas Medicaid-attested National Provider Identifier (NPI). We regret to inform you that we are unable to accept your request for participation at this time for the following reason:  You do not have a Texas Medicaid-attested individual NPI for the Group or Physical Address listed on your letter  of interest questionnaire  Please contact Texas Medicaid & Healthcare Partnership online at www.tmhp.com., or by phone at 800-925-9126, (Option 3) to have the information corrected/updated. Once you have received confirmation that the information has been corrected/updated, you may re-apply for participation with Texas Children’s Health Plan.  Sincerely,  Contracts Administration Texas Children’s Health Plan\"  Replied with:  \"Hello Deborah,   I appreciate the update but as per my discussion with TMHP both the NPI of the group and the individual provider are attested. What exactly seems to be missing?  Thank you. \"', NULL, NULL, '2021-07-26 12:23:31', '2021-07-26 12:23:31'),
(23459, 1006, 22305, NULL, '2021-08-05 00:00:00.000', 'In Process', 'We received the following reply from danisbet@texaschildrens.org:  Sub: Ramegowda Belaker, MD  \"Hi Brad,  Please resubmit your application and I will have it submitted.  Thanks, Deb\"  Re-sent the application. ', NULL, NULL, '2021-07-29 14:29:15', '2021-07-29 14:29:15'),
(23460, 1006, 22305, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Sent f/u email @ \"Nisbet, Deborah A. (Deb)\" danisbet@texaschildrens.org:  Sub: Ramegowda Belaker, MD  \"Hello Deborah,   I hope you\'re doing well, I just wanted to get an update regarding this request. Has the LOI been processed yet?  Thank you. \"', NULL, NULL, '2021-08-11 17:07:09', '2021-08-11 17:07:09'),
(23461, 1006, 22305, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Sent f/u email @ danisbet@texaschildrens.org:  Sub: Ramegowda Belaker, MD  \"Hello Deb,   I wanted to get an update regarding the status of our request.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-31 15:58:27', '2021-08-31 15:58:27'),
(23462, 11056, 22305, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Email sent to : danisbet@texaschildrens.org  Sub : Re: Ramegowda Belaker, MD  Good Morning!  Hope this email finds you well. I want to know the enrollment status of the following providers and practice soon. Please update me soon.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-09-03 09:01:30', '2021-09-03 09:01:30'),
(23463, 11056, 22305, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email received from : bxgupta@texaschildrens.org  Sub : PIF & Roster  Good morning Alex,  Please see attached PIF & Roster for you to complete and return for next step in process for contracting team. Would appreciate it greatly.   Have a great day,  Kind regards,  Roster and and forms has been submitted. Please see the attachment.', NULL, NULL, '2021-09-17 08:36:27', '2021-09-17 08:36:27'),
(23464, 11056, 22305, NULL, '2021-10-04 00:00:00.000', 'In Process', 'I have words with Nuerez Liz. She demanded us the hospital admitting privileges and has been provided by our side.  She going to review and going to contact us back regarding that if anything else is needed.', NULL, NULL, '2021-09-27 16:48:27', '2021-09-27 16:48:27'),
(23465, 11056, 22305, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email received from : danisbet@texaschildrens.org  Sub : Ramegowda Belaker, MD  Greetings,  Please see the attached for important information regarding your recent application.  Thank you.  Seeing this matter. Trying to figure this out.', NULL, NULL, '2021-10-04 17:05:07', '2021-10-04 17:05:07'),
(23466, 11056, 22305, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep : Bharvi Gupta  Status: TCHP can\'t credential any practitioner if their Admitting privileges Hospital hasn\'t credentialed with THCP.  If we want to credential with TCHP we have to credential our Admitting Hospital too. Otherwise, we have to find a hospital already credentialed with THCP and have to link our MD to it.   Ref code : bharvi10212021', NULL, NULL, '2021-10-21 07:58:22', '2021-10-21 07:58:22'),
(23467, 11056, 22305, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to Mr Jobi :rightstepmedicalcenter@yahoo.com  Sub  :  TCHP In Network Hospitals  Good Morning Dr. Jobi,  Hope you are doing well, This is to inform you that TCHP is not covering the hospitals where Dr. Ram has Admitting Privileges, I have attached the list of Hospitals which are covered by TCHP so if Dr. Ram can have Admitting Privileges in one of them the Hospital should be within 10 miles radius of our location.  Let me know if you have any questions.   Regards,', NULL, NULL, '2021-11-11 09:17:02', '2021-11-11 09:17:02'),
(23468, 11056, 22305, NULL, '2021-11-25 00:00:00.000', 'On Hold', 'Waiting for the list of TCHP In-Network Hospitals.', NULL, NULL, '2021-11-18 12:16:29', '2021-11-18 12:16:29'),
(23469, 19067, 22305, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from:  mdfouts@texaschildrens.org  Subject: RE: TCHP - RSM - GROUP & Providers Applications   Hello Alex,  I have passed this along to our contract specialists who work the LOIs when they come in. The contract specialist will send a Confidentiality Agreement to the signature authority for signature. Once we receive the NDA back, a contract agreement will be created by a Contract Administrator, who will be in touch with you.     Beginning March 10, I will be on leave so it’s best that you communicate directly with our team through the TCHP network management email:  tchpnetworkmanagement@texaschildrens.org.     I have enjoyed working with you and my best to you,  Melissa', NULL, NULL, '2022-03-01 11:52:00', '2022-03-01 11:52:00'),
(23470, 19067, 22305, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Email sent to: mdfouts@texaschildrens.org  Subject: TCHP - RSM - GROUP & Providers Applications    Good Morning Melissa,  Hope you\'re doing good, can you please get the attached application process as this will be a  new group, and the application was denied before due hospital privileges, which is nor sorted out and we have hospitals privileges for all 3 plans of TCHP. Let me knoe if you have any questions.    Regards, Alex', NULL, NULL, '2022-03-11 10:33:04', '2022-03-11 10:33:04'),
(23471, 19067, 22305, NULL, '2022-04-13 00:00:00.000', 'In Process', 'Email received from: jointchp@texaschildrens.org  Subject: RE: PIF received for Right Step Medical Center LLC    Hello,     Thank you for your interest in our health plan’s network. Your LOI  has been received on for Ramegowda_Belaker_Right_Step_LOI  and communication will be sent out to you once the review has been completed.  Thank you     Contract Specialist  Texas Children’s Health Plan', NULL, NULL, '2022-04-06 08:32:15', '2022-04-06 08:32:15'),
(23472, 19067, 22305, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: TCHP - RSM - GROUP & Providers Applications    Hello Melissa,  We sent you the application for enrollment what is the update on that. We sent the applications on 03/01/2022.  Thanks, Hammad', NULL, NULL, '2022-04-27 07:27:52', '2022-04-27 07:27:52'),
(23473, 1006, 22306, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:45:49', '2021-03-16 15:45:49'),
(23474, 3040, 22306, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicare & Medicaid. ', NULL, NULL, '2021-04-05 10:36:43', '2021-04-05 10:36:43'),
(23475, 1006, 22306, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'The request is pending Medicaid enrollment.', NULL, NULL, '2021-05-25 10:20:03', '2021-05-25 10:20:03'),
(23476, 1006, 22306, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Sent enrollment request @ jointchp@texaschildrens.org:  Sub: Enrollment Request - RSM - TCHP  \"Hello,   Please find the attached LOI Questionnaire with the W9, do let me know if anything else is needed to proceed with the request for enrollment.   Thank you. \"  Enrollment form is attached in group task.', NULL, NULL, '2021-06-14 15:24:12', '2021-06-14 15:24:12'),
(23477, 1006, 22306, NULL, '2021-07-09 00:00:00.000', 'In Process', 'We received the following reply from jointchp@texaschildrens.org:  Sub: Enrollment Request - RSM - TCHP  \"Please resubmit your Letter of interest questionnaire with a w9.  Thank you\"  Sent W9: \"Hello,   Please find the attached form. let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-07-02 16:24:24', '2021-07-02 16:24:24'),
(23478, 1006, 22306, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Received the following reply from TCHP @ danisbet@texaschildrens.org: \"July 23, 2021 Ramegowda Belaker, MD Right Step Medical Center, LLC 11925 Southwest Freeway, Suite 12 Stafford, TX  Re: Participation in Texas Children’s Health Plan, Inc.  Dear Provider: Thank you for your interest in becoming a participating provider in Texas Children’s Health Plan, Inc. (TCHP).  In order to be considered for participation in TCHP, all providers must have a Texas Medicaid-attested National Provider Identifier (NPI). We regret to inform you that we are unable to accept your request for participation at this time for the following reason:  You do not have a Texas Medicaid-attested individual NPI for the Group or Physical Address listed on your letter  of interest questionnaire  Please contact Texas Medicaid & Healthcare Partnership online at www.tmhp.com., or by phone at 800-925-9126, (Option 3) to have the information corrected/updated. Once you have received confirmation that the information has been corrected/updated, you may re-apply for participation with Texas Children’s Health Plan.  Sincerely,  Contracts Administration Texas Children’s Health Plan\"  Replied with:  \"Hello Deborah,   I appreciate the update but as per my discussion with TMHP both the NPI of the group and the individual provider is attested. What exactly seems to be missing?  Thank you. \"', NULL, NULL, '2021-07-26 12:23:38', '2021-07-26 12:23:38'),
(23479, 1006, 22306, NULL, '2021-08-05 00:00:00.000', 'In Process', 'We received the following reply from danisbet@texaschildrens.org:  Sub: Ramegowda Belaker, MD  \"Hi Brad,  Please resubmit your application and I will have it submitted.  Thanks, Deb\"  Re-sent the application. ', NULL, NULL, '2021-07-29 14:29:09', '2021-07-29 14:29:09'),
(23480, 1006, 22306, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Sent f/u email @ \"Nisbet, Deborah A. (Deb)\" danisbet@texaschildrens.org:  Sub: Ramegowda Belaker, MD  \"Hello Deborah,   I hope you\'re doing well, I just wanted to get an update regarding this request. Has the LOI been processed yet?  Thank you. \"', NULL, NULL, '2021-08-11 17:06:58', '2021-08-11 17:06:58'),
(23481, 1006, 22306, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Sent f/u email @ danisbet@texaschildrens.org:  Sub: Ramegowda Belaker, MD  \"Hello Deb,   I wanted to get an update regarding the status of our request.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-08-31 15:58:23', '2021-08-31 15:58:23'),
(23482, 11056, 22306, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Email sent to : danisbet@texaschildrens.org  Sub : Re: Ramegowda Belaker, MD  Good Morning!  Hope this email finds you well. I want to know the enrollment status of the following providers and practice soon. Please update me soon.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-09-03 09:01:13', '2021-09-03 09:01:13'),
(23483, 11056, 22306, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email received from : bxgupta@texaschildrens.org  Sub : PIF & Roster  Good morning Alex,  Please see attached PIF & Roster for you to complete and return for next step in process for contracting team. Would appreciate it greatly.   Have a great day,  Kind regards,  Roster and and forms has been submitted. Please see the attachment.', NULL, NULL, '2021-09-17 08:37:06', '2021-09-17 08:37:06'),
(23484, 11056, 22306, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : 	TCHPnetworkmanagement@texaschildren.org Join TCHP jointchp@texaschildrens.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract   Good morning!  Hope you had a great and safe weekend. I am still waiting to get assistance on enrolling the below mentioned providers and practice with TCHP. But no one haven\'t responded to my query yet.   Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary Location	3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242 Provider Name	NPI Stephane Cyriaque (FNP)	1780192633 Shametria Tann  (FNP)	1124615612 Segun Adeoye (Supervising Physician)	1629418025  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-09-27 10:01:32', '2021-09-27 10:01:32'),
(23485, 11056, 22306, NULL, '2021-10-04 00:00:00.000', 'In Process', 'I have words with Nuerez Liz. She demanded us the hospital admitting privileges and has been provided by our side.  She going to review and going to contact us back regarding that if anything else is needed.', NULL, NULL, '2021-09-27 16:48:12', '2021-09-27 16:48:12'),
(23486, 11056, 22306, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email received from : danisbet@texaschildrens.org  Sub : Ramegowda Belaker, MD  Greetings,  Please see the attached for important information regarding your recent application.  Thank you.  Seeing this matter. Trying to figure this out.', NULL, NULL, '2021-10-04 17:04:52', '2021-10-04 17:04:52'),
(23487, 11056, 22306, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep : Bharvi Gupta  Status: TCHP can\'t credential any practitioner if their Admitting privileges Hospital hasn\'t credentialed with THCP.  If we want to credential with TCHP we have to credential our Admitting Hospital too. Otherwise, we have to find a hospital already credentialed with THCP and have to link our MD to it.   Ref code : bharvi10212021', NULL, NULL, '2021-10-21 07:57:33', '2021-10-21 07:57:33'),
(23488, 11056, 22306, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to Mr Jobi :rightstepmedicalcenter@yahoo.com  Sub  :  TCHP In Network Hospitals  Good Morning Dr. Jobi,  Hope you are doing well, This is to inform you that TCHP is not covering the hospitals where Dr. Ram has Admitting Privileges, I have attached the list of Hospitals which are covered by TCHP so if Dr. Ram can have Admitting Privileges in one of them the Hospital should be within 10 miles radius of our location.  Let me know if you have any questions.   Regards,', NULL, NULL, '2021-11-11 09:16:49', '2021-11-11 09:16:49'),
(23489, 11056, 22306, NULL, '2021-11-25 00:00:00.000', 'On Hold', 'Waiting for the list  of TCHP In-Network Hospitals. ', NULL, NULL, '2021-11-18 12:16:08', '2021-11-18 12:16:08'),
(23490, 19067, 22306, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from:  mdfouts@texaschildrens.org  Subject: RE: TCHP - RSM - GROUP & Providers Applications   Hello Alex,  I have passed this along to our contract specialists who work the LOIs when they come in. The contract specialist will send a Confidentiality Agreement to the signature authority for signature. Once we receive the NDA back, a contract agreement will be created by a Contract Administrator, who will be in touch with you.     Beginning March 10, I will be on leave so it’s best that you communicate directly with our team through the TCHP network management email:  tchpnetworkmanagement@texaschildrens.org.     I have enjoyed working with you and my best to you,  Melissa', NULL, NULL, '2022-03-01 11:52:05', '2022-03-01 11:52:05'),
(23491, 19067, 22306, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Email sent to: mdfouts@texaschildrens.org  Subject: TCHP - RSM - GROUP & Providers Applications    Good Morning Melissa,  Hope you\'re doing good, can you please get the attached application process as this will be a  new group, and the application was denied before due hospital privileges, which is nor sorted out and we have hospitals privileges for all 3 plans of TCHP. Let me knoe if you have any questions.    Regards, Alex', NULL, NULL, '2022-03-11 10:33:09', '2022-03-11 10:33:09'),
(23492, 19067, 22306, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: TCHP - RSM - GROUP & Providers Applications    Hello Melissa,  We sent you the application for enrollment what is the update on that. We sent the applications on 03/01/2022.  Thanks, Hammad', NULL, NULL, '2022-04-27 07:27:45', '2022-04-27 07:27:45'),
(23493, 3040, 22307, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:45:52', '2021-03-16 15:45:52'),
(23494, 3040, 22307, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Email sent to: PDSDallas@aetna.com  Subject: Enroll Group & Provider || Ladot Healthcare LLC || Group & Providers || First Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in First Health under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-01 16:03:53', '2021-04-01 16:03:53'),
(23495, 3040, 22307, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: PDSDallas@aetna.com  Subject: Enroll Group & Provider || Ladot Healthcare LLC || Group & Providers || First Health ||  Hello,   Please advise me the enrollment process for the below mentioned group and providers.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  Waiting for your response.   Thanks', NULL, NULL, '2021-04-30 12:54:16', '2021-04-30 12:54:16'),
(23496, 3040, 22307, NULL, '2021-06-01 00:00:00.000', 'In Process', 'I had a word with (Dona) First Health representative and she advised to fill out the First Health participation from submitted online.   Please see attachment', NULL, NULL, '2021-05-25 14:55:03', '2021-05-25 14:55:03'),
(23497, 1006, 22307, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent f/u email @ pdsdallas@aetna.com:  Sub: Enrollment Status - LHC - First Health  \"Hello,  I hope you\'re doing well, we submitted enrollment forms for the following providers under our group and I wanted to get an update regarding their enrollment status, their information is as follows:  Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283Practice NPI# 1912502626  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  Please get back to me as soon as possible. Thank you.\"', NULL, NULL, '2021-06-11 12:02:40', '2021-06-11 12:02:40'),
(23498, 1006, 22307, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email received from: MadirajuP@aetna.com  Sub : Enrollment Status - LHC - First Health Hi,     Good Afternoon!   Please find the status of the below Providers.   PROVIDER NAME	    CPD ID    TAX ID	        NPI	            EFFECTIVE DATE     Status 1)Dada, Oladipo	2912147	  85-2432283	 1760700223	              -	                Given tin is not                                                                                                                        linked with First Health 2)Dada, Atinuke             -      85-2432283	   1154782720      -	           Provider not linked                                                                                                                               with First  Health   Thank You, Phani', NULL, NULL, '2021-06-30 14:05:09', '2021-06-30 14:05:09'),
(23499, 11056, 22307, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to : MadirajuP@aetna.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Good morning,  I hope you are doing well. Kindly tell us about how to link the provider and TIN with First Health. Guide us to the procedure soon.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Providers: Provider 1: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI # : 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-12 11:01:49', '2021-07-12 11:01:49'),
(23500, 11056, 22307, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to  : MadirajuP@aetna.com      &    pdsdallas@aetna.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Good Afternoon!  I hope you are doing well. Kindly tell us about how to link the provider and Tax I.D (TIN) with First Health. Guide us to the procedure as soon as possible. Eagerly waiting for your reply.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Providers: Provider 1: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI # : 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 13:58:03', '2021-07-19 13:58:03'),
(23501, 11056, 22307, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to  : MadirajuP@aetna.com      &    pdsdallas@aetna.com   &  SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Good Afternoon!  I hope you are doing well. Kindly tell us about how to link the provider and Tax I.D (TIN) with First Health. Guide us to the procedure as soon as possible. Eagerly waiting for your reply.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Providers: Provider 1: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI # : 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-30 14:06:52', '2021-07-30 14:06:52'),
(23502, 11056, 22307, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to :  BharathB@aetna.com,  &    MadirajuP@aetna.com, PDS Dallas pdsdallas@aetna.com  Sub :   Good Afternoon!  I hope you are doing well. It has been a long time since you haven\'t responded to our emails. Kindly tell us about how to link the provider and Tax I.D (TIN) with First Health. Guide us to the procedure as soon as possible.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Providers: Provider 1: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI # : 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 10:08:09', '2021-08-03 10:08:09'),
(23503, 11056, 22307, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Hello,     I hope that this email finds you well!     This TIN is still not participating within the First Health Network. The new group agreement sent over to email address adil@claimsmedinc.com on 7/3 is still out for review and has not yet been returned signed. I do show that it was viewed on 7/5, however, it is still in process and has not been completed on your signers side.     Please let me know if I need to redirect the agreement to a different email address for review/signature.     Additionally, please send over your most current roster of providers/locations that you would like to be linked to the new group agreement once signed.     Please do not hesitate to reach out if you have any questions or concerns.     Take care,     Jeanette Sidley  Network Relations Consultant', NULL, NULL, '2021-08-09 15:18:22', '2021-08-09 15:18:22'),
(23504, 11056, 22307, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Hey Jeanette!  Hope you are doing well. Yes please redirect the agreement to me at sta@claimsmedinc.com for review/signature. Here is the most current roster of location mentioned below. Please see the attachment.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Furthermore, If you need any additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-16 09:26:00', '2021-08-16 09:26:00'),
(23505, 11056, 22307, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : Enrollment Procedure Guideline - LHC - First Health  Good morning,     You are most welcome! I have just re-assigned the agreement to your email address for review/signature.     Please do not hesitate to reach out if you have any questions or concerns when reviewing.     Take care,  Jeanette', NULL, NULL, '2021-08-23 09:27:07', '2021-08-23 09:27:07'),
(23506, 11056, 22307, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Hello!  I actually forwarded it over on Friday after I responded to your email. It will come over via Adobe EchoSign. I will send another link again through the system.   Please let me know if you do not get it by the end of today. I will send it multiple times.  Thank you! Jeanette', NULL, NULL, '2021-09-01 08:47:40', '2021-09-01 08:47:40'),
(23507, 11056, 22307, NULL, '2021-09-20 00:00:00.000', 'Approved', 'Approval Email received from : SidleyJ1@firsthealth.com  Sub : Ladot Healthcare LLC - First Health Network   Hello,  It is with great pleasure to welcome you to the First Health Network. I would like to personally thank you for all of your time and efforts during the contracting process. You should have already received your fully executed copy of the First Health Agreement.  I would like to take a moment to share what to expect next and share important resources with you in order to allow a smooth process as your contract is implemented and beyond.  Please see welcome letter below. The contract will be fully in the systems by the effective date of 10/1.  The new group agreement/rates do not become effective until 10/1 so any claims before then will not price to the contracted rates.  Please feel free to forward this information to anyone that you feel would benefit.  Thank you, Jeanette Sidley  eff date is :  10/01/2021   confirmed by a call rep. too.  Agreement is attached. Please see the attachment.', NULL, NULL, '2021-09-13 16:09:58', '2021-09-13 16:09:58'),
(23508, 3046, 22308, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:07', '2021-03-16 15:46:07'),
(23509, 3040, 22308, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject:  Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||   Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 13:05:08', '2021-03-29 13:05:08'),
(23510, 3040, 22308, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com, Provider_Relations_South_Texas@bcbstx.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 08:37:50', '2021-03-30 08:37:50'),
(23511, 1006, 22308, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Sent f/u @ TX NM South Texas Provider_Relations_South_Texas@bcbstx.com: Sub: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Group || BCBS ||  \"Hello,   I wanted to get an update regarding a demographic update request we submitted last month for the following group:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 168992490  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2021-04-15 08:43:28', '2021-04-15 08:43:28'),
(23512, 1006, 22308, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Provider: CAPUPUS, MARI A, PA Record ID:  H08KB31901 PPO:  11/06/18 HMO:  11/06/18 HME:  11/06/18 PPLAN:  11/06/18 ', NULL, NULL, '2021-04-27 08:56:01', '2021-04-27 08:56:01'),
(23513, 3046, 22309, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:13', '2021-03-16 15:46:13'),
(23514, 3040, 22309, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject:  Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||   Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 13:04:57', '2021-03-29 13:04:57'),
(23515, 3040, 22309, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com, Provider_Relations_South_Texas@bcbstx.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 08:39:35', '2021-03-30 08:39:35'),
(23516, 1006, 22309, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Sent f/u @ TX NM South Texas Provider_Relations_South_Texas@bcbstx.com: Sub: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Group || BCBS ||  \"Hello,   I wanted to get an update regarding a demographic update request we submitted last month for the following group:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 168992490  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2021-04-15 08:43:32', '2021-04-15 08:43:32'),
(23517, 1006, 22309, NULL, '2021-05-04 00:00:00.000', 'Approved', '	 Received approval letters for the main BCBS plans, Blue Essentials, HMO, PPO, STAR with effective date: 08/27/2020  Approval letters are attached for all the plans.    Eff: 08/27/2020', NULL, NULL, '2021-04-27 10:07:52', '2021-04-27 10:07:52'),
(23518, 3046, 22310, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:16', '2021-03-16 15:46:16'),
(23519, 3040, 22310, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject:  Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||   Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 13:04:46', '2021-03-29 13:04:46'),
(23520, 3040, 22310, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com, Provider_Relations_South_Texas@bcbstx.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 08:40:05', '2021-03-30 08:40:05'),
(23521, 1006, 22310, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Sent f/u @ TX NM South Texas Provider_Relations_South_Texas@bcbstx.com: Sub: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Group || BCBS ||  \"Hello,   I wanted to get an update regarding a demographic update request we submitted last month for the following group:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 168992490  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2021-04-15 08:43:36', '2021-04-15 08:43:36'),
(23522, 1006, 22310, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Provider Fully Contracted with RHC\'s all servicing locations under following Plans: Blue Advantage HMOSM Blue EssentialsSM Blue Essentials AccessSM Blue Choice PPOSM ParPlan  Effective Date: 06/27/2019 ', NULL, NULL, '2021-04-27 10:22:14', '2021-04-27 10:22:14'),
(23523, 3046, 22311, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:19', '2021-03-16 15:46:19');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(23524, 3040, 22311, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject:  Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||   Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 13:04:41', '2021-03-29 13:04:41'),
(23525, 3040, 22311, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com, Provider_Relations_South_Texas@bcbstx.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 08:40:22', '2021-03-30 08:40:22'),
(23526, 1006, 22311, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Sent f/u @ TX NM South Texas Provider_Relations_South_Texas@bcbstx.com: Sub: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Group || BCBS ||  \"Hello,   I wanted to get an update regarding a demographic update request we submitted last month for the following group:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 168992490  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2021-04-15 08:43:41', '2021-04-15 08:43:41'),
(23527, 1006, 22311, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Provider is enrolled with BCBS, approval confirmation and welcome letter is attached for reference.   Eff: 06/01/2019 ', NULL, NULL, '2021-04-27 10:26:44', '2021-04-27 10:26:44'),
(23528, 1006, 22312, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:20', '2021-03-16 15:46:20'),
(23529, 3040, 22312, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicaid approval.', NULL, NULL, '2021-04-05 09:39:58', '2021-04-05 09:39:58'),
(23530, 1006, 22312, NULL, '2021-06-02 00:00:00.000', 'On Hold', 'Pending Medicaid approval. ', NULL, NULL, '2021-05-26 09:04:42', '2021-05-26 09:04:42'),
(23531, 1006, 22312, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Enrollment request has been submitted @ TX Credentialing TXCredentialing@amerigroup.com:  Sub:   \"Hello,   I hope you\'re doing well, please find the attached credentialing request form and W9, do let me know if anything else is required to proceed with this request.  Thank you. \"  Application attached in main group task as this is an ancillary contract request.', NULL, NULL, '2021-06-14 11:41:42', '2021-06-14 11:41:42'),
(23532, 1006, 22312, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from Geiger, Rachel Rachel.Geiger@anthem.com:  Sub; Amerigroup agreement - Right Step Medical Center LLC  \"This message was encrypted by Proofpoint Encryption Please review the attached agreement.  Please sign and return the signature page.   Thank You, Rachel N. Geiger, RN, EJD, CPHQ, MHP, CLNC Director, Network Management / Provider Contracting Amerigroup m: 419-340-1744|fax: 877-744-2341\"  The contract was filled out and is attached in the main group task for reference as it\'s an ancillary contract. ', NULL, NULL, '2021-07-01 12:43:40', '2021-07-01 12:43:40'),
(23533, 1006, 22312, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Received reply Geiger, Rachel Rachel.Geiger@anthem.com:  Sub: Amerigroup agreement - Right Step Medical Center LLC  \"Thank you.  It will be effective on 7/31.  Thank You,  Rachel N. Geiger, RN, EJD, CPHQ, MHP, CLNC Director, Network Management / Provider Contracting Amerigroup m: 419-340-1744|fax: 877-744-2341\"  Replied:  \"Hello Rachel,   I appreciate the update, when can we expect to get a copy of the welcome letter or executed contract?  Thank you!\"', NULL, NULL, '2021-07-27 17:00:49', '2021-07-27 17:00:49'),
(23534, 1006, 22312, NULL, '2021-08-09 00:00:00.000', 'Approved', 'The executed agreement was received and attached. It is a facility agreement.   Eff: 07/31/2021', NULL, NULL, '2021-08-02 08:52:23', '2021-08-02 08:52:23'),
(23535, 1006, 22313, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:21', '2021-03-16 15:46:21'),
(23536, 3040, 22313, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicaid approval.', NULL, NULL, '2021-04-05 09:40:00', '2021-04-05 09:40:00'),
(23537, 1006, 22313, NULL, '2021-06-02 00:00:00.000', 'On Hold', 'Pending Medicaid approval. ', NULL, NULL, '2021-05-26 09:04:52', '2021-05-26 09:04:52'),
(23538, 1006, 22313, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Enrollment request has been submitted @ TX Credentialing TXCredentialing@amerigroup.com:  Sub:   \"Hello,   I hope you\'re doing well, please find the attached credentialing request form and W9, do let me know if anything else is required to proceed with this request.  Thank you. \"  Application attached in main group task as this is an ancillary contract request.', NULL, NULL, '2021-06-14 11:41:59', '2021-06-14 11:41:59'),
(23539, 1006, 22313, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from Geiger, Rachel Rachel.Geiger@anthem.com:  Sub; Amerigroup agreement - Right Step Medical Center LLC  \"This message was encrypted by Proofpoint Encryption Please review the attached agreement.  Please sign and return the signature page.   Thank You, Rachel N. Geiger, RN, EJD, CPHQ, MHP, CLNC Director, Network Management / Provider Contracting Amerigroup m: 419-340-1744|fax: 877-744-2341\"  The contract was filled out and is attached in the main group task for reference as it\'s an ancillary contract. ', NULL, NULL, '2021-07-01 12:43:57', '2021-07-01 12:43:57'),
(23540, 1006, 22313, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Received reply Geiger, Rachel Rachel.Geiger@anthem.com:  Sub: Amerigroup agreement - Right Step Medical Center LLC  \"Thank you.  It will be effective on 7/31.  Thank You,  Rachel N. Geiger, RN, EJD, CPHQ, MHP, CLNC Director, Network Management / Provider Contracting Amerigroup m: 419-340-1744|fax: 877-744-2341\"  Replied:  \"Hello Rachel,   I appreciate the update, when can we expect to get a copy of the welcome letter or executed contract?  Thank you!\"', NULL, NULL, '2021-07-27 17:01:03', '2021-07-27 17:01:03'),
(23541, 1006, 22313, NULL, '2021-08-09 00:00:00.000', 'Approved', 'The executed agreement was received and attached. It is a facility agreement.   Eff: 07/31/2021 ', NULL, NULL, '2021-08-02 08:58:25', '2021-08-02 08:58:25'),
(23542, 3046, 22314, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:22', '2021-03-16 15:46:22'),
(23543, 3040, 22314, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject:  Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||   Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 13:04:36', '2021-03-29 13:04:36'),
(23544, 3040, 22314, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com, Provider_Relations_South_Texas@bcbstx.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 08:40:51', '2021-03-30 08:40:51'),
(23545, 1006, 22314, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Sent f/u @ TX NM South Texas Provider_Relations_South_Texas@bcbstx.com: Sub: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Group || BCBS ||  \"Hello,   I wanted to get an update regarding a demographic update request we submitted last month for the following group:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 168992490  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2021-04-15 08:43:46', '2021-04-15 08:43:46'),
(23546, 1006, 22314, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Received an email from Bel Villarreal (Bel_Villarreal@bcbstx.com  \"RE: Credentialing Status - Petina Rogers- STATCARE MINOR EMERGENCY CLINIC  Good Afternoon Ahmed,   The providers effective network date is 11/19/2019, for the following networks: Blue Choice PPO, Blue Essentials HMO/Health select, Blue Advantage HMO, Chip, and Medicare Advantage PPO. \"  The provider has been added to the location, location confirmation is attached for reference.', NULL, NULL, '2021-04-27 07:22:35', '2021-04-27 07:22:35'),
(23547, 1006, 22315, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:22', '2021-03-16 15:46:22'),
(23548, 3040, 22315, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicaid approval.', NULL, NULL, '2021-04-05 09:40:01', '2021-04-05 09:40:01'),
(23549, 1006, 22315, NULL, '2021-06-02 00:00:00.000', 'On Hold', 'Pending Medicaid approval. ', NULL, NULL, '2021-05-26 09:04:59', '2021-05-26 09:04:59'),
(23550, 1006, 22315, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Enrollment request has been submitted @ TX Credentialing TXCredentialing@amerigroup.com:  Sub:   \"Hello,   I hope you\'re doing well, please find the attached credentialing request form and W9, do let me know if anything else is required to proceed with this request.  Thank you. \"  Application attached in main group task as this is an ancillary contract request.', NULL, NULL, '2021-06-14 11:41:56', '2021-06-14 11:41:56'),
(23551, 1006, 22315, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from Geiger, Rachel Rachel.Geiger@anthem.com:  Sub; Amerigroup agreement - Right Step Medical Center LLC  \"This message was encrypted by Proofpoint Encryption Please review the attached agreement.  Please sign and return the signature page.   Thank You, Rachel N. Geiger, RN, EJD, CPHQ, MHP, CLNC Director, Network Management / Provider Contracting Amerigroup m: 419-340-1744|fax: 877-744-2341\"  The contract was filled out and is attached in the main group task for reference as it\'s an ancillary contract. ', NULL, NULL, '2021-07-01 12:43:54', '2021-07-01 12:43:54'),
(23552, 1006, 22315, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Received reply Geiger, Rachel Rachel.Geiger@anthem.com:  Sub: Amerigroup agreement - Right Step Medical Center LLC  \"Thank you.  It will be effective on 7/31.  Thank You,  Rachel N. Geiger, RN, EJD, CPHQ, MHP, CLNC Director, Network Management / Provider Contracting Amerigroup m: 419-340-1744|fax: 877-744-2341\"  Replied:  \"Hello Rachel,   I appreciate the update, when can we expect to get a copy of the welcome letter or executed contract?  Thank you!\"', NULL, NULL, '2021-07-27 17:01:00', '2021-07-27 17:01:00'),
(23553, 1006, 22315, NULL, '2021-08-09 00:00:00.000', 'Approved', 'The executed agreement was received and attached. It is a facility agreement.   Eff: 07/31/2021 ', NULL, NULL, '2021-08-02 08:58:33', '2021-08-02 08:58:33'),
(23554, 1006, 22316, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:23', '2021-03-16 15:46:23'),
(23555, 3040, 22316, NULL, '2021-04-12 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicaid approval.', NULL, NULL, '2021-04-05 09:40:06', '2021-04-05 09:40:06'),
(23556, 1006, 22316, NULL, '2021-06-02 00:00:00.000', 'On Hold', 'Pending Medicaid approval. ', NULL, NULL, '2021-05-26 09:06:48', '2021-05-26 09:06:48'),
(23557, 1006, 22316, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Enrollment request has been submitted @ TX Credentialing TXCredentialing@amerigroup.com:  Sub:   \"Hello,   I hope you\'re doing well, please find the attached credentialing request form and W9, do let me know if anything else is required to proceed with this request.  Thank you. \"  Application attached in main group task as this is an ancillary contract request.', NULL, NULL, '2021-06-14 11:41:52', '2021-06-14 11:41:52'),
(23558, 1006, 22316, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from Geiger, Rachel Rachel.Geiger@anthem.com:  Sub; Amerigroup agreement - Right Step Medical Center LLC  \"This message was encrypted by Proofpoint Encryption Please review the attached agreement.  Please sign and return the signature page.   Thank You, Rachel N. Geiger, RN, EJD, CPHQ, MHP, CLNC Director, Network Management / Provider Contracting Amerigroup m: 419-340-1744|fax: 877-744-2341\"  The contract was filled out and is attached in the main group task for reference as it\'s an ancillary contract. ', NULL, NULL, '2021-07-01 12:43:51', '2021-07-01 12:43:51'),
(23559, 1006, 22316, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Received reply Geiger, Rachel Rachel.Geiger@anthem.com:  Sub: Amerigroup agreement - Right Step Medical Center LLC  \"Thank you.  It will be effective on 7/31.  Thank You,  Rachel N. Geiger, RN, EJD, CPHQ, MHP, CLNC Director, Network Management / Provider Contracting Amerigroup m: 419-340-1744|fax: 877-744-2341\"  Replied:  \"Hello Rachel,   I appreciate the update, when can we expect to get a copy of the welcome letter or executed contract?  Thank you!\"', NULL, NULL, '2021-07-27 17:00:57', '2021-07-27 17:00:57'),
(23560, 1006, 22316, NULL, '2021-08-09 00:00:00.000', 'Approved', 'The executed agreement was received and attached. It is a facility agreement.   Eff: 07/31/2021 ', NULL, NULL, '2021-08-02 08:58:36', '2021-08-02 08:58:36'),
(23561, 3046, 22317, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:25', '2021-03-16 15:46:25'),
(23562, 3040, 22317, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject:  Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||   Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 13:04:22', '2021-03-29 13:04:22'),
(23563, 3040, 22317, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com, Provider_Relations_South_Texas@bcbstx.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 08:41:09', '2021-03-30 08:41:09'),
(23564, 1006, 22317, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Sent f/u @ TX NM South Texas Provider_Relations_South_Texas@bcbstx.com: Sub: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Group || BCBS ||  \"Hello,   I wanted to get an update regarding a demographic update request we submitted last month for the following group:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 168992490  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2021-04-15 08:43:52', '2021-04-15 08:43:52'),
(23565, 1006, 22317, NULL, '2021-05-04 00:00:00.000', 'Approved', 'The provider is participating with BCBS, location confirmation and plans are attached for reference.', NULL, NULL, '2021-04-27 12:19:47', '2021-04-27 12:19:47'),
(23566, 3040, 22318, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:29', '2021-03-16 15:46:29'),
(23567, 3040, 22318, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Email sent to: dmarley@ghn-mci.com  Subject: Group & Provider || Ladot Healthcare LLC || Group and Providers || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Galaxy Health under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-01 16:42:05', '2021-04-01 16:42:05'),
(23568, 3040, 22318, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request for a group to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. As per your above email I sent the Participating Physician Agreement through fax for our group Ladot Health Care LLC.   Thank you ', NULL, NULL, '2021-05-05 16:08:09', '2021-05-05 16:08:09'),
(23569, 3040, 22318, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request for a group to join Galaxy Health Network  Hello Daniel.   Hope you are doing well. Please find the attached physical sign contract along with the documents as per your request. We have only 02 providers under the practice the first one is Internal Medicine & second is Nurse Practitioner.    If you need any additional information please feel free to contact me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-25 15:07:30', '2021-05-25 15:07:30'),
(23570, 1006, 22318, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent f/u email @ Daniel Marley dmarley@ghn-mci.com:  Sub: Re: Request for a group to join Galaxy Health Network  \"Hello Daniel,   I hope you\'re doing well, I wanted to follow up with you regarding the status of enrollment for our providers under the mentioned group. Please let me know how long this request will take.  Thank you. \"', NULL, NULL, '2021-06-11 12:05:34', '2021-06-11 12:05:34'),
(23571, 1006, 22318, NULL, '2021-07-07 00:00:00.000', 'In Process', 'The agreement has been faxed at 1-800-645-0154 as per the demand of  Daniel Marley.', NULL, NULL, '2021-06-30 13:38:12', '2021-06-30 13:38:12'),
(23572, 11056, 22318, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Waiting for the signatures from the providers.', NULL, NULL, '2021-07-12 10:52:42', '2021-07-12 10:52:42'),
(23573, 11056, 22318, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Waiting for the signatures from the providers. Haven\'t received yet. Although contacted twice, but no response from the providers yet.', NULL, NULL, '2021-07-23 08:50:57', '2021-07-23 08:50:57'),
(23574, 11056, 22318, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Sir,  After review, I do not show any supporting documents as having been received, license, DEA cert, Mal Practice etc. Could you please send that. In addition, this looks like it may have been electronically signed. If so could you please provide a copy physically signed by the provider? If this is not an electronic signature could you please advise that.  Thanks, Daniel M. Contract Specialist Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-07-30 14:17:52', '2021-07-30 14:17:52'),
(23575, 11056, 22318, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Good morning Daniel!  Hope you are doing well. Here is the contract signed by the provider and the documents are attached in it below. Please see the attachment.  If you have any questions or need any additional information or documents please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 12:53:09', '2021-08-03 12:53:09'),
(23576, 11056, 22318, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Please fax to 1-800-645-0154 for review.   The agreement has been faxed at 1-800-645-0154.', NULL, NULL, '2021-08-09 15:23:15', '2021-08-09 15:23:15'),
(23577, 11056, 22318, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Hey Daniel!  Hope you are doing well. The contract signed by the provider and the documents are attached in that has been faxed to you at 1-800-645-0154. Please inform me when you receive it. Kindly keep us updated with the credentialing process too.  Furthermore, If any documents or information needed feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-16 10:01:46', '2021-08-16 10:01:46'),
(23578, 11056, 22318, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Hey Daniel!  Sir, You haven\'t responded yet! Hope you are doing well. The contract signed by the provider and the documents are attached in that has been faxed to you at 1-800-645-0154. Please inform me when you receive it. Kindly keep us updated with the credentialing process too.  Furthermore, If any documents or information needed feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-23 09:16:55', '2021-08-23 09:16:55'),
(23579, 11056, 22318, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email received from : mmonroe@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Hello,  I am responding to your email below. Please provide me the providers  name and TAX ID, so I may look into this.     Thank you,     Michelle Michelle Monroe  Contract Specialist / Client Relations  Galaxy Health Network  2261 Brookhollow Plaza Drive  Suite 106  Arlington, TX 76006  PO Box 201425  Arlington, TX 76006-1425  mmonroe@ghn-mci.com  Phone (800) 975-3322 x1401  Fax directly (817)-394-2497  ', NULL, NULL, '2021-09-01 08:57:49', '2021-09-01 08:57:49'),
(23580, 11056, 22318, NULL, '2021-09-21 00:00:00.000', 'Approved', 'Approval Email received from : mmonroe@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network   Hello,  Provider has been entered into the system and is effective on 5-1-2021  Also confirmed with Karen Avalos through call at 800-975-3322 ext. 1601  eff date is :   05/01/2021   Please see the attachment.', NULL, NULL, '2021-09-14 08:40:11', '2021-09-14 08:40:11'),
(23581, 3040, 22319, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:38', '2021-03-16 15:46:38'),
(23582, 3040, 22319, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Email sent to: dmarley@ghn-mci.com  Subject: Group & Provider || Ladot Healthcare LLC || Group and Providers || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Galaxy Health under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-01 16:42:11', '2021-04-01 16:42:11'),
(23583, 3040, 22319, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request for a group to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. As per your above email I sent the Participating Physician Agreement through fax for our group Ladot Health Care LLC.   Thank you ', NULL, NULL, '2021-05-05 16:08:13', '2021-05-05 16:08:13'),
(23584, 3040, 22319, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request for a group to join Galaxy Health Network  Hello Daniel.   Hope you are doing well. Please find the attached physical sign contract along with the documents as per your request. We have only 02 providers under the practice the first one is Internal Medicine & second is Nurse Practitioner.    If you need any additional information please feel free to contact me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-25 15:07:31', '2021-05-25 15:07:31'),
(23585, 1006, 22319, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent f/u email @ Daniel Marley dmarley@ghn-mci.com:  Sub: Re: Request for a group to join Galaxy Health Network  \"Hello Daniel,   I hope you\'re doing well, I wanted to follow up with you regarding the status of enrollment for our providers under the mentioned group. Please let me know how long this request will take.  Thank you. \"', NULL, NULL, '2021-06-11 12:05:31', '2021-06-11 12:05:31'),
(23586, 1006, 22319, NULL, '2021-07-07 00:00:00.000', 'In Process', 'The agreement has been faxed at 1-800-645-0154 as per the demand of  Daniel Marley.', NULL, NULL, '2021-06-30 13:37:47', '2021-06-30 13:37:47'),
(23587, 11056, 22319, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Waiting for the signatures from the providers.', NULL, NULL, '2021-07-12 10:52:27', '2021-07-12 10:52:27'),
(23588, 11056, 22319, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Waiting for the signatures from the providers. Haven\'t received yet. Although contacted twice, but no response from the providers yet.', NULL, NULL, '2021-07-23 08:50:49', '2021-07-23 08:50:49'),
(23589, 11056, 22319, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Sir,  After review, I do not show any supporting documents as having been received, license, DEA cert, Mal Practice etc. Could you please send that. In addition, this looks like it may have been electronically signed. If so could you please provide a copy physically signed by the provider? If this is not an electronic signature could you please advise that.  Thanks, Daniel M. Contract Specialist Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-07-30 14:17:40', '2021-07-30 14:17:40'),
(23590, 11056, 22319, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Good morning Daniel!  Hope you are doing well. Here is the contract signed by the provider and the documents are attached in it below. Please see the attachment.  If you have any questions or need any additional information or documents please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 12:53:00', '2021-08-03 12:53:00'),
(23591, 11056, 22319, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Please fax to 1-800-645-0154 for review.   The agreement has been faxed at 1-800-645-0154.', NULL, NULL, '2021-08-09 15:23:36', '2021-08-09 15:23:36'),
(23592, 11056, 22319, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Hey Daniel!  Hope you are doing well. The contract signed by the provider and the documents are attached in that has been faxed to you at 1-800-645-0154. Please inform me when you receive it. Kindly keep us updated with the credentialing process too.  Furthermore, If any documents or information needed feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-16 10:01:40', '2021-08-16 10:01:40'),
(23593, 11056, 22319, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Hey Daniel!  Sir, You haven\'t responded yet! Hope you are doing well. The contract signed by the provider and the documents are attached in that has been faxed to you at 1-800-645-0154. Please inform me when you receive it. Kindly keep us updated with the credentialing process too.  Furthermore, If any documents or information needed feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-23 09:17:20', '2021-08-23 09:17:20'),
(23594, 11056, 22319, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email received from : mmonroe@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Hello,  I am responding to your email below. Please provide me the providers  name and TAX ID, so I may look into this.     Thank you,     Michelle Michelle Monroe  Contract Specialist / Client Relations  Galaxy Health Network  2261 Brookhollow Plaza Drive  Suite 106  Arlington, TX 76006  PO Box 201425  Arlington, TX 76006-1425  mmonroe@ghn-mci.com  Phone (800) 975-3322 x1401  Fax directly (817)-394-2497  ', NULL, NULL, '2021-09-01 08:57:43', '2021-09-01 08:57:43'),
(23595, 11056, 22319, NULL, '2021-09-21 00:00:00.000', 'Approved', 'Approval Email received from :   Sub :   Hello for provider Atinuke Dada effective date is 8/26/2021   Thanks;  Karen A.   Also confirmed with Karen Avalos through call at 800-975-3322 ext. 1601  eff date is :  08/26/2021  Please see the attachment.', NULL, NULL, '2021-09-14 08:35:10', '2021-09-14 08:35:10'),
(23596, 3040, 22320, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:44', '2021-03-16 15:46:44'),
(23597, 3040, 22320, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Email sent to: dmarley@ghn-mci.com  Subject: Group & Provider || Ladot Healthcare LLC || Group and Providers || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Galaxy Health under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-01 16:42:19', '2021-04-01 16:42:19'),
(23598, 3040, 22320, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request for a group to join Galaxy Health Network  Hello Daniel,   Hope you are doing well. As per your above email I sent the Participating Physician Agreement through fax for our group Ladot Health Care LLC.   Thank you ', NULL, NULL, '2021-05-05 16:08:18', '2021-05-05 16:08:18'),
(23599, 3040, 22320, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Request for a group to join Galaxy Health Network  Hello Daniel.   Hope you are doing well. Please find the attached physical sign contract along with the documents as per your request. We have only 02 providers under the practice the first one is Internal Medicine & second is Nurse Practitioner.    If you need any additional information please feel free to contact me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-25 15:07:32', '2021-05-25 15:07:32'),
(23600, 1006, 22320, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent f/u email @ Daniel Marley dmarley@ghn-mci.com:  Sub: Re: Request for a group to join Galaxy Health Network  \"Hello Daniel,   I hope you\'re doing well, I wanted to follow up with you regarding the status of enrollment for our providers under the mentioned group. Please let me know how long this request will take.  Thank you. \"', NULL, NULL, '2021-06-11 12:05:27', '2021-06-11 12:05:27'),
(23601, 1006, 22320, NULL, '2021-07-07 00:00:00.000', 'In Process', 'The agreement has been faxed at 1-800-645-0154 as per the demand of  Daniel Marley.', NULL, NULL, '2021-06-30 13:38:27', '2021-06-30 13:38:27'),
(23602, 11056, 22320, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Waiting for the signatures from the providers.', NULL, NULL, '2021-07-12 10:52:18', '2021-07-12 10:52:18'),
(23603, 11056, 22320, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Waiting for the signatures from the providers. Haven\'t received yet. Although contacted twice, but no response from the providers yet. ', NULL, NULL, '2021-07-23 08:50:34', '2021-07-23 08:50:34'),
(23604, 11056, 22320, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Sir,  After review, I do not show any supporting documents as having been received, license, DEA cert, Mal Practice etc. Could you please send that. In addition, this looks like it may have been electronically signed. If so could you please provide a copy physically signed by the provider? If this is not an electronic signature could you please advise that.  Thanks, Daniel M. Contract Specialist Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-07-30 14:16:54', '2021-07-30 14:16:54'),
(23605, 11056, 22320, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Good morning Daniel!  Hope you are doing well. Here is the contract signed by the provider and the documents are attached in it below. Please see the attachment.  If you have any questions or need any additional information or documents please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 12:52:41', '2021-08-03 12:52:41'),
(23606, 11056, 22320, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Please fax to 1-800-645-0154 for review.   The agreement has been faxed at 1-800-645-0154.', NULL, NULL, '2021-08-09 15:23:45', '2021-08-09 15:23:45'),
(23607, 11056, 22320, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Hey Daniel!  Hope you are doing well. The contract signed by the provider and the documents are attached in that has been faxed to you at 1-800-645-0154. Please inform me when you receive it. Kindly keep us updated with the credentialing process too.  Furthermore, If any documents or information needed feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-16 10:00:25', '2021-08-16 10:00:25'),
(23608, 11056, 22320, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Hey Daniel!  Sir, You haven\'t responded yet! Hope you are doing well. The contract signed by the provider and the documents are attached in that has been faxed to you at 1-800-645-0154. Please inform me when you receive it. Kindly keep us updated with the credentialing process too.  Furthermore, If any documents or information needed feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-23 09:17:28', '2021-08-23 09:17:28'),
(23609, 11056, 22320, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email received from : mmonroe@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network  Hello,  I am responding to your email below. Please provide me the providers  name and TAX ID, so I may look into this.     Thank you,     Michelle Michelle Monroe  Contract Specialist / Client Relations  Galaxy Health Network  2261 Brookhollow Plaza Drive  Suite 106  Arlington, TX 76006  PO Box 201425  Arlington, TX 76006-1425  mmonroe@ghn-mci.com  Phone (800) 975-3322 x1401  Fax directly (817)-394-2497      ', NULL, NULL, '2021-09-01 08:57:06', '2021-09-01 08:57:06'),
(23610, 11056, 22320, NULL, '2021-09-21 00:00:00.000', 'Approved', 'Approval Email received from : mmonroe@ghn-mci.com  Sub : Fwd: Request for a group to join Galaxy Health Network    Hello,  Provider has been entered into the system and is effective on 5-1-2021  Also confirmed with Karen Avalos through call at 800-975-3322 ext. 1601  eff date is :   05/01/2021    Please see the attachment.', NULL, NULL, '2021-09-14 08:40:54', '2021-09-14 08:40:54'),
(23611, 1006, 22321, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:45', '2021-03-16 15:46:45'),
(23612, 1006, 22321, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'The task is pending due to Medicare/Medicaid enrollment. ', NULL, NULL, '2021-04-01 09:45:33', '2021-04-01 09:45:33'),
(23613, 1006, 22321, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'The task is pending due to Medicaid enrollment. ', NULL, NULL, '2021-05-25 10:14:13', '2021-05-25 10:14:13');
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
(23614, 1006, 22321, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Enrollment request has been submitted @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Request - RSM - CHC  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  Application is attached in the main group task.', NULL, NULL, '2021-06-14 15:04:58', '2021-06-14 15:04:58'),
(23615, 1006, 22321, NULL, '2021-07-06 00:00:00.000', 'Not Eligible', 'We received the following denial letter from CHC. Attached for reference. ', NULL, NULL, '2021-06-29 11:31:12', '2021-06-29 11:31:12'),
(23616, 19067, 22321, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: chc.contracting@communityhealthchoice.org  Subject: Enrollment Query || Providers & Group || RSM || CHC ||   Hello,  We would like to enroll the providers and group as in-network with Community Health Choice. We sent the applications for enrollment last year and we got a denial letter stating that the panels are closed for a year. Below is the information  for our facility,  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite# 12, Stafford, TX 77477-2300 Provider Name	NPI Shybi Varghese	1285270991 Ramegowda Belakere	1235166687 Glory Abraham	1194206490   Kindly respond to our query as we are already late in the process.  Thanks,', NULL, NULL, '2022-04-27 07:41:47', '2022-04-27 07:41:47'),
(23617, 19067, 22321, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email received from: CHC.Contracting@communitycares.com  Subject: RE: Enrollment Query || Providers & Group || RSM || CHC ||    Good Morning,  An agreement was emailed for review and signature on 1/31/2022 by Contract Specialist, Rajika Reid.  Please confirm if the agreement was received. If not, please advise to re-send documentation.  Thank you,  Contracting Team', NULL, NULL, '2022-04-27 10:05:39', '2022-04-27 10:05:39'),
(23618, 19067, 22321, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: Enrollment Query || Providers & Group || RSM || CHC ||   Subject: CHC.Contracting@communitycares.com   Hey,  Can you please re-send the documentation?  Thanks, Hammad Ahmed', NULL, NULL, '2022-04-27 10:07:17', '2022-04-27 10:07:17'),
(23619, 1006, 22322, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:46', '2021-03-16 15:46:46'),
(23620, 1006, 22322, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'The task is pending due to Medicare/Medicaid enrollment.  ', NULL, NULL, '2021-04-01 09:45:42', '2021-04-01 09:45:42'),
(23621, 1006, 22322, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'The task is pending due to Medicaid enrollment. ', NULL, NULL, '2021-05-25 10:14:21', '2021-05-25 10:14:21'),
(23622, 1006, 22322, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Enrollment request has been submitted @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Request - RSM - CHC  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  Application is attached in the main group task.', NULL, NULL, '2021-06-14 15:05:04', '2021-06-14 15:05:04'),
(23623, 1006, 22322, NULL, '2021-07-06 00:00:00.000', 'In Process', 'We received the following denial letter from CHC. Attached for reference. ', NULL, NULL, '2021-06-29 11:31:06', '2021-06-29 11:31:06'),
(23624, 1006, 22322, NULL, '2021-07-06 00:00:00.000', 'Not Eligible', '', NULL, NULL, '2021-06-29 11:31:37', '2021-06-29 11:31:37'),
(23625, 19067, 22322, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: chc.contracting@communityhealthchoice.org  Subject: Enrollment Query || Providers & Group || RSM || CHC ||   Hello,  We would like to enroll the providers and group as in-network with Community Health Choice. We sent the applications for enrollment last year and we got a denial letter stating that the panels are closed for a year. Below is the information  for our facility,  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite# 12, Stafford, TX 77477-2300 Provider Name	NPI Shybi Varghese	1285270991 Ramegowda Belakere	1235166687 Glory Abraham	1194206490   Kindly respond to our query as we are already late in the process.  Thanks,', NULL, NULL, '2022-04-27 07:41:43', '2022-04-27 07:41:43'),
(23626, 19067, 22322, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email received from: CHC.Contracting@communitycares.com  Subject: RE: Enrollment Query || Providers & Group || RSM || CHC ||    Good Morning,  An agreement was emailed for review and signature on 1/31/2022 by Contract Specialist, Rajika Reid.  Please confirm if the agreement was received. If not, please advise to re-send documentation.  Thank you,  Contracting Team', NULL, NULL, '2022-04-27 10:05:34', '2022-04-27 10:05:34'),
(23627, 19067, 22322, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: Enrollment Query || Providers & Group || RSM || CHC ||   Subject: CHC.Contracting@communitycares.com   Hey,  Can you please re-send the documentation?  Thanks, Hammad Ahmed', NULL, NULL, '2022-04-27 10:07:06', '2022-04-27 10:07:06'),
(23628, 1006, 22323, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:46', '2021-03-16 15:46:46'),
(23629, 1006, 22323, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'The task is pending due to Medicare/Medicaid enrollment.  ', NULL, NULL, '2021-04-01 09:45:45', '2021-04-01 09:45:45'),
(23630, 1006, 22323, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'The task is pending due to Medicaid enrollment. ', NULL, NULL, '2021-05-25 10:14:25', '2021-05-25 10:14:25'),
(23631, 1006, 22323, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Enrollment request has been submitted @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Request - RSM - CHC  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  Application is attached in the main group task.', NULL, NULL, '2021-06-14 15:05:08', '2021-06-14 15:05:08'),
(23632, 1006, 22323, NULL, '2021-07-06 00:00:00.000', 'In Process', 'We received the following denial letter from CHC. Attached for reference. ', NULL, NULL, '2021-06-29 11:31:00', '2021-06-29 11:31:00'),
(23633, 1006, 22323, NULL, '2021-07-06 00:00:00.000', 'Not Eligible', '', NULL, NULL, '2021-06-29 11:31:32', '2021-06-29 11:31:32'),
(23634, 19067, 22323, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: chc.contracting@communityhealthchoice.org  Subject: Enrollment Query || Providers & Group || RSM || CHC ||   Hello,  We would like to enroll the providers and group as in-network with Community Health Choice. We sent the applications for enrollment last year and we got a denial letter stating that the panels are closed for a year. Below is the information  for our facility,  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite# 12, Stafford, TX 77477-2300 Provider Name	NPI Shybi Varghese	1285270991 Ramegowda Belakere	1235166687 Glory Abraham	1194206490   Kindly respond to our query as we are already late in the process.  Thanks,', NULL, NULL, '2022-04-27 07:41:36', '2022-04-27 07:41:36'),
(23635, 19067, 22323, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email received from: CHC.Contracting@communitycares.com  Subject: RE: Enrollment Query || Providers & Group || RSM || CHC ||    Good Morning,  An agreement was emailed for review and signature on 1/31/2022 by Contract Specialist, Rajika Reid.  Please confirm if the agreement was received. If not, please advise to re-send documentation.  Thank you,  Contracting Team', NULL, NULL, '2022-04-27 10:05:29', '2022-04-27 10:05:29'),
(23636, 19067, 22323, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: Enrollment Query || Providers & Group || RSM || CHC ||   Subject: CHC.Contracting@communitycares.com   Hey,  Can you please re-send the documentation?  Thanks, Hammad Ahmed', NULL, NULL, '2022-04-27 10:07:00', '2022-04-27 10:07:00'),
(23637, 1006, 22324, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:46:47', '2021-03-16 15:46:47'),
(23638, 1006, 22324, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'The task is pending due to Medicare/Medicaid enrollment.  ', NULL, NULL, '2021-04-01 09:45:48', '2021-04-01 09:45:48'),
(23639, 1006, 22324, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'The task is pending due to Medicaid enrollment. ', NULL, NULL, '2021-05-25 10:14:30', '2021-05-25 10:14:30'),
(23640, 1006, 22324, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Enrollment request has been submitted @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Request - RSM - CHC  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  Application is attached in the main group task.', NULL, NULL, '2021-06-14 15:05:12', '2021-06-14 15:05:12'),
(23641, 1006, 22324, NULL, '2021-07-06 00:00:00.000', 'Not Eligible', 'We received the following denial letter from CHC. Attached for reference. ', NULL, NULL, '2021-06-29 11:30:52', '2021-06-29 11:30:52'),
(23642, 19067, 22324, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: chc.contracting@communityhealthchoice.org  Subject: Enrollment Query || Providers & Group || RSM || CHC ||   Hello,  We would like to enroll the providers and group as in-network with Community Health Choice. We sent the applications for enrollment last year and we got a denial letter stating that the panels are closed for a year. Below is the information  for our facility,  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite# 12, Stafford, TX 77477-2300 Provider Name	NPI Shybi Varghese	1285270991 Ramegowda Belakere	1235166687 Glory Abraham	1194206490   Kindly respond to our query as we are already late in the process.  Thanks,', NULL, NULL, '2022-04-27 07:41:30', '2022-04-27 07:41:30'),
(23643, 19067, 22324, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email received from: CHC.Contracting@communitycares.com  Subject: RE: Enrollment Query || Providers & Group || RSM || CHC ||    Good Morning,  An agreement was emailed for review and signature on 1/31/2022 by Contract Specialist, Rajika Reid.  Please confirm if the agreement was received. If not, please advise to re-send documentation.  Thank you,  Contracting Team', NULL, NULL, '2022-04-27 10:05:22', '2022-04-27 10:05:22'),
(23644, 19067, 22324, NULL, '2022-05-04 00:00:00.000', 'In Process', 'Email sent to: Enrollment Query || Providers & Group || RSM || CHC ||   Subject: CHC.Contracting@communitycares.com   Hey,  Can you please re-send the documentation?  Thanks, Hammad Ahmed', NULL, NULL, '2022-04-27 10:06:16', '2022-04-27 10:06:16'),
(23645, 3046, 22325, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:47:14', '2021-03-16 15:47:14'),
(23646, 3040, 22325, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject:  Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||   Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 13:05:03', '2021-03-29 13:05:03'),
(23647, 3040, 22325, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com, Provider_Relations_South_Texas@bcbstx.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 08:38:18', '2021-03-30 08:38:18'),
(23648, 1006, 22325, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Sent f/u @ TX NM South Texas Provider_Relations_South_Texas@bcbstx.com: Sub: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Group || BCBS ||  \"Hello,   I wanted to get an update regarding a demographic update request we submitted last month for the following group:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 168992490  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2021-04-15 08:43:57', '2021-04-15 08:43:57'),
(23649, 1006, 22325, NULL, '2021-05-04 00:00:00.000', 'Approved', 'The provider is now in network effective 12/04/2020. Par plan details uploaded in the attachments. Confirmation email received from Connie and email sent to the billing. ', NULL, NULL, '2021-04-27 12:16:06', '2021-04-27 12:16:06'),
(23650, 1006, 22326, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:47:44', '2021-03-16 15:47:44'),
(23651, 1006, 22326, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Submitted enrollment request @ PDSDallas@aetna.com:   Sub: Group & Provider Enrollment - RSM - First Health  \"Hello,   We want to enroll the following group and providers with First Health, the information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-04-02 10:57:19', '2021-04-02 10:57:19'),
(23652, 1006, 22326, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent a f/u @ PDSDallas@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Good morning,   Please get back to me on the status of this request as soon as you\'re able, the group and providers information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  The request has been pending since last month.  Thank you. \"', NULL, NULL, '2021-05-03 07:55:45', '2021-05-03 07:55:45'),
(23653, 1006, 22326, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent following email @ \"Madiraju, Phani X\" MadirajuP@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hello Phani,  I hope you\'re doing well, please let me know what is required to get our providers linked with the TIN and First Health? Thank you. \"', NULL, NULL, '2021-05-31 11:25:20', '2021-05-31 11:25:20'),
(23654, 1006, 22326, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Sent another f/u email @ \"Madiraju, Phani X\" MadirajuP@aetna.com & pdsdallas@aetna.com:  Sub; Group & Provider Enrollment - RSM - First Health  \"Hello Phani,   I hope you\'re doing well, we are still waiting to get an update regarding our request to link the mentioned providers to our TIN. Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-17 16:56:20', '2021-06-17 16:56:20'),
(23655, 1006, 22326, NULL, '2021-06-25 00:00:00.000', 'In Process', 'We received the following reply from Madiraju, Phani X MadirajuP@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hi Peterson,  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.\"  Sent following requested information to them:  \"Hello Phani,  Sure thing, here\'s the requested information: Provider Name: Ramegowda Belakere DOB: 04/03/1959 Billing/Practice Location:11925 Southwest Freeway, Suite 12, Stafford, TX 77477-2300 Phone# 281-741-9145 Fax# 832-230-0875  Provider Name: Glory Abraham DOB: 10/24/1977 Billing/Practice Location:11925 Southwest Freeway, Suite 12, Stafford, TX 77477-2300 Phone# 281-741-9145 Fax# 832-230-0875  Provider Name: Shybi Varghese DOB: 05/09/1983 Billing/Practice Location:11925 Southwest Freeway, Suite 12, Stafford, TX 77477-2300 Phone# 281-741-9145 Fax# 832-230-0875  Please let me know what the expected time frame is for these providers to be added to our group? Thank you!\"', NULL, NULL, '2021-06-18 12:45:19', '2021-06-18 12:45:19'),
(23656, 1006, 22326, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Sent f/u email @ \"Madiraju, Phani X\" MadirajuP@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hello Phani,   I hope you\'re doing well, I wanted to get an update regarding the status of enrollment for the above-mentioned providers.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-07 14:22:33', '2021-07-07 14:22:33'),
(23657, 1006, 22326, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ \"Madiraju, Phani X\" MadirajuP@aetna.com', NULL, NULL, '2021-07-27 17:08:14', '2021-07-27 17:08:14'),
(23658, 1006, 22326, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Sent f/u email @ PDSDallas@aetna.com since we can\'t f/u on call:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:   Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-08-11 12:55:24', '2021-08-11 12:55:24'),
(23659, 1006, 22326, NULL, '2021-09-02 00:00:00.000', 'In Process', 'We received the following update from SingaramS1@aetna.com:  Sub: First Health Network Dr. Ramegowda Belakere & Glory Abraham & Shybi Varghese TIN 85-3252700 Case# 15655818  \"Hi,  Thank you for your interest with the First Health Network.  Please visit Aetna.com.  Choose “Health Care Professionals/Join the Network to submit a request to join our Network.  Please be sure to select the “Request First Health participation” section in your request.  To request network participation or for new credentialing provider steps:  Go to www.aetna.com Choose Health Care Professional Choose Join the Network Choose Medical Providers  For convenient real-time status and tools, log onto our secure Provider Websites: Aetna’s Secure Provider Website:  https://navinet.navimedix.com/Main.asp Coventry’s Secure Provider Website:  https://directprovider.com https://www.aetna.com/health-care-professionals/contact-aetna.html  ADDITIONAL INFORMATION: First Health Provider Services 800-226-5116 Coventry Workers’ Compensation / Auto Provider Services 800-937-6824 / Option 4 Cofinity customer service number which is 800-831-1166 Aetna Provider Services 800-624-0756 / 888-632-3862   If you require assistance from an Aetna Network Representative ask the Provider Services Center contact to submit a Network Assistance Form on your behalf.  Thanks, Sivaranjani.\"  Submitted the request for enrollment. Attached for reference in provider tasks. ', NULL, NULL, '2021-08-26 12:40:04', '2021-08-26 12:40:04'),
(23660, 11056, 22326, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Fwd: First Health Network Dr. Ramegowda Belakere & Glory Abraham & Shybi Varghese TIN 85-3252700 Case# 14095695  Good afternoon!  Hope this email finds you well. Please let me know the latest enrollment status for the following providers and practice as soon as possible.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-09-02 16:55:46', '2021-09-02 16:55:46'),
(23661, 11056, 22326, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have words with rep. She provide the below mentioned details.  Call rep. : MARS R REF CODE. : Hang up the call deliberately  The participation is out of network but still working to bring in network.  Application ticket no. : NAF454645', NULL, NULL, '2021-09-08 10:22:51', '2021-09-08 10:22:51'),
(23662, 11056, 22326, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Rep : Stacy M  Ref code : 99777  Status : First of all we have to be credentialed with aetna. After the completion with Aetna first health credentialing will be started.  Shybi : Application is in review by verfier.  Contact no. : 8002265116', NULL, NULL, '2021-09-24 16:40:17', '2021-09-24 16:40:17'),
(23663, 11056, 22326, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Signed Agreement has been received. Please see the attachment.', NULL, NULL, '2021-10-04 12:21:19', '2021-10-04 12:21:19'),
(23664, 11056, 22326, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Rep : Robin H  Status : After the completion of enrollment with Aetna fill out the applications & after that it will take 90 - 180 days.  Ref code : 99777  Contact no. : 8002265116 ', NULL, NULL, '2021-10-13 11:01:11', '2021-10-13 11:01:11'),
(23665, 11056, 22326, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep : Jam P  Status :  Process is completed. Loaded on the system and linked with the tax ID Future effective date is 11/01/2021   Ref code. : 6051507347  contact no : 800-353-1232', NULL, NULL, '2021-10-21 11:55:38', '2021-10-21 11:55:38'),
(23666, 11056, 22326, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Rep:  Mark L  Status:  The group is in-network. Going to provide welcome letters in 10 business days for the providers.  Ref code: 6054022733  contact no : 800-353-1232', NULL, NULL, '2021-11-01 10:28:13', '2021-11-01 10:28:13'),
(23667, 11056, 22326, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Rep : Vinz  S   Status: In-network case properly started in 9/15/21 ticket# NAF454645 Welcome letters are expected in the next week. The future effective date is 11/01/2021  Refcode: 6057564480', NULL, NULL, '2021-11-11 15:38:01', '2021-11-11 15:38:01'),
(23668, 11056, 22326, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Rep: Cris S  Status:  Ramegowda Belakere: The application is in process. Needs around 30-40 days more.  Glory Abraham: completed. In-network  Refcode:  6058727694', NULL, NULL, '2021-11-18 12:01:40', '2021-11-18 12:01:40'),
(23669, 11056, 22326, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Rep: Arianne E   Status: Applications are still in process. Welcome letters can be expected soon.   Refcode: 11302021Ariannee', NULL, NULL, '2021-11-30 17:33:14', '2021-11-30 17:33:14'),
(23670, 11056, 22326, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Rep: Mark C  Status:  11/1/2021 linked and credentialed under the facility TIN.  Plans:  Aetna Medicare Aetna Medicaid  Refcode: 6062355331', NULL, NULL, '2021-12-08 12:43:26', '2021-12-08 12:43:26'),
(23671, 11056, 22326, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Rep: Gelo C   Status:Fully loaded in the system.Gonna receive soon a welcome letter  Ref code: 6065804152', NULL, NULL, '2021-12-22 13:55:30', '2021-12-22 13:55:30'),
(23672, 20067, 22326, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: sidleyj1@firsthealth.com  Subject:  First Health Network Dr. Ramegowda Belakere & Glory Abraham & Shybi Varghese TIN 85-3252700 Case# 14095695   Good Afternoon, Hope you had a great day. I would like to know the enrollment status of the below-mentioned providers under Right Step Medical Center LLC.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite# 12, Stafford, TX 77477-2300 Provider Name	NPI Ancy Kurian	1316558935 SHYBI VARGHESE	1285270991 Glory Abraham	1194206490  Eagerly waiting for your response.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 17:51:34', '2022-01-06 17:51:34'),
(23673, 19067, 22326, NULL, '2022-02-01 00:00:00.000', 'Approved', 'See attachment for provider\'s directory.', NULL, NULL, '2022-01-25 15:47:01', '2022-01-25 15:47:01'),
(23674, 1006, 22327, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:47:46', '2021-03-16 15:47:46'),
(23675, 1006, 22327, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Submitted enrollment request @ PDSDallas@aetna.com:   Sub: Group & Provider Enrollment - RSM - First Health  \"Hello,   We want to enroll the following group and providers with First Health, the information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-04-02 10:57:35', '2021-04-02 10:57:35'),
(23676, 1006, 22327, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent a f/u @ PDSDallas@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Good morning,   Please get back to me on the status of this request as soon as you\'re able, the group and providers information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  The request has been pending since last month.  Thank you. \"', NULL, NULL, '2021-05-03 07:55:39', '2021-05-03 07:55:39'),
(23677, 1006, 22327, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We received the following reply from Madiraju, Phani X MadirajuP@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hi Peterson,  Good Morning!  Please find the status of the below Providers.   PROVIDER NAME            CPD ID          TAX ID             NPI    EFFECTIVE DATE    Status  Ramegowda Belakere  2918595   853252700  1235166687             -  Given tin is not linked with First Health/Coventry  Glory Abraham                    -           853252700   1194206490         -  Provider not linked with First Health/ Coventry  Shybi Varghese                    -           853252700  1285270991           -  Provider not linked with First Health/ Coventry  Thank you, Phani\"  Replied with:  \"Hello Phani,  I hope you\'re doing well, please let me know what is required to get our providers linked with the TIN and First Health? Thank you. \" ', NULL, NULL, '2021-05-31 11:24:06', '2021-05-31 11:24:06'),
(23678, 1006, 22327, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Sent another f/u email @ \"Madiraju, Phani X\" MadirajuP@aetna.com & pdsdallas@aetna.com:  Sub; Group & Provider Enrollment - RSM - First Health  \"Hello Phani,   I hope you\'re doing well, we are still waiting to get an update regarding our request to link the mentioned providers to our TIN. Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-17 16:56:17', '2021-06-17 16:56:17'),
(23679, 1006, 22327, NULL, '2021-06-25 00:00:00.000', 'In Process', 'We received the following reply from Madiraju, Phani X MadirajuP@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hi Peterson,  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.\"  Sent following requested information to them:  \"Hello Phani,  Sure thing, here\'s the requested information: Provider Name: Ramegowda Belakere DOB: 04/03/1959 Billing/Practice Location:11925 Southwest Freeway, Suite 12, Stafford, TX 77477-2300 Phone# 281-741-9145 Fax# 832-230-0875  Provider Name: Glory Abraham DOB: 10/24/1977 Billing/Practice Location:11925 Southwest Freeway, Suite 12, Stafford, TX 77477-2300 Phone# 281-741-9145 Fax# 832-230-0875  Provider Name: Shybi Varghese DOB: 05/09/1983 Billing/Practice Location:11925 Southwest Freeway, Suite 12, Stafford, TX 77477-2300 Phone# 281-741-9145 Fax# 832-230-0875  Please let me know what the expected time frame is for these providers to be added to our group? Thank you!\"', NULL, NULL, '2021-06-18 12:45:16', '2021-06-18 12:45:16'),
(23680, 1006, 22327, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Sent f/u email @ \"Madiraju, Phani X\" MadirajuP@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hello Phani,   I hope you\'re doing well, I wanted to get an update regarding the status of enrollment for the above-mentioned providers.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-07 14:22:29', '2021-07-07 14:22:29'),
(23681, 1006, 22327, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ \"Madiraju, Phani X\" MadirajuP@aetna.com', NULL, NULL, '2021-07-27 17:08:11', '2021-07-27 17:08:11'),
(23682, 1006, 22327, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Sent f/u email @ PDSDallas@aetna.com since we can\'t f/u on call:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:   Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-08-11 12:55:38', '2021-08-11 12:55:38'),
(23683, 1006, 22327, NULL, '2021-09-02 00:00:00.000', 'In Process', 'We received the following update from SingaramS1@aetna.com:  Sub: First Health Network Dr. Ramegowda Belakere & Glory Abraham & Shybi Varghese TIN 85-3252700 Case# 15655818  \"Hi,  Thank you for your interest with the First Health Network.  Please visit Aetna.com.  Choose “Health Care Professionals/Join the Network to submit a request to join our Network.  Please be sure to select the “Request First Health participation” section in your request.  To request network participation or for new credentialing provider steps:  Go to www.aetna.com Choose Health Care Professional Choose Join the Network Choose Medical Providers  For convenient real-time status and tools, log onto our secure Provider Websites: Aetna’s Secure Provider Website:  https://navinet.navimedix.com/Main.asp Coventry’s Secure Provider Website:  https://directprovider.com https://www.aetna.com/health-care-professionals/contact-aetna.html  ADDITIONAL INFORMATION: First Health Provider Services 800-226-5116 Coventry Workers’ Compensation / Auto Provider Services 800-937-6824 / Option 4 Cofinity customer service number which is 800-831-1166 Aetna Provider Services 800-624-0756 / 888-632-3862   If you require assistance from an Aetna Network Representative ask the Provider Services Center contact to submit a Network Assistance Form on your behalf.  Thanks, Sivaranjani.\"  Submitted the request for enrollment. Attached for reference. ', NULL, NULL, '2021-08-26 12:39:06', '2021-08-26 12:39:06'),
(23684, 11056, 22327, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Fwd: First Health Network Dr. Ramegowda Belakere & Glory Abraham & Shybi Varghese TIN 85-3252700 Case# 14095695  Good afternoon!  Hope this email finds you well. Please let me know the latest enrollment status for the following providers and practice as soon as possible.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-09-02 16:55:34', '2021-09-02 16:55:34'),
(23685, 11056, 22327, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have words with rep. She provide the below mentioned details.  Call rep. : MARS R REF CODE. : Hang up the call deliberately  The participation is out of network but still working to bring in network.  Application ticket no. : NAF454645', NULL, NULL, '2021-09-08 10:22:41', '2021-09-08 10:22:41'),
(23686, 11056, 22327, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Rep : Stacy M  Ref code : 99777  Status : First of all we have to be credentialed with aetna. After the completion with Aetna first health credentialing will be started.  Shybi : Application is in review by verfier.  Contact no. : 8002265116', NULL, NULL, '2021-09-24 16:40:12', '2021-09-24 16:40:12'),
(23687, 11056, 22327, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Signed Agreement has been received. Please see the attachment.', NULL, NULL, '2021-10-04 12:21:07', '2021-10-04 12:21:07'),
(23688, 11056, 22327, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Rep : Robin H  Status : After the completion of enrollment with Aetna fill out the applications & after that it will take 90 - 180 days.  Ref code : 99777  Contact no. : 8002265116 ', NULL, NULL, '2021-10-13 11:01:05', '2021-10-13 11:01:05'),
(23689, 11056, 22327, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep : Jam P  Status :  Process is completed. Loaded on the system and linked with the tax ID Future effective date is 11/01/2021   Ref code. : 6051507347  contact no : 800-353-1232', NULL, NULL, '2021-10-21 11:55:32', '2021-10-21 11:55:32'),
(23690, 11056, 22327, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Rep:  Mark L  Status:  The group is in-network. Going to provide welcome letters in 10 business days for the providers.  Ref code: 6054022733  contact no : 800-353-1232', NULL, NULL, '2021-11-01 10:28:08', '2021-11-01 10:28:08'),
(23691, 11056, 22327, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Rep : Vinz  S   Status: In-network case properly started in 9/15/21 ticket# NAF454645 Welcome letters are expected in the next week. The future effective date is 11/01/2021  Refcode: 6057564480', NULL, NULL, '2021-11-11 15:37:55', '2021-11-11 15:37:55'),
(23692, 11056, 22327, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Rep: Cris S  Status:  Ramegowda Belakere: The application is in process. Needs around 30-40 days more.  Glory Abraham: completed. In-network  Refcode:  6058727694', NULL, NULL, '2021-11-18 12:01:45', '2021-11-18 12:01:45'),
(23693, 11056, 22327, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Rep: Arianne E   Status: Applications are still in process. Welcome letters can be expected soon.   Refcode: 11302021Ariannee', NULL, NULL, '2021-11-30 17:33:07', '2021-11-30 17:33:07'),
(23694, 11056, 22327, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Rep: Gelo C   Status:Fully loaded in the system.Gonna receive soon a welcome letter  Ref code: 6065804152', NULL, NULL, '2021-12-22 13:55:25', '2021-12-22 13:55:25'),
(23695, 20067, 22327, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: sidleyj1@firsthealth.com  Subject:  First Health Network Dr. Ramegowda Belakere & Glory Abraham & Shybi Varghese TIN 85-3252700 Case# 14095695   Good Afternoon, Hope you had a great day. I would like to know the enrollment status of the below-mentioned providers under Right Step Medical Center LLC.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite# 12, Stafford, TX 77477-2300 Provider Name	NPI Ancy Kurian	1316558935 SHYBI VARGHESE	1285270991 Glory Abraham	1194206490  Eagerly waiting for your response.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 17:51:24', '2022-01-06 17:51:24'),
(23696, 19067, 22327, NULL, '2022-02-01 00:00:00.000', 'Approved', 'See attachment for provider\'s directory.', NULL, NULL, '2022-01-25 15:45:21', '2022-01-25 15:45:21'),
(23697, 1006, 22328, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:47:47', '2021-03-16 15:47:47'),
(23698, 1006, 22328, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Submitted enrollment request @ PDSDallas@aetna.com:   Sub: Group & Provider Enrollment - RSM - First Health  \"Hello,   We want to enroll the following group and providers with First Health, the information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-04-02 10:57:44', '2021-04-02 10:57:44'),
(23699, 1006, 22328, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent a f/u @ PDSDallas@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Good morning,   Please get back to me on the status of this request as soon as you\'re able, the group and providers information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  The request has been pending since last month.  Thank you. \"', NULL, NULL, '2021-05-03 07:55:31', '2021-05-03 07:55:31'),
(23700, 1006, 22328, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We received the following reply from Madiraju, Phani X MadirajuP@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hi Peterson,  Good Morning!  Please find the status of the below Providers.   PROVIDER NAME            CPD ID          TAX ID             NPI    EFFECTIVE DATE    Status  Ramegowda Belakere  2918595   853252700  1235166687             -  Given tin is not linked with First Health/Coventry  Glory Abraham                    -           853252700   1194206490         -  Provider not linked with First Health/ Coventry  Shybi Varghese                    -           853252700  1285270991           -  Provider not linked with First Health/ Coventry  Thank you, Phani\"  Replied with:  \"Hello Phani,  I hope you\'re doing well, please let me know what is required to get our providers linked with the TIN and First Health? Thank you. \" ', NULL, NULL, '2021-05-31 11:24:13', '2021-05-31 11:24:13'),
(23701, 1006, 22328, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Sent another f/u email @ \"Madiraju, Phani X\" MadirajuP@aetna.com & pdsdallas@aetna.com:  Sub; Group & Provider Enrollment - RSM - First Health  \"Hello Phani,   I hope you\'re doing well, we are still waiting to get an update regarding our request to link the mentioned providers to our TIN. Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-17 16:56:14', '2021-06-17 16:56:14'),
(23702, 1006, 22328, NULL, '2021-06-25 00:00:00.000', 'In Process', 'We received the following reply from Madiraju, Phani X MadirajuP@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hi Peterson,  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.\"  Sent following requested information to them:  \"Hello Phani,  Sure thing, here\'s the requested information: Provider Name: Ramegowda Belakere DOB: 04/03/1959 Billing/Practice Location:11925 Southwest Freeway, Suite 12, Stafford, TX 77477-2300 Phone# 281-741-9145 Fax# 832-230-0875  Provider Name: Glory Abraham DOB: 10/24/1977 Billing/Practice Location:11925 Southwest Freeway, Suite 12, Stafford, TX 77477-2300 Phone# 281-741-9145 Fax# 832-230-0875  Provider Name: Shybi Varghese DOB: 05/09/1983 Billing/Practice Location:11925 Southwest Freeway, Suite 12, Stafford, TX 77477-2300 Phone# 281-741-9145 Fax# 832-230-0875  Please let me know what the expected time frame is for these providers to be added to our group? Thank you!\"', NULL, NULL, '2021-06-18 12:45:13', '2021-06-18 12:45:13'),
(23703, 1006, 22328, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Sent f/u email @ \"Madiraju, Phani X\" MadirajuP@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hello Phani,   I hope you\'re doing well, I wanted to get an update regarding the status of enrollment for the above-mentioned providers.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-07 14:22:26', '2021-07-07 14:22:26'),
(23704, 1006, 22328, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ \"Madiraju, Phani X\" MadirajuP@aetna.com', NULL, NULL, '2021-07-27 17:08:08', '2021-07-27 17:08:08'),
(23705, 1006, 22328, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Sent f/u email @ PDSDallas@aetna.com since we can\'t f/u on call:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:   Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-08-11 12:55:29', '2021-08-11 12:55:29'),
(23706, 1006, 22328, NULL, '2021-09-02 00:00:00.000', 'In Process', 'We received the following update from SingaramS1@aetna.com:  Sub: First Health Network Dr. Ramegowda Belakere & Glory Abraham & Shybi Varghese TIN 85-3252700 Case# 15655818  \"Hi,  Thank you for your interest with the First Health Network.  Please visit Aetna.com.  Choose “Health Care Professionals/Join the Network to submit a request to join our Network.  Please be sure to select the “Request First Health participation” section in your request.  To request network participation or for new credentialing provider steps:  Go to www.aetna.com Choose Health Care Professional Choose Join the Network Choose Medical Providers  For convenient real-time status and tools, log onto our secure Provider Websites: Aetna’s Secure Provider Website:  https://navinet.navimedix.com/Main.asp Coventry’s Secure Provider Website:  https://directprovider.com https://www.aetna.com/health-care-professionals/contact-aetna.html  ADDITIONAL INFORMATION: First Health Provider Services 800-226-5116 Coventry Workers’ Compensation / Auto Provider Services 800-937-6824 / Option 4 Cofinity customer service number which is 800-831-1166 Aetna Provider Services 800-624-0756 / 888-632-3862   If you require assistance from an Aetna Network Representative ask the Provider Services Center contact to submit a Network Assistance Form on your behalf.  Thanks, Sivaranjani.\"  Submitted the request for enrollment. Attached for reference. ', NULL, NULL, '2021-08-26 12:38:15', '2021-08-26 12:38:15'),
(23707, 11056, 22328, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Fwd: First Health Network Dr. Ramegowda Belakere & Glory Abraham & Shybi Varghese TIN 85-3252700 Case# 14095695  Good afternoon!  Hope this email finds you well. Please let me know the latest enrollment status for the following providers and practice as soon as possible.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-09-02 16:55:26', '2021-09-02 16:55:26'),
(23708, 11056, 22328, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have words with rep. She provide the below mentioned details.  Call rep. : MARS R REF CODE. : Hang up the call deliberately  The participation is out of network but still working to bring in network.  Application ticket no. : NAF454645', NULL, NULL, '2021-09-08 10:22:35', '2021-09-08 10:22:35'),
(23709, 11056, 22328, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Rep : Stacy M  Ref code : 99777  Status : First of all we have to be credentialed with aetna. After the completion with Aetna first health credentialing will be started.  Shybi : Application is in review by verfier.  Contact no. : 8002265116', NULL, NULL, '2021-09-24 16:40:06', '2021-09-24 16:40:06'),
(23710, 11056, 22328, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Signed Agreement has been received. Please see the attachment.', NULL, NULL, '2021-10-04 12:20:55', '2021-10-04 12:20:55'),
(23711, 11056, 22328, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Rep : Robin H  Status : After the completion of enrollment with Aetna fill out the applications & after that it will take 90 - 180 days.  Ref code : 99777  Contact no. : 8002265116 ', NULL, NULL, '2021-10-13 11:01:00', '2021-10-13 11:01:00');
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
(23712, 11056, 22328, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep : Jam P  Status :  Process is completed. Loaded on the system and linked with the tax ID Future effective date is 11/01/2021   Ref code. : 6051507347  contact no : 800-353-1232', NULL, NULL, '2021-10-21 11:55:24', '2021-10-21 11:55:24'),
(23713, 11056, 22328, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Rep:  Mark L  Status:  The group is in-network. Going to provide welcome letters in 10 business days for the providers.  Ref code: 6054022733  contact no : 800-353-1232', NULL, NULL, '2021-11-01 10:28:02', '2021-11-01 10:28:02'),
(23714, 11056, 22328, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Rep : Vinz  S   Status: In-network case properly started in 9/15/21 ticket# NAF454645 Welcome letters are expected in the next week. The future effective date is 11/01/2021  Refcode: 6057564480', NULL, NULL, '2021-11-11 15:37:50', '2021-11-11 15:37:50'),
(23715, 11056, 22328, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Rep: Cris S  Status:  Ramegowda Belakere: The application is in process. Needs around 30-40 days more.  Glory Abraham: completed. In-network  Refcode:  6058727694', NULL, NULL, '2021-11-18 12:01:53', '2021-11-18 12:01:53'),
(23716, 11056, 22328, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Rep: Arianne E   Status: Applications are still in process. Welcome letters can be expected soon.   Refcode: 11302021Ariannee', NULL, NULL, '2021-11-30 17:33:00', '2021-11-30 17:33:00'),
(23717, 11056, 22328, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Rep: Mark C  Status:  11/1/2021 linked and credentialed under the facility TIN.  Plans:  Aetna Medicare Aetna Medicaid  Refcode: 6062355331', NULL, NULL, '2021-12-08 12:43:19', '2021-12-08 12:43:19'),
(23718, 11056, 22328, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Rep: Gelo C   Status:Fully loaded in the system.Gonna receive soon a welcome letter  Ref code: 6065804152', NULL, NULL, '2021-12-22 13:55:20', '2021-12-22 13:55:20'),
(23719, 20067, 22328, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: sidleyj1@firsthealth.com  Subject:  First Health Network Dr. Ramegowda Belakere & Glory Abraham & Shybi Varghese TIN 85-3252700 Case# 14095695   Good Afternoon, Hope you had a great day. I would like to know the enrollment status of the below-mentioned providers under Right Step Medical Center LLC.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite# 12, Stafford, TX 77477-2300 Provider Name	NPI Ancy Kurian	1316558935 SHYBI VARGHESE	1285270991 Glory Abraham	1194206490  Eagerly waiting for your response.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 17:51:16', '2022-01-06 17:51:16'),
(23720, 19067, 22328, NULL, '2022-02-01 00:00:00.000', 'Approved', 'See attachment for provider\'s directory.', NULL, NULL, '2022-01-25 15:43:29', '2022-01-25 15:43:29'),
(23721, 3040, 22329, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:47:47', '2021-03-16 15:47:47'),
(23722, 3040, 22329, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group || Ladot Healthcare LLC || Group || Health Smart ||  Greetings,  Hope you are doing well. I wanted to know the status for the practice Ladot Health Care LLC in Health Smart under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Below are the mentioned providers enrolled with Health Smart:  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720 Effective Date: 03/01/2021  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223 Effective Date: 03/01/2021  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-01 15:04:05', '2021-04-01 15:04:05'),
(23723, 3040, 22329, NULL, '2021-04-19 00:00:00.000', 'Not Eligible', 'Health smart don\'t do the group contract separately. They can do only ancillary contract via Anci care.   Both providers are enrolled in Health Smart.', NULL, NULL, '2021-04-12 10:20:40', '2021-04-12 10:20:40'),
(23724, 1006, 22330, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:47:48', '2021-03-16 15:47:48'),
(23725, 1006, 22330, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Submitted enrollment request @ PDSDallas@aetna.com:   Sub: Group & Provider Enrollment - RSM - First Health  \"Hello,   We want to enroll the following group and providers with First Health, the information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-04-02 10:59:17', '2021-04-02 10:59:17'),
(23726, 1006, 22330, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent a f/u @ PDSDallas@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Good morning,   Please get back to me on the status of this request as soon as you\'re able, the group and providers information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  The request has been pending since last month.  Thank you. \"', NULL, NULL, '2021-05-03 07:55:09', '2021-05-03 07:55:09'),
(23727, 1006, 22330, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We received the following reply from Madiraju, Phani X MadirajuP@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hi Peterson,  Good Morning!  Please find the status of the below Providers.   PROVIDER NAME            CPD ID          TAX ID             NPI    EFFECTIVE DATE    Status  Ramegowda Belakere  2918595   853252700  1235166687             -  Given tin is not linked with First Health/Coventry  Glory Abraham                    -           853252700   1194206490         -  Provider not linked with First Health/ Coventry  Shybi Varghese                    -           853252700  1285270991           -  Provider not linked with First Health/ Coventry  Thank you, Phani\"  Replied with:  \"Hello Phani,  I hope you\'re doing well, please let me know what is required to get our providers linked with the TIN and First Health? Thank you. \" ', NULL, NULL, '2021-05-31 11:24:18', '2021-05-31 11:24:18'),
(23728, 1006, 22330, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Sent another f/u email @ \"Madiraju, Phani X\" MadirajuP@aetna.com & pdsdallas@aetna.com:  Sub; Group & Provider Enrollment - RSM - First Health  \"Hello Phani,   I hope you\'re doing well, we are still waiting to get an update regarding our request to link the mentioned providers to our TIN. Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-17 16:56:07', '2021-06-17 16:56:07'),
(23729, 1006, 22330, NULL, '2021-06-25 00:00:00.000', 'In Process', 'We received the following reply from Madiraju, Phani X MadirajuP@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hi Peterson,  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.\"  Sent following requested information to them:  \"Hello Phani,  Sure thing, here\'s the requested information: Provider Name: Ramegowda Belakere DOB: 04/03/1959 Billing/Practice Location:11925 Southwest Freeway, Suite 12, Stafford, TX 77477-2300 Phone# 281-741-9145 Fax# 832-230-0875  Provider Name: Glory Abraham DOB: 10/24/1977 Billing/Practice Location:11925 Southwest Freeway, Suite 12, Stafford, TX 77477-2300 Phone# 281-741-9145 Fax# 832-230-0875  Provider Name: Shybi Varghese DOB: 05/09/1983 Billing/Practice Location:11925 Southwest Freeway, Suite 12, Stafford, TX 77477-2300 Phone# 281-741-9145 Fax# 832-230-0875  Please let me know what the expected time frame is for these providers to be added to our group? Thank you!\"', NULL, NULL, '2021-06-18 12:45:05', '2021-06-18 12:45:05'),
(23730, 1006, 22330, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Sent f/u email @ \"Madiraju, Phani X\" MadirajuP@aetna.com:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hello Phani,   I hope you\'re doing well, I wanted to get an update regarding the status of enrollment for the above-mentioned providers.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-07 14:22:20', '2021-07-07 14:22:20'),
(23731, 1006, 22330, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ \"Madiraju, Phani X\" MadirajuP@aetna.com', NULL, NULL, '2021-07-27 17:08:02', '2021-07-27 17:08:02'),
(23732, 1006, 22330, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Sent f/u email @ PDSDallas@aetna.com since we can\'t f/u on call:  Sub: Group & Provider Enrollment - RSM - First Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:   Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-08-11 12:55:34', '2021-08-11 12:55:34'),
(23733, 1006, 22330, NULL, '2021-09-02 00:00:00.000', 'In Process', 'We received the following update from SingaramS1@aetna.com:  Sub: First Health Network Dr. Ramegowda Belakere & Glory Abraham & Shybi Varghese TIN 85-3252700 Case# 15655818  \"Hi,  Thank you for your interest with the First Health Network.  Please visit Aetna.com.  Choose “Health Care Professionals/Join the Network to submit a request to join our Network.  Please be sure to select the “Request First Health participation” section in your request.  To request network participation or for new credentialing provider steps:  Go to www.aetna.com Choose Health Care Professional Choose Join the Network Choose Medical Providers  For convenient real-time status and tools, log onto our secure Provider Websites: Aetna’s Secure Provider Website:  https://navinet.navimedix.com/Main.asp Coventry’s Secure Provider Website:  https://directprovider.com https://www.aetna.com/health-care-professionals/contact-aetna.html  ADDITIONAL INFORMATION: First Health Provider Services 800-226-5116 Coventry Workers’ Compensation / Auto Provider Services 800-937-6824 / Option 4 Cofinity customer service number which is 800-831-1166 Aetna Provider Services 800-624-0756 / 888-632-3862   If you require assistance from an Aetna Network Representative ask the Provider Services Center contact to submit a Network Assistance Form on your behalf.  Thanks, Sivaranjani.\"  Submitted the request for enrollment. Attached for reference. ', NULL, NULL, '2021-08-26 12:39:38', '2021-08-26 12:39:38'),
(23734, 11056, 22330, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : Fwd: First Health Network Dr. Ramegowda Belakere & Glory Abraham & Shybi Varghese TIN 85-3252700 Case# 14095695  Good afternoon!  Hope this email finds you well. Please let me know the latest enrollment status for the following providers and practice as soon as possible.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-09-02 16:55:07', '2021-09-02 16:55:07'),
(23735, 11056, 22330, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have words with rep. She provide the below mentioned details.  Call rep. : MARS R REF CODE. : Hang up the call deliberately  The participation is out of network but still working to bring in network.  Application ticket no. : NAF454645', NULL, NULL, '2021-09-08 10:22:28', '2021-09-08 10:22:28'),
(23736, 11056, 22330, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Rep : Stacy M  Ref code : 99777  Status : First of all we have to be credentialed with aetna. After the completion with Aetna first health credentialing will be started.  Shybi : Application is in review by verfier.  Contact no. : 8002265116', NULL, NULL, '2021-09-24 16:39:30', '2021-09-24 16:39:30'),
(23737, 11056, 22330, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Signed Agreement has been received. Please see the attachment.', NULL, NULL, '2021-10-04 12:20:36', '2021-10-04 12:20:36'),
(23738, 11056, 22330, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Rep : Robin H  Status : After the completion of enrollment with Aetna fill out the applications & after that it will take 90 - 180 days.  Ref code : 99777  Contact no. : 8002265116 ', NULL, NULL, '2021-10-13 10:58:49', '2021-10-13 10:58:49'),
(23739, 11056, 22330, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep : Jam P  Status :  Process is completed. Loaded on the system and linked with the tax ID Future effective date is 11/01/2021   Ref code. : 6051507347  contact no : 800-353-1232', NULL, NULL, '2021-10-21 11:55:18', '2021-10-21 11:55:18'),
(23740, 11056, 22330, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Rep:  Mark L  Status:  The group is in-network. Going to provide welcome letters in 10 business days for the providers.  Ref code: 6054022733  contact no : 800-353-1232', NULL, NULL, '2021-11-01 10:28:34', '2021-11-01 10:28:34'),
(23741, 11056, 22330, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Rep : Vinz  S   Status: In-network case properly started in 9/15/21 ticket# NAF454645 Welcome letters are expected in the next week. The future effective date is 11/01/2021  Refcode: 6057564480', NULL, NULL, '2021-11-11 15:37:40', '2021-11-11 15:37:40'),
(23742, 11056, 22330, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Rep: Cris S  Status:  Ramegowda Belakere: The application is in process. Needs around 30-40 days more.  Glory Abraham: completed. In-network  Refcode:  6058727694', NULL, NULL, '2021-11-18 12:01:58', '2021-11-18 12:01:58'),
(23743, 11056, 22330, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Rep: Arianne E   Status: Applications are still in process. Welcome letters can be expected soon.   Refcode: 11302021Ariannee', NULL, NULL, '2021-11-30 17:32:55', '2021-11-30 17:32:55'),
(23744, 11056, 22330, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Rep: Mark C  Status:  11/1/2021 linked and credentialed under the facility TIN.  Plans:  Aetna Medicare Aetna Medicaid  Refcode: 6062355331', NULL, NULL, '2021-12-08 12:42:57', '2021-12-08 12:42:57'),
(23745, 11056, 22330, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Rep: Gelo C   Status:Fully loaded in the system.Gonna receive soon a welcome letter  Ref code: 6065804152', NULL, NULL, '2021-12-22 13:55:12', '2021-12-22 13:55:12'),
(23746, 20067, 22330, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: sidleyj1@firsthealth.com  Subject:  First Health Network Dr. Ramegowda Belakere & Glory Abraham & Shybi Varghese TIN 85-3252700 Case# 14095695   Good Afternoon, Hope you had a great day. I would like to know the enrollment status of the below-mentioned providers under Right Step Medical Center LLC.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite# 12, Stafford, TX 77477-2300 Provider Name	NPI Ancy Kurian	1316558935 SHYBI VARGHESE	1285270991 Glory Abraham	1194206490  Eagerly waiting for your response.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 17:50:52', '2022-01-06 17:50:52'),
(23747, 19067, 22330, NULL, '2022-02-01 00:00:00.000', 'Approved', 'See attachment for provider directory.', NULL, NULL, '2022-01-25 15:41:22', '2022-01-25 15:41:22'),
(23748, 1006, 22331, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:48:05', '2021-03-16 15:48:05'),
(23749, 1006, 22331, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Sent following enrollment request email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Hello,   We wish to enroll/contract our providers with Health Smart, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-04-01 11:26:00', '2021-04-01 11:26:00'),
(23750, 1006, 22331, NULL, '2021-04-08 00:00:00.000', 'In Process', 'We received the following reply from @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Thank you for your interest in joining the Healthsmart network.  Please click the link below and complete the group join our network form.  https://www.healthsmart.com/Service-Centers/Provider-Center/Join-Our-Network  Thank you,  Michelle Adams | Provider Relations HealthSmart | Network Solutions 222 W. Las Colinas Blvd | Suite 500 N | Irving, TX 75039 www.HealthSmart.com \"  Group enrollment request submitted via HealthSmart portal. Attached for reference in group task. ', NULL, NULL, '2021-04-01 14:48:39', '2021-04-01 14:48:39'),
(23751, 1006, 22331, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Sent a f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Hello,   I am still waiting on an update on the enrollment request that we submitted, has it been received? If so, what is the enrollment time frame?  Thank you. \"', NULL, NULL, '2021-04-06 11:52:35', '2021-04-06 11:52:35'),
(23752, 1006, 22331, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent a f/u @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Good morning,  I wanted to get an update regarding the status of enrollment for the following group and providers: Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible as the request has been pending for over a month.   Thank you. \"', NULL, NULL, '2021-05-03 08:09:56', '2021-05-03 08:09:56'),
(23753, 1006, 22331, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,  We want to get an update regarding the enrollment status for the following providers under the mentioned group: Group Name: Right Step Medical Center LLC TIN# 85-3252700 Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible regarding the status of our providers. Thank you.\"', NULL, NULL, '2021-05-31 13:18:25', '2021-05-31 13:18:25'),
(23754, 1006, 22331, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Submitted enrollment forms and contract @ pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,   Please find the attached information as requested, do let me know if anything else is required.  Thank you!\" ', NULL, NULL, '2021-06-17 17:25:35', '2021-06-17 17:25:35'),
(23755, 1006, 22331, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group and providers:   Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-07 13:29:42', '2021-07-07 13:29:42'),
(23756, 1006, 22331, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com', NULL, NULL, '2021-07-27 17:12:31', '2021-07-27 17:12:31'),
(23757, 1006, 22331, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Received the following update from mdiprsupport@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hi,  Thank you for your submission. The applications have been forwarded to credentialing for the following providers. Please follow up in 30 days for a status.  Providers Name GLORY ABRAHAM, NP RAMEGOWDA BELAKERE, MD SHYBI VARGHESE, NP  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :77868)  Thanks HealthSmart Provider Relations.\"', NULL, NULL, '2021-07-30 08:23:00', '2021-07-30 08:23:00'),
(23758, 1006, 22331, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Sent f/u email @ pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers:  Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-08-11 13:03:20', '2021-08-11 13:03:20'),
(23759, 1006, 22331, NULL, '2021-08-20 00:00:00.000', 'In Process', 'We received the following update from pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hi,  Below providers are currently in the credentialing process.  Providers Name GLORY ABRAHAM, NP RAMEGOWDA BELAKERE, MD SHYBI VARGHESE, NP  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :77868)  Thanks HealthSmart Provider Relations.\"', NULL, NULL, '2021-08-13 09:38:24', '2021-08-13 09:38:24'),
(23760, 1006, 22331, NULL, '2021-08-23 00:00:00.000', 'In Process', 'We received the following update from Leslie.Perez@healthsmart.com:  Sub; Shybi Varghese NPI 1285270991  \"Hello,  I need the following information on Shybi Varghese NPI 1285270991.  Once, I\'ve obtained this information I will continue to credential this provider.                     Copy of current board of specialty --   American Academy of Nurse Practitioners   Thank you,  Leslie Perez Credentialing Specialist 222 W. Las Colinas Blvd., Suite 500N Irving, TX 75039 PH:  214-574-1152   FAX 214-574-2368 Leslie.Perez@HealthSmart.com www.HealthSmart.com\"  Replied with AANP. ', NULL, NULL, '2021-08-16 15:40:10', '2021-08-16 15:40:10'),
(23761, 1006, 22331, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Sent f/u email @ pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,   I wanted to get an update regarding the credentialing status for the following providers under our group:  Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-25 16:08:37', '2021-08-25 16:08:37'),
(23762, 11056, 22331, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Good Afternoon!  Hope this email finds you well. Please provide us with a welcome letter or approval letter as soon as possible.  Please assist us in adding these providers and practice on the Health smart\'s directory.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-09-02 16:32:51', '2021-09-02 16:32:51'),
(23763, 11056, 22331, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Enrollment Status - HealthSmart - RSM  The committee will approve this month and then welcome letters are generated and mailed out. Please allow 45 days.     Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions Office: 214 574 1174 I Fax: 214 574 2368 6303 Commerce Drive | Suite 180 | Irving, TX 75039 pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-09-17 12:05:33', '2021-09-17 12:05:33'),
(23764, 11056, 22331, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM  Good morning Diamond!  Hope this email finds you well. Please assist us in adding these providers and practice on the Health smart\'s directory. Kindly assist us regarding checking patients before the effective date. Is it possible to take patients in back date?  Thank you! Have a wonderful day!', NULL, NULL, '2021-09-27 13:41:56', '2021-09-27 13:41:56'),
(23765, 11056, 22331, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM  Good morning Diamond!  Hope this email finds you well. Hey! You haven\'t responded to my last query yet. And I am still waiting to get the welcome letter, kindly provide that soon.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank You! Have a great day!', NULL, NULL, '2021-10-04 12:41:44', '2021-10-04 12:41:44'),
(23766, 11056, 22331, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM   As a reminder, The committee met last week, letters will be generated and mailed in the next two weeks.   Diamond Lucero |Sr. Provider Relations HealthSmart | Network Solutions 6303 Commerce Drive | Suite 180 | Irving, TX 75039', NULL, NULL, '2021-10-13 09:55:39', '2021-10-13 09:55:39'),
(23767, 11056, 22331, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub  : Re: Fw: Enrollment Status - HealthSmart - RSM   Good morning!  Hope all is well with you. Please provide me with a welcome letter whenever it is convenient for you. Please assist me regarding the group enrollment too.  Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-10-20 15:38:41', '2021-10-20 15:38:41'),
(23768, 11056, 22331, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com>  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM  Good morning!  Hope all is well with you. It has been a long time since I asked you guys for the welcome or approval letters for all 3 providers, although I haven\'t received them yet.  Please provide me with that at your earliest convenience.  Kindly respond to my query soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-01 08:42:15', '2021-11-01 08:42:15'),
(23769, 11056, 22331, NULL, '2021-11-18 00:00:00.000', 'Approved', 'Email received from: mdiprsupport@healthsmart.com  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM  Hi,  Please see below the provider\'s effective date.  Provider Name                                  Effective Date  Ramegowda Belakere, MD     10/01/2021   Glory Abraham, NP   10/01/2021   Shybi Varghese, NP       10/01/2021    All communication, including requested documents, should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.  (Inventory Log ID:77868)  Thanks. HealthSmart Provider Relations.   Please see the attachment.', NULL, NULL, '2021-11-11 17:12:46', '2021-11-11 17:12:46'),
(23770, 1006, 22332, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:48:07', '2021-03-16 15:48:07'),
(23771, 1006, 22332, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Sent following enrollment request email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Hello,   We wish to enroll/contract our providers with Health Smart, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-04-01 11:25:50', '2021-04-01 11:25:50'),
(23772, 1006, 22332, NULL, '2021-04-08 00:00:00.000', 'In Process', 'We received the following reply from @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Thank you for your interest in joining the Healthsmart network.  Please click the link below and complete the group join our network form.  https://www.healthsmart.com/Service-Centers/Provider-Center/Join-Our-Network  Thank you,  Michelle Adams | Provider Relations HealthSmart | Network Solutions 222 W. Las Colinas Blvd | Suite 500 N | Irving, TX 75039 www.HealthSmart.com \"  Group enrollment request submitted via HealthSmart portal. Attached for reference in group task. ', NULL, NULL, '2021-04-01 14:48:47', '2021-04-01 14:48:47'),
(23773, 1006, 22332, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Sent a f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Hello,   I am still waiting on an update on the enrollment request that we submitted, has it been received? If so, what is the enrollment time frame?  Thank you. \"', NULL, NULL, '2021-04-06 11:52:43', '2021-04-06 11:52:43'),
(23774, 1006, 22332, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent a f/u @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Good morning,  I wanted to get an update regarding the status of enrollment for the following group and providers: Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible as the request has been pending for over a month.   Thank you. \"', NULL, NULL, '2021-05-03 08:09:53', '2021-05-03 08:09:53'),
(23775, 1006, 22332, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,  We want to get an update regarding the enrollment status for the following providers under the mentioned group: Group Name: Right Step Medical Center LLC TIN# 85-3252700 Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible regarding the status of our providers. Thank you.\"', NULL, NULL, '2021-05-31 13:18:18', '2021-05-31 13:18:18'),
(23776, 1006, 22332, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Submitted enrollment forms and contract @ pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,   Please find the attached information as requested, do let me know if anything else is required.  Thank you!\"', NULL, NULL, '2021-06-17 17:22:53', '2021-06-17 17:22:53'),
(23777, 1006, 22332, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group and providers:   Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-07 13:29:38', '2021-07-07 13:29:38'),
(23778, 1006, 22332, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com', NULL, NULL, '2021-07-27 17:12:28', '2021-07-27 17:12:28'),
(23779, 1006, 22332, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Received the following update from mdiprsupport@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hi,  Thank you for your submission. The applications have been forwarded to credentialing for the following providers. Please follow up in 30 days for a status.  Providers Name GLORY ABRAHAM, NP RAMEGOWDA BELAKERE, MD SHYBI VARGHESE, NP  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :77868)  Thanks HealthSmart Provider Relations.\"', NULL, NULL, '2021-07-30 08:22:57', '2021-07-30 08:22:57'),
(23780, 1006, 22332, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Sent f/u email @ pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers:  Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-08-11 13:03:16', '2021-08-11 13:03:16'),
(23781, 1006, 22332, NULL, '2021-08-20 00:00:00.000', 'In Process', 'We received the following update from pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hi,  Below providers are currently in the credentialing process.  Providers Name GLORY ABRAHAM, NP RAMEGOWDA BELAKERE, MD SHYBI VARGHESE, NP  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :77868)  Thanks HealthSmart Provider Relations.\"', NULL, NULL, '2021-08-13 09:30:38', '2021-08-13 09:30:38'),
(23782, 1006, 22332, NULL, '2021-08-20 00:00:00.000', 'In Process', 'We received the following update from pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hi,  Below providers are currently in the credentialing process.  Providers Name GLORY ABRAHAM, NP RAMEGOWDA BELAKERE, MD SHYBI VARGHESE, NP  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :77868)  Thanks HealthSmart Provider Relations.\"', NULL, NULL, '2021-08-13 09:38:35', '2021-08-13 09:38:35'),
(23783, 1006, 22332, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Sent f/u email @ pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,   I wanted to get an update regarding the credentialing status for the following providers under our group:  Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-25 16:08:33', '2021-08-25 16:08:33'),
(23784, 11056, 22332, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Good Afternoon!  Hope this email finds you well. Please provide us with a welcome letter or approval letter as soon as possible.  Please assist us in adding these providers and practice on the Health smart\'s directory.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-09-02 16:32:46', '2021-09-02 16:32:46'),
(23785, 11056, 22332, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Enrollment Status - HealthSmart - RSM  The committee will approve this month and then welcome letters are generated and mailed out. Please allow 45 days.     Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions Office: 214 574 1174 I Fax: 214 574 2368 6303 Commerce Drive | Suite 180 | Irving, TX 75039 pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-09-17 12:05:28', '2021-09-17 12:05:28'),
(23786, 11056, 22332, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM  Good morning Diamond!  Hope this email finds you well. Please assist us in adding these providers and practice on the Health smart\'s directory. Kindly assist us regarding checking patients before the effective date. Is it possible to take patients in back date?  Thank you! Have a wonderful day!', NULL, NULL, '2021-09-27 13:41:51', '2021-09-27 13:41:51'),
(23787, 11056, 22332, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM  Good morning Diamond!  Hope this email finds you well. Hey! You haven\'t responded to my last query yet. And I am still waiting to get the welcome letter, kindly provide that soon.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank You! Have a great day!', NULL, NULL, '2021-10-04 12:41:36', '2021-10-04 12:41:36'),
(23788, 11056, 22332, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM   As a reminder, The committee met last week, letters will be generated and mailed in the next two weeks.   Diamond Lucero |Sr. Provider Relations HealthSmart | Network Solutions 6303 Commerce Drive | Suite 180 | Irving, TX 75039', NULL, NULL, '2021-10-13 09:55:34', '2021-10-13 09:55:34'),
(23789, 11056, 22332, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub  : Re: Fw: Enrollment Status - HealthSmart - RSM   Good morning!  Hope all is well with you. Please provide me with a welcome letter whenever it is convenient for you. Please assist me regarding the group enrollment too.  Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-10-20 15:38:30', '2021-10-20 15:38:30'),
(23790, 11056, 22332, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com>  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM  Good morning!  Hope all is well with you. It has been a long time since I asked you guys for the welcome or approval letters for all 3 providers, although I haven\'t received them yet.  Please provide me with that at your earliest convenience.  Kindly respond to my query soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-01 08:42:09', '2021-11-01 08:42:09'),
(23791, 11056, 22332, NULL, '2021-11-18 00:00:00.000', 'Approved', 'Email received from: mdiprsupport@healthsmart.com  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM  Hi,  Please see below the provider\'s effective date.  Provider Name                                  Effective Date  Ramegowda Belakere, MD     10/01/2021   Glory Abraham, NP   10/01/2021   Shybi Varghese, NP       10/01/2021    All communication, including requested documents, should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.  (Inventory Log ID:77868)  Thanks. HealthSmart Provider Relations.   Please see the attachment.', NULL, NULL, '2021-11-11 17:12:31', '2021-11-11 17:12:31'),
(23792, 1006, 22333, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:48:08', '2021-03-16 15:48:08'),
(23793, 1006, 22333, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Sent following enrollment request email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Hello,   We wish to enroll/contract our providers with Health Smart, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-04-01 11:26:05', '2021-04-01 11:26:05'),
(23794, 1006, 22333, NULL, '2021-04-08 00:00:00.000', 'In Process', 'We received the following reply from @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Thank you for your interest in joining the Healthsmart network.  Please click the link below and complete the group join our network form.  https://www.healthsmart.com/Service-Centers/Provider-Center/Join-Our-Network  Thank you,  Michelle Adams | Provider Relations HealthSmart | Network Solutions 222 W. Las Colinas Blvd | Suite 500 N | Irving, TX 75039 www.HealthSmart.com \"  Group enrollment request submitted via HealthSmart portal. Attached for reference in group task. ', NULL, NULL, '2021-04-01 14:48:51', '2021-04-01 14:48:51'),
(23795, 1006, 22333, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Sent a f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Hello,   I am still waiting on an update on the enrollment request that we submitted, has it been received? If so, what is the enrollment time frame?  Thank you. \"', NULL, NULL, '2021-04-06 11:52:47', '2021-04-06 11:52:47'),
(23796, 1006, 22333, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent a f/u @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Good morning,  I wanted to get an update regarding the status of enrollment for the following group and providers: Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible as the request has been pending for over a month.   Thank you. \"', NULL, NULL, '2021-05-03 08:09:51', '2021-05-03 08:09:51'),
(23797, 1006, 22333, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,  We want to get an update regarding the enrollment status for the following providers under the mentioned group: Group Name: Right Step Medical Center LLC TIN# 85-3252700 Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible regarding the status of our providers. Thank you.\"', NULL, NULL, '2021-05-31 13:18:30', '2021-05-31 13:18:30'),
(23798, 1006, 22333, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Submitted enrollment forms and contract @ pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,   Please find the attached information as requested, do let me know if anything else is required.  Thank you!\"', NULL, NULL, '2021-06-17 17:22:41', '2021-06-17 17:22:41'),
(23799, 1006, 22333, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the mentioned group and providers:   Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-07 13:29:33', '2021-07-07 13:29:33'),
(23800, 1006, 22333, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com', NULL, NULL, '2021-07-27 17:12:24', '2021-07-27 17:12:24'),
(23801, 1006, 22333, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Received the following update from mdiprsupport@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hi,  Thank you for your submission. The applications have been forwarded to credentialing for the following providers. Please follow up in 30 days for a status.  Providers Name GLORY ABRAHAM, NP RAMEGOWDA BELAKERE, MD SHYBI VARGHESE, NP  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :77868)  Thanks HealthSmart Provider Relations.\"', NULL, NULL, '2021-07-30 08:22:53', '2021-07-30 08:22:53'),
(23802, 1006, 22333, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Sent f/u email @ pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers:  Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-08-11 13:03:09', '2021-08-11 13:03:09'),
(23803, 1006, 22333, NULL, '2021-08-20 00:00:00.000', 'In Process', 'We received the following update from pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hi,  Below providers are currently in the credentialing process.  Providers Name GLORY ABRAHAM, NP RAMEGOWDA BELAKERE, MD SHYBI VARGHESE, NP  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID :77868)  Thanks HealthSmart Provider Relations.\"', NULL, NULL, '2021-08-13 09:30:22', '2021-08-13 09:30:22'),
(23804, 1006, 22333, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Sent f/u email @ pr.south@healthsmart.com:  Sub: Enrollment Status - HealthSmart - RSM  \"Hello,   I wanted to get an update regarding the credentialing status for the following providers under our group:  Group Name: Right Step Medical Center LLC TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-25 16:08:28', '2021-08-25 16:08:28'),
(23805, 11056, 22333, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Good Afternoon!  Hope this email finds you well. Please provide us with a welcome letter or approval letter as soon as possible.  Please assist us in adding these providers and practice on the Health smart\'s directory.  Practice Details : Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  Provider Name: Glory Abraham Provider NPI # : 1194206490  Provider Name: Shybi Varghese Provider NPI # :1285270991  If you need any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-09-02 16:32:41', '2021-09-02 16:32:41'),
(23806, 11056, 22333, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Enrollment Status - HealthSmart - RSM  The committee will approve this month and then welcome letters are generated and mailed out. Please allow 45 days.     Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions Office: 214 574 1174 I Fax: 214 574 2368 6303 Commerce Drive | Suite 180 | Irving, TX 75039 pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-09-17 12:05:08', '2021-09-17 12:05:08'),
(23807, 11056, 22333, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM  Good morning Diamond!  Hope this email finds you well. Please assist us in adding these providers and practice on the Health smart\'s directory. Kindly assist us regarding checking patients before the effective date. Is it possible to take patients in back date?  Thank you! Have a wonderful day!', NULL, NULL, '2021-09-27 13:41:32', '2021-09-27 13:41:32');
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
(23808, 11056, 22333, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM  Good morning Diamond!  Hope this email finds you well. Hey! You haven\'t responded to my last query yet. And I am still waiting to get the welcome letter, kindly provide that soon.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank You! Have a great day!', NULL, NULL, '2021-10-04 12:41:11', '2021-10-04 12:41:11'),
(23809, 11056, 22333, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM   As a reminder, The committee met last week, letters will be generated and mailed in the next two weeks.   Diamond Lucero |Sr. Provider Relations HealthSmart | Network Solutions 6303 Commerce Drive | Suite 180 | Irving, TX 75039', NULL, NULL, '2021-10-13 09:55:18', '2021-10-13 09:55:18'),
(23810, 11056, 22333, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub  : Re: Fw: Enrollment Status - HealthSmart - RSM   Good morning!  Hope all is well with you. Please provide me with a welcome letter whenever it is convenient for you. Please assist me regarding the group enrollment too.  Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-10-20 15:38:11', '2021-10-20 15:38:11'),
(23811, 11056, 22333, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com>  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM  Good morning!  Hope all is well with you. It has been a long time since I asked you guys for the welcome or approval letters for all 3 providers, although I haven\'t received them yet.  Please provide me with that at your earliest convenience.  Kindly respond to my query soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-01 08:41:55', '2021-11-01 08:41:55'),
(23812, 11056, 22333, NULL, '2021-11-18 00:00:00.000', 'Approved', 'Email received from: mdiprsupport@healthsmart.com  Sub : Re: Fw: Enrollment Status - HealthSmart - RSM  Hi,  Please see below the provider\'s effective date.  Provider Name                                  Effective Date  Ramegowda Belakere, MD     10/01/2021   Glory Abraham, NP   10/01/2021   Shybi Varghese, NP       10/01/2021    All communication, including requested documents, should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.  (Inventory Log ID:77868)  Thanks. HealthSmart Provider Relations.   Please see the attachment.', NULL, NULL, '2021-11-11 17:11:39', '2021-11-11 17:11:39'),
(23813, 1006, 22334, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:48:09', '2021-03-16 15:48:09'),
(23814, 1006, 22334, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Sent following enrollment request email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Hello,   We wish to enroll/contract our providers with Health Smart, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-04-01 11:25:43', '2021-04-01 11:25:43'),
(23815, 1006, 22334, NULL, '2021-04-08 00:00:00.000', 'In Process', 'We received the following reply from @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Thank you for your interest in joining the Healthsmart network.  Please click the link below and complete the group join our network form.  https://www.healthsmart.com/Service-Centers/Provider-Center/Join-Our-Network  Thank you,  Michelle Adams | Provider Relations HealthSmart | Network Solutions 222 W. Las Colinas Blvd | Suite 500 N | Irving, TX 75039 www.HealthSmart.com \"  Group enrollment request submitted via HealthSmart portal. Attached for reference. ', NULL, NULL, '2021-04-01 14:44:50', '2021-04-01 14:44:50'),
(23816, 1006, 22334, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Sent a f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Hello,   I am still waiting on an update on the enrollment request that we submitted, has it been received? If so, what is the enrollment time frame?  Thank you. \"', NULL, NULL, '2021-04-06 11:52:52', '2021-04-06 11:52:52'),
(23817, 1006, 22334, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent a f/u @ Provider Relations - South pr.south@healthsmart.com:  Sub: Provider Enrollment - RSM - Health Smart  \"Good morning,  I wanted to get an update regarding the status of enrollment for the following group and providers: Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible as the request has been pending for over a month.   Thank you. \"', NULL, NULL, '2021-05-03 08:09:49', '2021-05-03 08:09:49'),
(23818, 1006, 22334, NULL, '2021-06-07 00:00:00.000', 'Not Eligible', 'The group is unable to be enrolled with Healthsmart, only Anci-Care allows group enrollment under group. ', NULL, NULL, '2021-05-31 13:19:21', '2021-05-31 13:19:21'),
(23819, 3040, 22335, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:48:14', '2021-03-16 15:48:14'),
(23820, 3040, 22335, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicaid approval. ', NULL, NULL, '2021-04-01 14:35:04', '2021-04-01 14:35:04'),
(23821, 3040, 22335, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Group request from filled and send it for mail. ', NULL, NULL, '2021-04-02 16:53:30', '2021-04-02 16:53:30'),
(23822, 3040, 22335, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: baileyk@usamco.com  Subject: Ladot Heathcare LLC Exhibit B  Exhibit B form sent out to Bailey', NULL, NULL, '2021-05-06 12:51:46', '2021-05-06 12:51:46'),
(23823, 3040, 22335, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: baileyk@usamco.com  Subject:  Ladot Heathcare LLC Exhibit B  Hello Kristen,   I wanted to follow up regarding the enrollment status for the below mentioned group & providers in MCO for our group Ladot Health Care LLC under below locations.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573   Provider 1: Provider Name: Dada, Oladipo Provider NPI# 1760700223   Provider 2:   Provider Name: Dada, Atinuke Provider NPI# 1154782720 Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-25 15:58:50', '2021-05-25 15:58:50'),
(23824, 1006, 22335, NULL, '2021-06-16 00:00:00.000', 'In Process', 'We received the following reply from \"Kirsten Bailey\" baileyk@usamco.com:  \"The Ex B was returned.  I just need the documents that were listed on the ancillary list and if there is no Accreditation that note and the NPDB form as you did with the other and that one will be complete.  Thanks Brad\"  Need to send her the requested documents.', NULL, NULL, '2021-06-09 16:47:05', '2021-06-09 16:47:05'),
(23825, 1006, 22335, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Replied to Kirsten with the requested information @ \"Kirsten Bailey\" baileyk@usamco.com ', NULL, NULL, '2021-06-09 17:14:47', '2021-06-09 17:14:47'),
(23826, 1006, 22335, NULL, '2021-06-18 00:00:00.000', 'In Process', 'We received the following reply from Kirsten: \"Good Morning,  Thank you Brad, I will work on this!  Kirsten\"', NULL, NULL, '2021-06-11 10:16:28', '2021-06-11 10:16:28'),
(23827, 1006, 22335, NULL, '2021-06-30 00:00:00.000', 'In Process', 'We received the following email from Kirsten Bailey baileyk@usamco.com:  Sub: Ladot  \"Good Morning Brad,  Credentialing is requesting an urgent care license for Ladot, do you have this?  Thank you, J  USA MCO rising star Kirsten Bailey, Provider Network Development Rep USA Managed Care Organization usamco.com Austin: P: 512.306.0201 Ext. 4486 F: 512.306.1369\"  Replied: \"Hello Kirsten,   I apologize for the confusion, Ladot is not an urgent care. It\'s currently a telehealth clinic.   What can we do to get this information updated?  Thank you!\"  and reply received:  \"Hi Brad,  I have updated the information and will not require the license, credentialing just wants to clarify a few things so that the listing in the directory can be correct.  Thanks  Kirsten Bailey Provider Network Development Rep\"  ', NULL, NULL, '2021-06-23 09:10:10', '2021-06-23 09:10:10'),
(23828, 1006, 22335, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ Kirsten Bailey baileyk@usamco.com:  Sub: Ladot  \"Hello Kirsten,   I hope you\'re doing well, I just wanted to check in on the status of enrollment for Ladot Healthcare, could you please let me know?  Thank you. \"', NULL, NULL, '2021-07-08 16:49:54', '2021-07-08 16:49:54'),
(23829, 1006, 22335, NULL, '2021-07-20 00:00:00.000', 'In Process', 'We received the following update from Kirsten Bailey baileyk@usamco.com:  Sub: Ladot  \"Good Morning Brad,  Hope all is well! Just an update in case you have not received one.  Ladot is complete and the effective date is 06/18/21, provider ID is 1318438- please let me know if there is anything is you need.  Thanks\"  Replied with:  \"Hello Kirsten,   I appreciate the update, can you please send us a copy of the executed contract for our records?  Thank you.\"', NULL, NULL, '2021-07-13 10:38:55', '2021-07-13 10:38:55'),
(23830, 11056, 22335, NULL, '2021-07-24 00:00:00.000', 'Approved', 'Received the following approval confirmation from : MyartL@usamco.com  Sub:  LADOT HEALTHCARE LLC Final Packet  Good morning ,  Attached is the Final Packet for your facility Ladot Healthcare LLC effective 6/18/2021.  If you have any questions please feel free to give me a call.  Thank you.  LaNetrice Myart, PNA Director USA Managed Care Organization usamco.com Austin: P: 512.306.0201 ext.4138 F: 512.306.1921', NULL, NULL, '2021-07-16 16:52:30', '2021-07-16 16:52:30'),
(23831, 3040, 22336, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:48:22', '2021-03-16 15:48:22'),
(23832, 3040, 22336, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicare & Medicaid approval. ', NULL, NULL, '2021-04-01 14:35:19', '2021-04-01 14:35:19'),
(23833, 3040, 22336, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Group request from filled and send it for mail. ', NULL, NULL, '2021-04-02 16:53:29', '2021-04-02 16:53:29'),
(23834, 3040, 22336, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: baileyk@usamco.com  Subject: Ladot Heathcare LLC Exhibit B  Exhibit B form sent out to Bailey  ', NULL, NULL, '2021-05-06 12:51:46', '2021-05-06 12:51:46'),
(23835, 3040, 22336, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: baileyk@usamco.com  Subject:  Ladot Heathcare LLC Exhibit B  Hello Kristen,   I wanted to follow up regarding the enrollment status for the below mentioned group & providers in MCO for our group Ladot Health Care LLC under below locations.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573   Provider 1: Provider Name: Dada, Oladipo Provider NPI# 1760700223   Provider 2:   Provider Name: Dada, Atinuke Provider NPI# 1154782720 Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-25 15:58:54', '2021-05-25 15:58:54'),
(23836, 1006, 22336, NULL, '2021-06-16 00:00:00.000', 'In Process', 'We received the following reply from \"Kirsten Bailey\" baileyk@usamco.com:  \"The Ex B was returned.  I just need the documents that were listed on the ancillary list and if there is no Accreditation that note and the NPDB form as you did with the other and that one will be complete.  Thanks Brad\"  Need to send her the requested documents.', NULL, NULL, '2021-06-09 16:47:01', '2021-06-09 16:47:01'),
(23837, 1006, 22336, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Replied to Kirsten with the requested information @ \"Kirsten Bailey\" baileyk@usamco.com ', NULL, NULL, '2021-06-09 17:14:42', '2021-06-09 17:14:42'),
(23838, 1006, 22336, NULL, '2021-06-18 00:00:00.000', 'In Process', 'We received the following reply from Kirsten: \"Good Morning,  Thank you Brad, I will work on this!  Kirsten\"', NULL, NULL, '2021-06-11 10:16:24', '2021-06-11 10:16:24'),
(23839, 1006, 22336, NULL, '2021-06-30 00:00:00.000', 'In Process', 'We received the following email from Kirsten Bailey baileyk@usamco.com:  Sub: Ladot  \"Good Morning Brad,  Credentialing is requesting an urgent care license for Ladot, do you have this?  Thank you, J  USA MCO rising star Kirsten Bailey, Provider Network Development Rep USA Managed Care Organization usamco.com Austin: P: 512.306.0201 Ext. 4486 F: 512.306.1369\"  Replied: \"Hello Kirsten,   I apologize for the confusion, Ladot is not an urgent care. It\'s currently a telehealth clinic.   What can we do to get this information updated?  Thank you!\"  and reply received:  \"Hi Brad,  I have updated the information and will not require the license, credentialing just wants to clarify a few things so that the listing in the directory can be correct.  Thanks  Kirsten Bailey Provider Network Development Rep\"  ', NULL, NULL, '2021-06-23 09:10:07', '2021-06-23 09:10:07'),
(23840, 1006, 22336, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ Kirsten Bailey baileyk@usamco.com:  Sub: Ladot  \"Hello Kirsten,   I hope you\'re doing well, I just wanted to check in on the status of enrollment for Ladot Healthcare, could you please let me know?  Thank you. \"', NULL, NULL, '2021-07-08 16:50:03', '2021-07-08 16:50:03'),
(23841, 1006, 22336, NULL, '2021-07-20 00:00:00.000', 'In Process', 'We received the following update from Kirsten Bailey baileyk@usamco.com:  Sub: Ladot  \"Good Morning Brad,  Hope all is well! Just an update in case you have not received one.  Ladot is complete and the effective date is 06/18/21, provider ID is 1318438- please let me know if there is anything is you need.  Thanks\"  Replied with:  \"Hello Kirsten,   I appreciate the update, can you please send us a copy of the executed contract for our records?  Thank you.\"', NULL, NULL, '2021-07-13 10:38:51', '2021-07-13 10:38:51'),
(23842, 11056, 22336, NULL, '2021-07-24 00:00:00.000', 'Approved', 'Received the following approval confirmation from : MyartL@usamco.com  Sub:  LADOT HEALTHCARE LLC Final Packet  Good morning ,  Attached is the Final Packet for your facility Ladot Healthcare LLC effective 6/18/2021.  If you have any questions please feel free to give me a call.  Thank you.  LaNetrice Myart, PNA Director USA Managed Care Organization usamco.com Austin: P: 512.306.0201 ext.4138 F: 512.306.1921', NULL, NULL, '2021-07-16 16:52:40', '2021-07-16 16:52:40'),
(23843, 3040, 22337, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:48:29', '2021-03-16 15:48:29'),
(23844, 3040, 22337, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicaid approval. ', NULL, NULL, '2021-04-01 14:35:09', '2021-04-01 14:35:09'),
(23845, 3040, 22337, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Group request from filled and send it for mail. ', NULL, NULL, '2021-04-02 16:53:28', '2021-04-02 16:53:28'),
(23846, 3040, 22337, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: baileyk@usamco.com  Subject: Ladot Heathcare LLC Exhibit B  Exhibit B form sent out to Bailey', NULL, NULL, '2021-05-06 12:51:47', '2021-05-06 12:51:47'),
(23847, 3040, 22337, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: baileyk@usamco.com  Subject:  Ladot Heathcare LLC Exhibit B  Hello Kristen,   I wanted to follow up regarding the enrollment status for the below mentioned group & providers in MCO for our group Ladot Health Care LLC under below locations.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573   Provider 1: Provider Name: Dada, Oladipo Provider NPI# 1760700223   Provider 2:   Provider Name: Dada, Atinuke Provider NPI# 1154782720 Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-25 15:58:58', '2021-05-25 15:58:58'),
(23848, 1006, 22337, NULL, '2021-06-16 00:00:00.000', 'In Process', 'We received the following reply from \"Kirsten Bailey\" baileyk@usamco.com:  \"The Ex B was returned.  I just need the documents that were listed on the ancillary list and if there is no Accreditation that note and the NPDB form as you did with the other and that one will be complete.  Thanks Brad\"  Need to send her the requested documents.', NULL, NULL, '2021-06-09 16:46:54', '2021-06-09 16:46:54'),
(23849, 1006, 22337, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Replied to Kirsten with the requested information @ \"Kirsten Bailey\" baileyk@usamco.com ', NULL, NULL, '2021-06-09 17:14:35', '2021-06-09 17:14:35'),
(23850, 1006, 22337, NULL, '2021-06-18 00:00:00.000', 'In Process', 'We received the following reply from Kirsten: \"Good Morning,  Thank you Brad, I will work on this!  Kirsten\"', NULL, NULL, '2021-06-11 10:16:17', '2021-06-11 10:16:17'),
(23851, 1006, 22337, NULL, '2021-06-30 00:00:00.000', 'In Process', 'We received the following email from Kirsten Bailey baileyk@usamco.com:  Sub: Ladot  \"Good Morning Brad,  Credentialing is requesting an urgent care license for Ladot, do you have this?  Thank you, J  USA MCO rising star Kirsten Bailey, Provider Network Development Rep USA Managed Care Organization usamco.com Austin: P: 512.306.0201 Ext. 4486 F: 512.306.1369\"  Replied: \"Hello Kirsten,   I apologize for the confusion, Ladot is not an urgent care. It\'s currently a telehealth clinic.   What can we do to get this information updated?  Thank you!\"  and reply received:  \"Hi Brad,  I have updated the information and will not require the license, credentialing just wants to clarify a few things so that the listing in the directory can be correct.  Thanks  Kirsten Bailey Provider Network Development Rep\"  ', NULL, NULL, '2021-06-23 09:10:03', '2021-06-23 09:10:03'),
(23852, 1006, 22337, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ Kirsten Bailey baileyk@usamco.com:  Sub: Ladot  \"Hello Kirsten,   I hope you\'re doing well, I just wanted to check in on the status of enrollment for Ladot Healthcare, could you please let me know?  Thank you. \"', NULL, NULL, '2021-07-08 16:50:00', '2021-07-08 16:50:00'),
(23853, 1006, 22337, NULL, '2021-07-20 00:00:00.000', 'In Process', 'We received the following update from Kirsten Bailey baileyk@usamco.com:  Sub: Ladot  \"Good Morning Brad,  Hope all is well! Just an update in case you have not received one.  Ladot is complete and the effective date is 06/18/21, provider ID is 1318438- please let me know if there is anything is you need.  Thanks\"  Replied with:  \"Hello Kirsten,   I appreciate the update, can you please send us a copy of the executed contract for our records?  Thank you.\"', NULL, NULL, '2021-07-13 10:38:30', '2021-07-13 10:38:30'),
(23854, 11056, 22337, NULL, '2021-07-24 00:00:00.000', 'Approved', 'Received the following approval confirmation from : MyartL@usamco.com  Sub:  LADOT HEALTHCARE LLC Final Packet  Good morning ,  Attached is the Final Packet for your facility Ladot Healthcare LLC effective 6/18/2021.  If you have any questions please feel free to give me a call.  Thank you.  LaNetrice Myart, PNA Director USA Managed Care Organization usamco.com Austin: P: 512.306.0201 ext.4138 F: 512.306.1921', NULL, NULL, '2021-07-16 16:51:33', '2021-07-16 16:51:33'),
(23855, 3040, 22338, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:06', '2021-03-16 15:49:06'),
(23856, 3040, 22338, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Application Status Submitted		 PEP Ticket Number 17686552 ', NULL, NULL, '2021-04-01 12:52:49', '2021-04-01 12:52:49'),
(23857, 3040, 22338, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Application Status PEP Ticket Number Submitted		17802673 ', NULL, NULL, '2021-05-24 12:17:53', '2021-05-24 12:17:53'),
(23858, 1005, 22338, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Checked online. The application is on \"In Progress\" status.', NULL, NULL, '2021-05-27 09:59:39', '2021-05-27 09:59:39'),
(23859, 1005, 22338, NULL, '2021-06-12 00:00:00.000', 'In Process', 'Checked online. Current Status: In Progress.', NULL, NULL, '2021-06-04 15:01:00', '2021-06-04 15:01:00'),
(23860, 1005, 22338, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Checked online. Current Status: In Progress.', NULL, NULL, '2021-06-09 15:23:57', '2021-06-09 15:23:57'),
(23861, 1006, 22338, NULL, '2021-06-21 00:00:00.000', 'Approved', 'The group has been enrolled with Medicaid. Approval confirmation is attached for reference.   Eff date: 12/03/2021 TPI# 423440301', NULL, NULL, '2021-06-14 10:21:35', '2021-06-14 10:21:35'),
(23862, 3046, 22339, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:12', '2021-03-16 15:49:12'),
(23863, 1006, 22339, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Sent following email @ intake_pdm@cigna.com: \"Hello,   Please find the attached LOI & W9 to add our quaternary location to our group as well as all of the providers linked to the group. Please let me know if anything else is required.  Thank you.\"', NULL, NULL, '2021-03-29 12:55:57', '2021-03-29 12:55:57'),
(23864, 1006, 22339, NULL, '2021-04-16 00:00:00.000', 'Initiated', 'The request has been submitted to Cigna for location addition with the group and all individual providers that are enrolled under it. It is currently in process.   Once location has been added, this task will be approved since Cigna is affiliated with HealthPartners. ', NULL, NULL, '2021-04-09 10:53:08', '2021-04-09 10:53:08'),
(23865, 1006, 22339, NULL, '2021-05-04 00:00:00.000', 'In Process', 'As per my discussion with Cigna 4th address has been added to the group, but not to any of the providers. Ref# Cherrelle 04/27/2021  I submitted another LOI/W9 with all provider\'s information to pdm_intake@cigna.com, attached in the group task.  ', NULL, NULL, '2021-04-27 16:00:26', '2021-04-27 16:00:26'),
(23866, 9057, 22339, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to intake_pdm@cigna.com Sub: Enrollment request status -RHC-Cigna  Hello, We submitted a request to add a quaternary location under our practice and providers. Kindly provide the current status for the above mentioned request.    Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able.  Thanks.', NULL, NULL, '2021-05-25 17:02:02', '2021-05-25 17:02:02'),
(23867, 1006, 22339, NULL, '2021-06-10 00:00:00.000', 'Approved', 'The address has been updated, location confirmation is attached for reference in individual provider tasks. ', NULL, NULL, '2021-06-03 15:32:01', '2021-06-03 15:32:01'),
(23868, 3046, 22340, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:14', '2021-03-16 15:49:14'),
(23869, 1006, 22340, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Sent following email @ intake_pdm@cigna.com: \"Hello,   Please find the attached LOI & W9 to add our quaternary location to our group as well as all of the providers linked to the group. Please let me know if anything else is required.  Thank you.\"', NULL, NULL, '2021-03-29 12:56:03', '2021-03-29 12:56:03'),
(23870, 1006, 22340, NULL, '2021-05-04 00:00:00.000', 'In Process', 'As per my discussion with Cigna 4th address has been added to the group, but not to any of the providers. Ref# Cherrelle 04/27/2021  I submitted another LOI/W9 with all provider\'s information to pdm_intake@cigna.com, attached in the group task.  ', NULL, NULL, '2021-04-27 16:00:19', '2021-04-27 16:00:19'),
(23871, 9057, 22340, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to intake_pdm@cigna.com Sub: Enrollment request status -RHC-Cigna  Hello, We submitted a request to add a quaternary location under our practice and providers. Kindly provide the current status for the above mentioned request.    Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able.  Thanks.', NULL, NULL, '2021-05-25 17:02:09', '2021-05-25 17:02:09'),
(23872, 1006, 22340, NULL, '2021-06-10 00:00:00.000', 'Approved', 'The address has been updated, location confirmation is attached for reference in individual provider tasks. ', NULL, NULL, '2021-06-03 15:31:51', '2021-06-03 15:31:51'),
(23873, 3046, 22341, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:15', '2021-03-16 15:49:15'),
(23874, 1006, 22341, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Sent following email @ intake_pdm@cigna.com: \"Hello,   Please find the attached LOI & W9 to add our quaternary location to our group as well as all of the providers linked to the group. Please let me know if anything else is required.  Thank you.\"', NULL, NULL, '2021-03-29 12:56:07', '2021-03-29 12:56:07'),
(23875, 1006, 22341, NULL, '2021-05-04 00:00:00.000', 'In Process', 'As per my discussion with Cigna 4th address has been added to the group, but not to any of the providers. Ref# Cherrelle 04/27/2021  I submitted another LOI/W9 with all provider\'s information to pdm_intake@cigna.com, attached in the group task.  ', NULL, NULL, '2021-04-27 16:00:13', '2021-04-27 16:00:13'),
(23876, 9057, 22341, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to intake_pdm@cigna.com Sub: Enrollment request status -RHC-Cigna  Hello, We submitted a request to add a quaternary location under our practice and providers. Kindly provide the current status for the above mentioned request.    Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able.  Thanks.', NULL, NULL, '2021-05-25 17:02:16', '2021-05-25 17:02:16'),
(23877, 1006, 22341, NULL, '2021-06-10 00:00:00.000', 'Approved', 'The address has been updated, location confirmation is attached for reference in individual provider tasks. ', NULL, NULL, '2021-06-03 15:31:39', '2021-06-03 15:31:39'),
(23878, 3040, 22342, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:16', '2021-03-16 15:49:16'),
(23879, 3040, 22342, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicare approval ', NULL, NULL, '2021-04-01 16:06:39', '2021-04-01 16:06:39'),
(23880, 1006, 22342, NULL, '2021-06-02 00:00:00.000', 'On Hold', 'Pending Oladipo/Group enrollment to Medicaid. ', NULL, NULL, '2021-05-26 08:14:02', '2021-05-26 08:14:02'),
(23881, 1005, 22342, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Checked online. Current Status: In Progress.', NULL, NULL, '2021-06-09 15:24:04', '2021-06-09 15:24:04'),
(23882, 1005, 22342, NULL, '2021-06-17 00:00:00.000', 'On Hold', 'Disregard previous comment.', NULL, NULL, '2021-06-09 15:24:47', '2021-06-09 15:24:47'),
(23883, 1006, 22342, NULL, '2021-06-18 00:00:00.000', 'Initiated', 'Enrollment request submitted via TMHP website: \"Application Status PEP Ticket Number Submitted		17842438\"', NULL, NULL, '2021-06-11 09:17:07', '2021-06-11 09:17:07'),
(23884, 1006, 22342, NULL, '2021-07-07 00:00:00.000', 'In Process', 'I have called at Medicaid ( Erica ). She said they have faxed us the welcome letter and it gonna take 24 hours to reach out to us. Ref code:   41746948001', NULL, NULL, '2021-06-30 15:01:25', '2021-06-30 15:01:25'),
(23885, 1006, 22342, NULL, '2021-07-08 00:00:00.000', 'Approved', 'TPI# 369195802 Effective Date: 02/05/2021  Approval letter is attached for reference. ', NULL, NULL, '2021-07-01 15:56:40', '2021-07-01 15:56:40'),
(23886, 3046, 22343, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:17', '2021-03-16 15:49:17'),
(23887, 1006, 22343, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Sent following email @ intake_pdm@cigna.com: \"Hello,   Please find the attached LOI & W9 to add our quaternary location to our group as well as all of the providers linked to the group. Please let me know if anything else is required.  Thank you.\"', NULL, NULL, '2021-03-29 12:56:11', '2021-03-29 12:56:11'),
(23888, 1006, 22343, NULL, '2021-05-04 00:00:00.000', 'In Process', 'As per my discussion with Cigna 4th address has been added to the group, but not to any of the providers. Ref# Cherrelle 04/27/2021  I submitted another LOI/W9 with all provider\'s information to pdm_intake@cigna.com, attached in the group task.  ', NULL, NULL, '2021-04-27 16:00:08', '2021-04-27 16:00:08'),
(23889, 9057, 22343, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to intake_pdm@cigna.com Sub: Enrollment request status -RHC-Cigna  Hello, We submitted a request to add a quaternary location under our practice and providers. Kindly provide the current status for the above mentioned request.    Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able.  Thanks.', NULL, NULL, '2021-05-25 17:02:25', '2021-05-25 17:02:25'),
(23890, 1006, 22343, NULL, '2021-06-10 00:00:00.000', 'Approved', 'The address has been updated, location confirmation is attached for reference in individual provider tasks. ', NULL, NULL, '2021-06-03 15:31:30', '2021-06-03 15:31:30'),
(23891, 3046, 22344, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:18', '2021-03-16 15:49:18'),
(23892, 1006, 22344, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Sent following email @ intake_pdm@cigna.com: \"Hello,   Please find the attached LOI & W9 to add our quaternary location to our group as well as all of the providers linked to the group. Please let me know if anything else is required.  Thank you.\"', NULL, NULL, '2021-03-29 12:56:15', '2021-03-29 12:56:15'),
(23893, 1006, 22344, NULL, '2021-05-04 00:00:00.000', 'In Process', 'As per my discussion with Cigna 4th address has been added to the group, but not to any of the providers. Ref# Cherrelle 04/27/2021  I submitted another LOI/W9 with all provider\'s information to pdm_intake@cigna.com, attached in the group task.  ', NULL, NULL, '2021-04-27 16:00:04', '2021-04-27 16:00:04'),
(23894, 9057, 22344, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to intake_pdm@cigna.com Sub: Enrollment request status -RHC-Cigna  Hello, We submitted a request to add a quaternary location under our practice and providers. Kindly provide the current status for the above mentioned request.    Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able.  Thanks.', NULL, NULL, '2021-05-25 17:02:34', '2021-05-25 17:02:34'),
(23895, 1006, 22344, NULL, '2021-06-10 00:00:00.000', 'Approved', 'The address has been updated, location confirmation is attached for reference in individual provider tasks. ', NULL, NULL, '2021-06-03 15:31:04', '2021-06-03 15:31:04'),
(23896, 3046, 22345, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:20', '2021-03-16 15:49:20'),
(23897, 1006, 22345, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Sent following email @ intake_pdm@cigna.com: \"Hello,   Please find the attached LOI & W9 to add our quaternary location to our group as well as all of the providers linked to the group. Please let me know if anything else is required.  Thank you.\"', NULL, NULL, '2021-03-29 12:56:19', '2021-03-29 12:56:19'),
(23898, 1006, 22345, NULL, '2021-05-04 00:00:00.000', 'In Process', 'As per my discussion with Cigna 4th address has been added to the group, but not to any of the providers. Ref# Cherrelle 04/27/2021  I submitted another LOI/W9 with all provider\'s information to pdm_intake@cigna.com, attached in the group task.  ', NULL, NULL, '2021-04-27 15:59:59', '2021-04-27 15:59:59'),
(23899, 9057, 22345, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to intake_pdm@cigna.com Sub: Enrollment request status -RHC-Cigna  Hello, We submitted a request to add a quaternary location under our practice and providers. Kindly provide the current status for the above mentioned request.    Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able.  Thanks.', NULL, NULL, '2021-05-25 17:02:43', '2021-05-25 17:02:43'),
(23900, 1006, 22345, NULL, '2021-06-10 00:00:00.000', 'Approved', 'The address has been updated, location confirmation is attached for reference in individual provider tasks. ', NULL, NULL, '2021-06-03 15:30:51', '2021-06-03 15:30:51'),
(23901, 3046, 22346, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:22', '2021-03-16 15:49:22'),
(23902, 1006, 22346, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Sent following email @ intake_pdm@cigna.com: \"Hello,   Please find the attached LOI & W9 to add our quaternary location to our group as well as all of the providers linked to the group. Please let me know if anything else is required.  Thank you.\"', NULL, NULL, '2021-03-29 12:56:23', '2021-03-29 12:56:23'),
(23903, 1006, 22346, NULL, '2021-05-04 00:00:00.000', 'Approved', 'As per my discussion with Cigna 4th address has been added to the group, but not to any of the providers. Ref# Cherrelle 04/27/2021  I submitted another LOI/W9 with all provider\'s information to pdm_intake@cigna.com, attached in the group task.  ', NULL, NULL, '2021-04-27 15:59:55', '2021-04-27 15:59:55'),
(23904, 3040, 22347, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:22', '2021-03-16 15:49:22'),
(23905, 3040, 22347, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Application Status Submitted		 PEP Ticket Number 17686552 ', NULL, NULL, '2021-04-01 12:52:53', '2021-04-01 12:52:53'),
(23906, 3040, 22347, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Application Status PEP Ticket Number Submitted		17802673 ', NULL, NULL, '2021-05-24 12:18:00', '2021-05-24 12:18:00'),
(23907, 1005, 22347, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Checked online. The application is on \"In Progress\" status.', NULL, NULL, '2021-05-27 10:00:05', '2021-05-27 10:00:05'),
(23908, 1005, 22347, NULL, '2021-06-12 00:00:00.000', 'In Process', 'Checked online. Current Status: In Progress.', NULL, NULL, '2021-06-04 15:00:54', '2021-06-04 15:00:54'),
(23909, 1006, 22347, NULL, '2021-06-21 00:00:00.000', 'Approved', 'The group has been enrolled with Medicaid. Approval confirmation is attached for reference.   Eff date: 12/03/2021 TPI# 324446910', NULL, NULL, '2021-06-14 10:22:15', '2021-06-14 10:22:15'),
(23910, 3046, 22348, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:23', '2021-03-16 15:49:23'),
(23911, 1006, 22348, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Sent following email @ intake_pdm@cigna.com: \"Hello,   Please find the attached LOI & W9 to add our quaternary location to our group as well as all of the providers linked to the group. Please let me know if anything else is required.  Thank you.\"', NULL, NULL, '2021-03-29 12:56:26', '2021-03-29 12:56:26'),
(23912, 1006, 22348, NULL, '2021-05-04 00:00:00.000', 'In Process', 'As per my discussion with Cigna 4th address has been added to the group, but not to any of the providers. Ref# Cherrelle 04/27/2021  I submitted another LOI/W9 with all provider\'s information to pdm_intake@cigna.com, attached in the group task.  ', NULL, NULL, '2021-04-27 15:59:49', '2021-04-27 15:59:49'),
(23913, 9057, 22348, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to intake_pdm@cigna.com Sub: Enrollment request status -RHC-Cigna  Hello, We submitted a request to add a quaternary location under our practice and providers. Kindly provide the current status for the above mentioned request.    Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able.  Thanks.', NULL, NULL, '2021-05-25 17:03:22', '2021-05-25 17:03:22'),
(23914, 1006, 22348, NULL, '2021-06-10 00:00:00.000', 'Approved', 'The address has been updated, location confirmation is attached for reference in individual provider tasks. ', NULL, NULL, '2021-06-03 15:28:49', '2021-06-03 15:28:49'),
(23915, 3046, 22349, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:25', '2021-03-16 15:49:25'),
(23916, 1006, 22349, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Sent following email @ intake_pdm@cigna.com: \"Hello,   Please find the attached LOI & W9 to add our quaternary location to our group as well as all of the providers linked to the group. Please let me know if anything else is required.  Thank you.\"', NULL, NULL, '2021-03-29 12:56:30', '2021-03-29 12:56:30'),
(23917, 1006, 22349, NULL, '2021-05-04 00:00:00.000', 'In Process', 'As per my discussion with Cigna 4th address has been added to the group, but not to any of the providers. Ref# Cherrelle 04/27/2021  I submitted another LOI/W9 with all provider\'s information to pdm_intake@cigna.com, attached in the group task.  ', NULL, NULL, '2021-04-27 15:59:44', '2021-04-27 15:59:44'),
(23918, 9057, 22349, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to intake_pdm@cigna.com Sub: Enrollment request status -RHC-Cigna  Hello, We submitted a request to add a quaternary location under our practice and providers. Kindly provide the current status for the above mentioned request.    Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able.  Thanks.', NULL, NULL, '2021-05-25 17:03:06', '2021-05-25 17:03:06'),
(23919, 1006, 22349, NULL, '2021-06-10 00:00:00.000', 'Approved', 'The address has been updated, location confirmation is attached for reference in individual provider tasks. ', NULL, NULL, '2021-06-03 15:27:57', '2021-06-03 15:27:57'),
(23920, 3040, 22350, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:39', '2021-03-16 15:49:39'),
(23921, 3040, 22350, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Please return to this tool after 30 calendar days with the reference number listed below to retrieve your PTAN information.  Key in your reference number, local Medicare Administrative Contractor (MAC) PTAN, your NPI, and the last 5 digits of your tax identification number, and the tool will confirm that your PTAN is active.  Reference Number :	21091001114 NPI :	1760700223 ', NULL, NULL, '2021-04-01 14:29:32', '2021-04-01 14:29:32'),
(23922, 1006, 22350, NULL, '2021-06-03 00:00:00.000', 'Approved', 'GROUP NAME	LADOT HEALTHCARE LLC GROUP PTAN	EA6990 BUSINESS STATE	TX EFFECTIVE DATE	12/03/2020 END DATE', NULL, NULL, '2021-05-27 12:03:39', '2021-05-27 12:03:39'),
(23923, 3040, 22351, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:49', '2021-03-16 15:49:49'),
(23924, 3040, 22351, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicare approval. ', NULL, NULL, '2021-04-01 14:12:52', '2021-04-01 14:12:52'),
(23925, 1006, 22351, NULL, '2021-06-02 00:00:00.000', 'On Hold', 'Request is pending due to following error:  At this time, we are unable to process your request because one or more of the data elements entered into this tool did not match your local Medicare Administrative Contractor (A/B MAC). If you believe you have received this message in error, please contact your local A/B MAC to validate the accuracy of the provider information you have entered into this tool.  ', NULL, NULL, '2021-05-26 08:50:07', '2021-05-26 08:50:07'),
(23926, 1006, 22351, NULL, '2021-06-25 00:00:00.000', 'Initiated', 'Enrollment request has been submitted via PTAN request tool:  \"Please allow three business days for the activation of this new PTAN.\"', NULL, NULL, '2021-06-18 14:54:04', '2021-06-18 14:54:04'),
(23927, 1006, 22351, NULL, '2021-07-12 00:00:00.000', 'Approved', '\"Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	ATINUKE O DADA NP PROVIDER PTAN	Q00087814 PROVIDER NPI	1154782720 EFFECTIVE DATE	02/05/2021 END DATE	 GROUP NAME	LADOT HEALTHCARE LLC GROUP PTAN	EA6990 BUSINESS STATE	TX EFFECTIVE DATE	12/03/2020 END DATE\"', NULL, NULL, '2021-07-05 11:02:23', '2021-07-05 11:02:23'),
(23928, 3040, 22352, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:56', '2021-03-16 15:49:56'),
(23929, 3040, 22352, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Please return to this tool after 30 calendar days with the reference number listed below to retrieve your PTAN information.  Key in your reference number, local Medicare Administrative Contractor (MAC) PTAN, your NPI, and the last 5 digits of your tax identification number, and the tool will confirm that your PTAN is active.  Reference Number :	21091001114 NPI :	1760700223 ', NULL, NULL, '2021-04-01 14:29:38', '2021-04-01 14:29:38'),
(23930, 1006, 22352, NULL, '2021-06-03 00:00:00.000', 'Approved', ' PROVIDER NAME	OLADIPO DADA MD PROVIDER PTAN	P02605794 PROVIDER NPI	1760700223 EFFECTIVE DATE	12/03/2020 END DATE', NULL, NULL, '2021-05-27 12:03:48', '2021-05-27 12:03:48'),
(23931, 3046, 22353, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:49:59', '2021-03-16 15:49:59');
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
(23932, 1006, 22353, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Sent following email @ intake_pdm@cigna.com: \"Hello,   Please find the attached LOI & W9 to add our quaternary location to our group as well as all of the providers linked to the group. Please let me know if anything else is required.  Thank you.\"', NULL, NULL, '2021-03-29 12:56:34', '2021-03-29 12:56:34'),
(23933, 1006, 22353, NULL, '2021-05-04 00:00:00.000', 'In Process', 'As per my discussion with Cigna 4th address has been added to the group, but not to any of the providers. Ref# Cherrelle 04/27/2021  I submitted another LOI/W9 with all provider\'s information to pdm_intake@cigna.com, attached in the group task. ', NULL, NULL, '2021-04-27 15:58:14', '2021-04-27 15:58:14'),
(23934, 1006, 22353, NULL, '2021-05-20 00:00:00.000', 'In Process', 'Received an email from Cigna asking for Effective date of address update. Sent them a reply. ', NULL, NULL, '2021-05-06 07:56:06', '2021-05-06 07:56:06'),
(23935, 9057, 22353, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to intake_pdm@cigna.com Sub: Enrollment request status -RHC-Cigna  Hello, We submitted a request to add a quaternary location under our practice and providers. Kindly provide the current status for the above mentioned request.    Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able.  Thanks.', NULL, NULL, '2021-05-25 17:02:52', '2021-05-25 17:02:52'),
(23936, 1006, 22353, NULL, '2021-06-10 00:00:00.000', 'Approved', 'The address has been updated, location confirmation is attached for reference in individual provider tasks. ', NULL, NULL, '2021-06-03 15:26:26', '2021-06-03 15:26:26'),
(23937, 3040, 22354, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:50:31', '2021-03-16 15:50:31'),
(23938, 3040, 22354, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicaid approval. ', NULL, NULL, '2021-04-01 13:21:22', '2021-04-01 13:21:22'),
(23939, 1006, 22354, NULL, '2021-06-02 00:00:00.000', 'On Hold', 'Pending Medicaid approval. ', NULL, NULL, '2021-05-26 08:54:07', '2021-05-26 08:54:07'),
(23940, 1006, 22354, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Submitted enrollment request @ MHMSProviderContracting MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Request - LHC - Molina Health  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  Enrollment form attached in group task for reference.', NULL, NULL, '2021-06-14 16:46:19', '2021-06-14 16:46:19'),
(23941, 1006, 22354, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Received the following reply from MHMSProviderContracting MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Request - LHC - Molina Health  \"Good Morning,  Thank you for reaching out. However, I believe you have reached the MS Health Plan by mistake. Please see below for information for the TX Health Plan.  Texas CREDENTIALING MHT.Credentialing@MolinaHealthCare.Com PROVIDER NETWORK ADMIN MHTProviderNetworkAdmin@MolinaHealthCare.Com CONTRACTING MHTContracting2@MolinaHealthCare.Com CONTRACT REQUEST MHTContractrequest@MolinaHealthCare.Com PROVIDER SERVICES MHTXProviderServices@MolinaHealthCare.Com  Provider Contracts Description: Description: Description: Description: Description: cid:image002.jpg@01CDB5C6.D25A2E90 Molina Healthcare of Mississippi, Inc. 188 East Capitol Street, Suite 700 Jackson, MS  39201\"  Sent corrected email & request @ MHTContractrequest mhtcontractrequest@molinahealthcare.com:  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  Form attached in group task for reference.', NULL, NULL, '2021-07-02 15:49:01', '2021-07-02 15:49:01'),
(23942, 11056, 22354, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Molina Provider Contract - Oladipo Dada  Good Afternoon,  Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for (Oladipo Dada) to contract under TAX ID number (85-2432283).     I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.     Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.     Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below:  HARRIS  Michele Thomas Martin  Michele.Thomas-Martin@MolinaHealthcare.com  888-562-5442 x200042Thomas           Have a wonderful day!  Thank you,  Tyhesha Price  MHT| Provider Contracts  Molina Healthcare of Texas, Inc.  1660 Westridge Circle N  Irving, TX 75038  Mhtcontractrequest@Molinahealthcare.com', NULL, NULL, '2021-07-13 17:03:47', '2021-07-13 17:03:47'),
(23943, 11056, 22354, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to : 	TexasExpansionContracting@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Hey Michele,  Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it.  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720   If you need any information or documents regarding enrollment feel free to call or email me.  Thank you! Have a great day!', NULL, NULL, '2021-07-13 17:13:42', '2021-07-13 17:13:42'),
(23944, 11056, 22354, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Record # 180028  Provider: Oladipo Dada  Good Morning,  Thank you for your inquiry.  I’ve located one request on file for Oladipo Dada.  The request is currently on hold awaiting the return of the requested documents.  We also never received a response to the attached email that was previously sent.   Please provide the name, email and title of the person that will be signing the contract.  The authorized person name has to match the signature.  Once I have the name and email of the actual person that will be signing the contract , the contract will be sent via DocuSign.  Thank You,  Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-07-20 06:21:21', '2021-07-20 06:21:21'),
(23945, 11056, 22354, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Good Afternoon,  Hope you are doing well. Here are the information and forms you requested for the enrollment and contracting of the providers and the group mentioned below. Kindly see the attachments .  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720  If you need any information or documents regarding enrollment feel free to call or email me.  Thank you! Have a great day!', NULL, NULL, '2021-07-20 06:30:14', '2021-07-20 06:30:14'),
(23946, 11056, 22354, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Contract Received from Email : \'Michele Thomas-Martin via DocuSign\' via Ladot Healthcare LLC   Sub :  Request for eSignatures   Michele Thomas-Martin sent you a document to review and sign. REVIEW DOCUMENT Michele Thomas-Martin Michele.Thomas-Martin@molinahealthcare.com Request for eSignatures. Please review and sign.   The contract has been reviewed and signed via Docusign .  Please see the attachment. ', NULL, NULL, '2021-07-27 09:29:08', '2021-07-27 09:29:08'),
(23947, 11056, 22354, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Record # 180265  Good Morning,  Thank you for submitting the documents.  Please update CAQH application to allow Molina authorization, if you haven’t already done so for Atinuke Dada.  Thank you for submitting the contracting documents, the documents have been loaded in the system and forwarded to credentialing.  The credentialing process could take 30-45 days to complete.  If not yet registered for Availity, go to www.Availity.com, click register in the top right of the page, then follow the organization registration process.  Once your registration is approved, you can proceed to the next step.  “Effective April 1, 2018, the state of Texas established a statewide concept to facilitate the credentialing process for Medicaid and CHIP providers in Texas.  This is facilitated by the Texas Association of Health Plans (TAHP), using a Credentialing Verification Organization (CVO) called Aperture.  Individual providers can use CAQH to enter their credentialing information and can upload any supporting documents.  This can be found at https://proview.caqh.org.  Or you may choose to complete the Texas Standardized Application for providers that is attached.  Facility providers can complete the Texas Standardized Application for HDO’s on the Availity portal.  You can register and complete the application by visiting www.availity.com.   Or you may choose to complete the Texas Standardized Application for facilities that is attached.”  We look forward to having you as a part of our network and encourage you to visit www.molinahealthcare.com to learn more about us.  My contact information is listed below should you have any questions or concerns. Thank you,', NULL, NULL, '2021-08-03 10:21:07', '2021-08-03 10:21:07'),
(23948, 11056, 22354, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Good Afternoon!  Hope you are doing well. The CAQH application is authorized and updated. You may do the authorization.  If you have any queries further feel free to reach out to me soon. Waiting for your response.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-08-09 15:26:53', '2021-08-09 15:26:53'),
(23949, 11056, 22354, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub :  Enrollment Status Update Needed - LHC - Molina Health  Good morning Thomas!  Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it soon.  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720  If you need any information or documents regarding enrollment feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-16 08:20:43', '2021-08-16 08:20:43'),
(23950, 11056, 22354, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Good Afternoon,     Thank you for your inquiry.   Please see the status updates below.      Oladipo Dada – The request has been sent to credentialing for processing, please allow 3-4 weeks for processing.  Atinuke Dada - The request has been sent to credentialing for processing, please allow 3-4 weeks for processing.', NULL, NULL, '2021-08-23 08:50:13', '2021-08-23 08:50:13'),
(23951, 11056, 22354, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good Morning,     Thank you for your inquiry.  Please see the status below for each provider.     Oladipo Dada – The credentialing application has been approved and the contract has been executed.   The request has been sent for loading in the billing system.  Please allow 30-45 days for this process to complete.     Atinuke Dada – The credentialing application is still in process, please allow a few more weeks for the application to complete.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2021-09-01 09:44:25', '2021-09-01 09:44:25'),
(23952, 11056, 22354, NULL, '2021-09-20 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good morning Michele!  Hope this email finds you well. Please let this not take so long. Kindly keep me updated and May this be completed instantly.  If you need any information or documents please let me know. Please don\'t hesitate to reach out to me.  Thank you! Have a great week ahead!', NULL, NULL, '2021-09-13 10:15:02', '2021-09-13 10:15:02'),
(23953, 11056, 22354, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Email receieved from : Margaret.White@molinahealthcare.com  Sub : Approval Letter 9/10/2021  September 10, 2021  Atinuke Dada, NP 2577 Madison Ave League City, TX 77573  Dear Atinuke Dada, NP:  Your credentialing file was reviewed by the Molina Healthcare of Texas Credentialing Committee on 9/10/2021.  After careful consideration of the information in your file, I am pleased to inform you that the Committee has approved your credentialing application in the primary specialty of Nurse Practitioner - Family.  Upon execution of your contract with Molina, you will receive under separate cover, a letter informing you of your effective date as a contracted, participating network provider.  Until that time, Molina will reimburse you for services provided to Molina members at the out-of-network rate subject to Title I, Part 15, Chapter 353, Subchapter A, Rule  §353.4 of the Texas Administrative Code  (c) Reasonable reimbursement methodology.    For questions regarding the contracting process please contact Contract Coordination at: 855-322-4080 or email: TexasExpansionContracting@MolinaHealthCare.Com    For Molina’s authorization requirements please refer to the forms at the link below: https://www.molinahealthcare.com/providers/tx/medicaid/forms/pages/fuf.aspx   Thank you for your commitment to joining with Molina Healthcare in providing our members with the best quality health care possible.  We look forward to our continuing successful partnership.   Sincerely, David Valdez MD Chief Medical Officer Molina Healthcare of Texas', NULL, NULL, '2021-09-23 11:08:59', '2021-09-23 11:08:59'),
(23954, 11056, 22354, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Hey Michele,     Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it.     Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke  Provider NPI# : 1154782720     Provider Name : Dada, Oladipo Provider NPI# : 1154782720     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.    Thank you!  Have a great weekend!', NULL, NULL, '2021-09-30 16:19:41', '2021-09-30 16:19:41'),
(23955, 11056, 22354, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good Morning,  Thank you for your inquiry.  Please see the status below for each provider.  Record # 180265 – Atinuke Dada -The credentialing application still in process.  Please allow more time for processing.  Submitted an email to credentialing for status.', NULL, NULL, '2021-10-06 08:59:04', '2021-10-06 08:59:04'),
(23956, 11056, 22354, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good Afternoon,     Thank you for your inquiry.  The request for both providers have been sent for loading in the billing system.  Please follow up after 10/1/21 for Oladipo Dada and after 10/15/21 for Atinuke Dada.', NULL, NULL, '2021-10-14 14:26:14', '2021-10-14 14:26:14'),
(23957, 11056, 22354, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good morning!  Hope you are doing great. Please provide me with latest updates on the following provider credentialing application.  Group Name	Ladot Healthcare LLC Tax ID	85-2432283 Group NPI	1912502626 Primary Location	2577 Madison Avenue, League City , TX 77573 Provider Name	NPI Atinuke Dada  	1154782720   If the credentialing and loading in the billing system has been completed, kindly do provide us with the welcome letter soon.  Thank you! Take Care!', NULL, NULL, '2021-10-21 15:37:05', '2021-10-21 15:37:05'),
(23958, 11056, 22354, NULL, '2021-11-19 00:00:00.000', 'Approved', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good Morning,   Thank you for your inquiry.   The provider has been loaded in the billing system effective 10/15/21 under all plans.  The group contract includes all plans including Marketplace.   The providers have been added under all plans ( Medicaid, Medicare, Dual MMP and Marketplace)  There is no welcome letter for the group only the providers.  The welcome letters for the providers have already been sent.', NULL, NULL, '2021-11-12 15:17:22', '2021-11-12 15:17:22'),
(23959, 3040, 22355, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:50:40', '2021-03-16 15:50:40'),
(23960, 3040, 22355, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicaid approval. ', NULL, NULL, '2021-04-01 13:21:26', '2021-04-01 13:21:26'),
(23961, 1006, 22355, NULL, '2021-06-02 00:00:00.000', 'On Hold', 'Pending Medicaid approval. ', NULL, NULL, '2021-05-26 09:01:38', '2021-05-26 09:01:38'),
(23962, 1006, 22355, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Submitted enrollment request @ MHMSProviderContracting MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Request - LHC - Molina Health  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  Enrollment form attached in group task for reference.', NULL, NULL, '2021-06-14 16:46:27', '2021-06-14 16:46:27'),
(23963, 1006, 22355, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Received the following reply from MHMSProviderContracting MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Request - LHC - Molina Health  \"Good Morning,  Thank you for reaching out. However, I believe you have reached the MS Health Plan by mistake. Please see below for information for the TX Health Plan.  Texas CREDENTIALING MHT.Credentialing@MolinaHealthCare.Com PROVIDER NETWORK ADMIN MHTProviderNetworkAdmin@MolinaHealthCare.Com CONTRACTING MHTContracting2@MolinaHealthCare.Com CONTRACT REQUEST MHTContractrequest@MolinaHealthCare.Com PROVIDER SERVICES MHTXProviderServices@MolinaHealthCare.Com  Provider Contracts Description: Description: Description: Description: Description: cid:image002.jpg@01CDB5C6.D25A2E90 Molina Healthcare of Mississippi, Inc. 188 East Capitol Street, Suite 700 Jackson, MS  39201\"  Sent corrected email & request @ MHTContractrequest mhtcontractrequest@molinahealthcare.com:  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  Form attached in group task for reference.', NULL, NULL, '2021-07-02 15:48:52', '2021-07-02 15:48:52'),
(23964, 11056, 22355, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Molina Provider Contract - Oladipo Dada  Good Afternoon,  Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for (Oladipo Dada) to contract under TAX ID number (85-2432283).     I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.     Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.     Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below:  HARRIS  Michele Thomas Martin  Michele.Thomas-Martin@MolinaHealthcare.com  888-562-5442 x200042Thomas           Have a wonderful day!  Thank you,  Tyhesha Price  MHT| Provider Contracts  Molina Healthcare of Texas, Inc.  1660 Westridge Circle N  Irving, TX 75038  Mhtcontractrequest@Molinahealthcare.com', NULL, NULL, '2021-07-13 17:03:57', '2021-07-13 17:03:57'),
(23965, 11056, 22355, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to : 	TexasExpansionContracting@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Hey Michele,  Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it.  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720   If you need any information or documents regarding enrollment feel free to call or email me.  Thank you! Have a great day!', NULL, NULL, '2021-07-13 17:14:22', '2021-07-13 17:14:22'),
(23966, 11056, 22355, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to : 	TexasExpansionContracting@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Hey Michele,  Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it.  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720   If you need any information or documents regarding enrollment feel free to call or email me.  Thank you! Have a great day!', NULL, NULL, '2021-07-13 17:14:22', '2021-07-13 17:14:22'),
(23967, 11056, 22355, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Record # 180028  Provider: Oladipo Dada  Good Morning,  Thank you for your inquiry.  I’ve located one request on file for Oladipo Dada.  The request is currently on hold awaiting the return of the requested documents.  We also never received a response to the attached email that was previously sent.   Please provide the name, email and title of the person that will be signing the contract.  The authorized person name has to match the signature.  Once I have the name and email of the actual person that will be signing the contract , the contract will be sent via DocuSign.  Thank You,  Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family ', NULL, NULL, '2021-07-20 06:21:12', '2021-07-20 06:21:12'),
(23968, 11056, 22355, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Good Afternoon,  Hope you are doing well. Here are the information and forms you requested for the enrollment and contracting of the providers and the group mentioned below. Kindly see the attachments .  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720  If you need any information or documents regarding enrollment feel free to call or email me.  Thank you! Have a great day!', NULL, NULL, '2021-07-20 06:29:42', '2021-07-20 06:29:42'),
(23969, 11056, 22355, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Contract Received from Email : \'Michele Thomas-Martin via DocuSign\' via Ladot Healthcare LLC   Sub :  Request for eSignatures   Michele Thomas-Martin sent you a document to review and sign. REVIEW DOCUMENT Michele Thomas-Martin Michele.Thomas-Martin@molinahealthcare.com Request for eSignatures. Please review and sign.   The contract has been reviewed and signed via Docusign .  Please see the attachment. ', NULL, NULL, '2021-07-27 09:28:55', '2021-07-27 09:28:55'),
(23970, 11056, 22355, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Record # 180265  Good Morning,  Thank you for submitting the documents.  Please update CAQH application to allow Molina authorization, if you haven’t already done so for Atinuke Dada.  Thank you for submitting the contracting documents, the documents have been loaded in the system and forwarded to credentialing.  The credentialing process could take 30-45 days to complete.  If not yet registered for Availity, go to www.Availity.com, click register in the top right of the page, then follow the organization registration process.  Once your registration is approved, you can proceed to the next step.  “Effective April 1, 2018, the state of Texas established a statewide concept to facilitate the credentialing process for Medicaid and CHIP providers in Texas.  This is facilitated by the Texas Association of Health Plans (TAHP), using a Credentialing Verification Organization (CVO) called Aperture.  Individual providers can use CAQH to enter their credentialing information and can upload any supporting documents.  This can be found at https://proview.caqh.org.  Or you may choose to complete the Texas Standardized Application for providers that is attached.  Facility providers can complete the Texas Standardized Application for HDO’s on the Availity portal.  You can register and complete the application by visiting www.availity.com.   Or you may choose to complete the Texas Standardized Application for facilities that is attached.”  We look forward to having you as a part of our network and encourage you to visit www.molinahealthcare.com to learn more about us.  My contact information is listed below should you have any questions or concerns. Thank you,', NULL, NULL, '2021-08-03 10:20:58', '2021-08-03 10:20:58'),
(23971, 11056, 22355, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Good Afternoon!  Hope you are doing well. The CAQH application is authorized and updated. You may do the authorization.  If you have any queries further feel free to reach out to me soon. Waiting for your response.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-08-09 15:26:45', '2021-08-09 15:26:45'),
(23972, 11056, 22355, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub :  Enrollment Status Update Needed - LHC - Molina Health  Good morning Thomas!  Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it soon.  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720  If you need any information or documents regarding enrollment feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-16 08:20:34', '2021-08-16 08:20:34'),
(23973, 11056, 22355, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Good Afternoon,     Thank you for your inquiry.   Please see the status updates below.      Oladipo Dada – The request has been sent to credentialing for processing, please allow 3-4 weeks for processing.  Atinuke Dada - The request has been sent to credentialing for processing, please allow 3-4 weeks for processing.', NULL, NULL, '2021-08-23 08:49:59', '2021-08-23 08:49:59'),
(23974, 11056, 22355, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good Morning,     Thank you for your inquiry.  Please see the status below for each provider.     Oladipo Dada – The credentialing application has been approved and the contract has been executed.   The request has been sent for loading in the billing system.  Please allow 30-45 days for this process to complete.     Atinuke Dada – The credentialing application is still in process, please allow a few more weeks for the application to complete.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2021-09-01 09:44:10', '2021-09-01 09:44:10'),
(23975, 11056, 22355, NULL, '2021-09-20 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good morning Michele!  Hope this email finds you well. Please let this not take so long. Kindly keep me updated and May this be completed instantly.  If you need any information or documents please let me know. Please don\'t hesitate to reach out to me.  Thank you! Have a great week ahead!', NULL, NULL, '2021-09-13 10:14:57', '2021-09-13 10:14:57'),
(23976, 11056, 22355, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Email receieved from : Margaret.White@molinahealthcare.com  Sub : Approval Letter 9/10/2021  September 10, 2021  Atinuke Dada, NP 2577 Madison Ave League City, TX 77573  Dear Atinuke Dada, NP:  Your credentialing file was reviewed by the Molina Healthcare of Texas Credentialing Committee on 9/10/2021.  After careful consideration of the information in your file, I am pleased to inform you that the Committee has approved your credentialing application in the primary specialty of Nurse Practitioner - Family.  Upon execution of your contract with Molina, you will receive under separate cover, a letter informing you of your effective date as a contracted, participating network provider.  Until that time, Molina will reimburse you for services provided to Molina members at the out-of-network rate subject to Title I, Part 15, Chapter 353, Subchapter A, Rule  §353.4 of the Texas Administrative Code  (c) Reasonable reimbursement methodology.    For questions regarding the contracting process please contact Contract Coordination at: 855-322-4080 or email: TexasExpansionContracting@MolinaHealthCare.Com    For Molina’s authorization requirements please refer to the forms at the link below: https://www.molinahealthcare.com/providers/tx/medicaid/forms/pages/fuf.aspx   Thank you for your commitment to joining with Molina Healthcare in providing our members with the best quality health care possible.  We look forward to our continuing successful partnership.   Sincerely, David Valdez MD Chief Medical Officer Molina Healthcare of Texas ', NULL, NULL, '2021-09-23 11:08:30', '2021-09-23 11:08:30'),
(23977, 11056, 22355, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Hey Michele,     Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it.     Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke  Provider NPI# : 1154782720     Provider Name : Dada, Oladipo Provider NPI# : 1154782720     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.    Thank you!  Have a great weekend!', NULL, NULL, '2021-09-30 16:19:28', '2021-09-30 16:19:28'),
(23978, 11056, 22355, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good Morning,  Thank you for your inquiry.  Please see the status below for each provider.  Record # 180265 – Atinuke Dada -The credentialing application still in process.  Please allow more time for processing.  Submitted an email to credentialing for status.', NULL, NULL, '2021-10-06 08:58:46', '2021-10-06 08:58:46'),
(23979, 11056, 22355, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good Afternoon,     Thank you for your inquiry.  The request for both providers have been sent for loading in the billing system.  Please follow up after 10/1/21 for Oladipo Dada and after 10/15/21 for Atinuke Dada.', NULL, NULL, '2021-10-14 14:25:09', '2021-10-14 14:25:09'),
(23980, 11056, 22355, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good morning!  Hope you are doing great. Please provide me with latest updates on the following provider credentialing application.  Group Name	Ladot Healthcare LLC Tax ID	85-2432283 Group NPI	1912502626 Primary Location	2577 Madison Avenue, League City , TX 77573 Provider Name	NPI Atinuke Dada  	1154782720   If the credentialing and loading in the billing system has been completed, kindly do provide us with the welcome letter soon.  Thank you! Take Care!', NULL, NULL, '2021-10-21 15:36:41', '2021-10-21 15:36:41'),
(23981, 11056, 22355, NULL, '2021-11-19 00:00:00.000', 'Approved', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good Morning,   Thank you for your inquiry.   The provider has been loaded in the billing system effective 10/15/21 under all plans.  The group contract includes all plans including Marketplace.   The providers have been added under all plans ( Medicaid, Medicare, Dual MMP and Marketplace)  There is no welcome letter for the group only the providers.  The welcome letters for the providers have already been sent.', NULL, NULL, '2021-11-12 15:10:14', '2021-11-12 15:10:14'),
(23982, 3040, 22356, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:50:46', '2021-03-16 15:50:46'),
(23983, 3040, 22356, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'Waiting for the Medicaid approval. ', NULL, NULL, '2021-04-01 13:21:30', '2021-04-01 13:21:30'),
(23984, 1006, 22356, NULL, '2021-06-02 00:00:00.000', 'On Hold', 'Pending Medicaid approval. ', NULL, NULL, '2021-05-26 09:01:45', '2021-05-26 09:01:45'),
(23985, 1006, 22356, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Submitted enrollment request @ MHMSProviderContracting MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Request - LHC - Molina Health  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  Enrollment form attached in group task for reference.', NULL, NULL, '2021-06-14 16:46:31', '2021-06-14 16:46:31'),
(23986, 1006, 22356, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Received the following reply from MHMSProviderContracting MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Request - LHC - Molina Health  \"Good Morning,  Thank you for reaching out. However, I believe you have reached the MS Health Plan by mistake. Please see below for information for the TX Health Plan.  Texas CREDENTIALING MHT.Credentialing@MolinaHealthCare.Com PROVIDER NETWORK ADMIN MHTProviderNetworkAdmin@MolinaHealthCare.Com CONTRACTING MHTContracting2@MolinaHealthCare.Com CONTRACT REQUEST MHTContractrequest@MolinaHealthCare.Com PROVIDER SERVICES MHTXProviderServices@MolinaHealthCare.Com  Provider Contracts Description: Description: Description: Description: Description: cid:image002.jpg@01CDB5C6.D25A2E90 Molina Healthcare of Mississippi, Inc. 188 East Capitol Street, Suite 700 Jackson, MS  39201\"  Sent corrected email & request @ MHTContractrequest mhtcontractrequest@molinahealthcare.com:  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  Form attached in group task for reference.', NULL, NULL, '2021-07-02 15:48:40', '2021-07-02 15:48:40'),
(23987, 1006, 22356, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Received the following reply from MHMSProviderContracting MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Request - LHC - Molina Health  \"Good Morning,  Thank you for reaching out. However, I believe you have reached the MS Health Plan by mistake. Please see below for information for the TX Health Plan.  Texas CREDENTIALING MHT.Credentialing@MolinaHealthCare.Com PROVIDER NETWORK ADMIN MHTProviderNetworkAdmin@MolinaHealthCare.Com CONTRACTING MHTContracting2@MolinaHealthCare.Com CONTRACT REQUEST MHTContractrequest@MolinaHealthCare.Com PROVIDER SERVICES MHTXProviderServices@MolinaHealthCare.Com  Provider Contracts Description: Description: Description: Description: Description: cid:image002.jpg@01CDB5C6.D25A2E90 Molina Healthcare of Mississippi, Inc. 188 East Capitol Street, Suite 700 Jackson, MS  39201\"  Sent corrected email & request @ MHTContractrequest mhtcontractrequest@molinahealthcare.com:  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  Form attached in group task for reference.', NULL, NULL, '2021-07-02 15:48:44', '2021-07-02 15:48:44'),
(23988, 11056, 22356, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Molina Provider Contract - Oladipo Dada  Good Afternoon,  Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for (Oladipo Dada) to contract under TAX ID number (85-2432283).     I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.     Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.     Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below:  HARRIS  Michele Thomas Martin  Michele.Thomas-Martin@MolinaHealthcare.com  888-562-5442 x200042Thomas           Have a wonderful day!  Thank you,  Tyhesha Price  MHT| Provider Contracts  Molina Healthcare of Texas, Inc.  1660 Westridge Circle N  Irving, TX 75038  Mhtcontractrequest@Molinahealthcare.com', NULL, NULL, '2021-07-13 17:03:25', '2021-07-13 17:03:25'),
(23989, 11056, 22356, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to : 	TexasExpansionContracting@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Hey Michele,  Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it.  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720   If you need any information or documents regarding enrollment feel free to call or email me.  Thank you! Have a great day!', NULL, NULL, '2021-07-13 17:19:56', '2021-07-13 17:19:56'),
(23990, 11056, 22356, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Record # 180028  Provider: Oladipo Dada  Good Morning,  Thank you for your inquiry.  I’ve located one request on file for Oladipo Dada.  The request is currently on hold awaiting the return of the requested documents.  We also never received a response to the attached email that was previously sent.   Please provide the name, email and title of the person that will be signing the contract.  The authorized person name has to match the signature.  Once I have the name and email of the actual person that will be signing the contract , the contract will be sent via DocuSign.  Thank You,  Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-07-20 06:20:39', '2021-07-20 06:20:39'),
(23991, 11056, 22356, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Good Afternoon,  Hope you are doing well. Here are the information and forms you requested for the enrollment and contracting of the providers and the group mentioned below. Kindly see the attachments .  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720  If you need any information or documents regarding enrollment feel free to call or email me.  Thank you! Have a great day!', NULL, NULL, '2021-07-20 06:30:03', '2021-07-20 06:30:03'),
(23992, 11056, 22356, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Contract Received from Email : \'Michele Thomas-Martin via DocuSign\' via Ladot Healthcare LLC   Sub :  Request for eSignatures   Michele Thomas-Martin sent you a document to review and sign. REVIEW DOCUMENT Michele Thomas-Martin Michele.Thomas-Martin@molinahealthcare.com Request for eSignatures. Please review and sign.   The contract has been reviewed and signed via Docusign .  Please see the attachment. ', NULL, NULL, '2021-07-27 09:25:52', '2021-07-27 09:25:52'),
(23993, 11056, 22356, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Record # 180265  Good Morning,  Thank you for submitting the documents.  Please update CAQH application to allow Molina authorization, if you haven’t already done so for Atinuke Dada.  Thank you for submitting the contracting documents, the documents have been loaded in the system and forwarded to credentialing.  The credentialing process could take 30-45 days to complete.  If not yet registered for Availity, go to www.Availity.com, click register in the top right of the page, then follow the organization registration process.  Once your registration is approved, you can proceed to the next step.  “Effective April 1, 2018, the state of Texas established a statewide concept to facilitate the credentialing process for Medicaid and CHIP providers in Texas.  This is facilitated by the Texas Association of Health Plans (TAHP), using a Credentialing Verification Organization (CVO) called Aperture.  Individual providers can use CAQH to enter their credentialing information and can upload any supporting documents.  This can be found at https://proview.caqh.org.  Or you may choose to complete the Texas Standardized Application for providers that is attached.  Facility providers can complete the Texas Standardized Application for HDO’s on the Availity portal.  You can register and complete the application by visiting www.availity.com.   Or you may choose to complete the Texas Standardized Application for facilities that is attached.”  We look forward to having you as a part of our network and encourage you to visit www.molinahealthcare.com to learn more about us.  My contact information is listed below should you have any questions or concerns. Thank you,', NULL, NULL, '2021-08-03 10:20:32', '2021-08-03 10:20:32'),
(23994, 11056, 22356, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Good Afternoon!  Hope you are doing well. The CAQH application is authorized and updated. You may do the authorization.  If you have any queries further feel free to reach out to me soon. Waiting for your response.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-08-09 15:26:20', '2021-08-09 15:26:20'),
(23995, 11056, 22356, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub :  Enrollment Status Update Needed - LHC - Molina Health  Good morning Thomas!  Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it soon.  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720  If you need any information or documents regarding enrollment feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-16 08:20:08', '2021-08-16 08:20:08'),
(23996, 11056, 22356, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Good Afternoon,     Thank you for your inquiry.   Please see the status updates below.      Oladipo Dada – The request has been sent to credentialing for processing, please allow 3-4 weeks for processing.  Atinuke Dada - The request has been sent to credentialing for processing, please allow 3-4 weeks for processing.', NULL, NULL, '2021-08-23 08:49:31', '2021-08-23 08:49:31');
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
(23997, 11056, 22356, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good Morning,     Thank you for your inquiry.  Please see the status below for each provider.     Oladipo Dada – The credentialing application has been approved and the contract has been executed.   The request has been sent for loading in the billing system.  Please allow 30-45 days for this process to complete.     Atinuke Dada – The credentialing application is still in process, please allow a few more weeks for the application to complete.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2021-09-01 09:43:49', '2021-09-01 09:43:49'),
(23998, 11056, 22356, NULL, '2021-09-20 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good morning Michele!  Hope this email finds you well. Please let this not take so long. Kindly keep me updated and May this be completed instantly.  If you need any information or documents please let me know. Please don\'t hesitate to reach out to me.  Thank you! Have a great week ahead!', NULL, NULL, '2021-09-13 10:14:28', '2021-09-13 10:14:28'),
(23999, 11056, 22356, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub :  RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good Morning,   Thank you for your inquiry.   Please see the status updates for each record below.    180028 – Oladipo Dada – The request under the final process.  The request has been sent for loading in the billing system.  Please allow 2-4 weeks for this process to complete. ', NULL, NULL, '2021-09-23 11:10:37', '2021-09-23 11:10:37'),
(24000, 11056, 22356, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Hey Michele,     Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it.     Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke  Provider NPI# : 1154782720     Provider Name : Dada, Oladipo Provider NPI# : 1154782720     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.    Thank you!  Have a great weekend!', NULL, NULL, '2021-09-30 16:18:47', '2021-09-30 16:18:47'),
(24001, 11056, 22356, NULL, '2021-10-07 00:00:00.000', 'Approved', 'Approval Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Marketplace  Good Afternoon,  Thank you for your inquiry.   The provider listed below has been added in the billing system effective 10/1/21 under all plans.   Please see the attached welcome letter.  Ladot Healthcare LLC – Oladipo Dada  Record # 180265 – Atinuke Dada – The provider has completed credentialing and the request has been sent for loading in the billing system.   Please allow 2-4 weeks for this process to complete.   Please see the attachment.', NULL, NULL, '2021-09-30 16:27:09', '2021-09-30 16:27:09'),
(24002, 3046, 22357, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:52:55', '2021-03-16 15:52:55'),
(24003, 1006, 22357, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 15:00:57', '2021-04-06 15:00:57'),
(24004, 3046, 22358, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:53:00', '2021-03-16 15:53:00'),
(24005, 1006, 22358, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 15:01:01', '2021-04-06 15:01:01'),
(24006, 3046, 22359, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:53:02', '2021-03-16 15:53:02'),
(24007, 1006, 22359, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 15:01:08', '2021-04-06 15:01:08'),
(24008, 3046, 22360, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:53:04', '2021-03-16 15:53:04'),
(24009, 1006, 22360, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 15:01:14', '2021-04-06 15:01:14'),
(24010, 3046, 22361, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:53:05', '2021-03-16 15:53:05'),
(24011, 1006, 22361, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 15:01:19', '2021-04-06 15:01:19'),
(24012, 3046, 22362, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:53:07', '2021-03-16 15:53:07'),
(24013, 1006, 22362, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 15:01:23', '2021-04-06 15:01:23'),
(24014, 3046, 22363, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:53:09', '2021-03-16 15:53:09'),
(24015, 1005, 22363, NULL, '2021-04-12 00:00:00.000', 'On Hold', 'from:	Karla Claunch Karla.Claunch@dchstx.org to:	Brad Peterson aa@claimsmedinc.com cc:	Rabagos HealthCare rhc@claimsmedinc.com,  Good morning,  Katherine Rabagos was withdrawn 10/21/2020 due to supervising physician is not participating provider with DHP.  The group will not be contracted without a participating provider.', NULL, NULL, '2021-04-05 15:50:00', '2021-04-05 15:50:00'),
(24016, 1006, 22363, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 15:01:36', '2021-04-06 15:01:36'),
(24017, 3046, 22364, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:53:10', '2021-03-16 15:53:10'),
(24018, 1006, 22364, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 15:01:40', '2021-04-06 15:01:40'),
(24019, 3046, 22365, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:53:13', '2021-03-16 15:53:13'),
(24020, 1006, 22365, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 15:01:49', '2021-04-06 15:01:49'),
(24021, 3046, 22366, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:53:15', '2021-03-16 15:53:15'),
(24022, 1006, 22366, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 15:01:55', '2021-04-06 15:01:55'),
(24023, 3046, 22367, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:53:22', '2021-03-16 15:53:22'),
(24024, 1006, 22367, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 15:02:01', '2021-04-06 15:02:01'),
(24025, 3046, 22368, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:54:50', '2021-03-16 15:54:50'),
(24026, 1006, 22368, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Received response stating that we should submit demographic update via https://swhp.org/forms/html/demographic-Update-Form.html  Request submitted:  \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 125c3a8b-5205-47a4-80f6-82a3d12c4451\"  It has been attached for reference in group task as our contract is a facility one. ', NULL, NULL, '2021-04-07 16:15:12', '2021-04-07 16:15:12'),
(24027, 9057, 22368, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent Following email to PRSupport@firstcare.com Sub: Additional location status request - RHC -Scott & White  Hello, We submitted a request for the addition of a location for the following group:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you ', NULL, NULL, '2021-05-25 14:02:30', '2021-05-25 14:02:30'),
(24028, 1006, 22368, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent another f/u email @ PR SUPPORT PRSUPPORT@bswhealth.org:  Sub: Enrollment Query/Location Addition - RHC - Scott & White  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the location status for the following group and providers, the information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-06-11 16:24:26', '2021-06-11 16:24:26'),
(24029, 1006, 22368, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The location has been added to the facility contract, confirmation for approval and location are attached for reference in the main group task as this is a facility contract.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 14:29:48', '2021-06-23 14:29:48'),
(24030, 3046, 22369, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:54:52', '2021-03-16 15:54:52'),
(24031, 1006, 22369, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Received response stating that we should submit demographic update via https://swhp.org/forms/html/demographic-Update-Form.html  Request submitted:  \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 125c3a8b-5205-47a4-80f6-82a3d12c4451\"  It has been attached for reference in group task as our contract is a facility one.  ', NULL, NULL, '2021-04-07 16:15:17', '2021-04-07 16:15:17'),
(24032, 9057, 22369, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent Following email to PRSupport@firstcare.com Sub: Additional location status request - RHC -Scott & White  Hello, We submitted a request for the addition of a location for the following group:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-25 14:04:39', '2021-05-25 14:04:39'),
(24033, 1006, 22369, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent another f/u email @ PR SUPPORT PRSUPPORT@bswhealth.org:  Sub: Enrollment Query/Location Addition - RHC - Scott & White  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the location status for the following group and providers, the information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-06-11 16:24:23', '2021-06-11 16:24:23'),
(24034, 1006, 22369, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The location has been added to the facility contract, confirmation for approval and location are attached for reference in the main group task as this is a facility contract.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 14:29:53', '2021-06-23 14:29:53'),
(24035, 3046, 22370, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:54:53', '2021-03-16 15:54:53'),
(24036, 1006, 22370, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Received response stating that we should submit demographic update via https://swhp.org/forms/html/demographic-Update-Form.html  Request submitted:  \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 125c3a8b-5205-47a4-80f6-82a3d12c4451\"  It has been attached for reference in group task as our contract is a facility one.  ', NULL, NULL, '2021-04-07 16:15:21', '2021-04-07 16:15:21'),
(24037, 9057, 22370, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent Following email to PRSupport@firstcare.com Sub: Additional location status request - RHC -Scott & White  Hello, We submitted a request for the addition of a location for the following group:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-25 14:04:49', '2021-05-25 14:04:49'),
(24038, 1006, 22370, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent another f/u email @ PR SUPPORT PRSUPPORT@bswhealth.org:  Sub: Enrollment Query/Location Addition - RHC - Scott & White  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the location status for the following group and providers, the information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-06-11 16:24:18', '2021-06-11 16:24:18'),
(24039, 1006, 22370, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The location has been added to the facility contract, confirmation for approval and location are attached for reference in the main group task as this is a facility contract.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 14:30:02', '2021-06-23 14:30:02'),
(24040, 3046, 22371, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:54:55', '2021-03-16 15:54:55'),
(24041, 1006, 22371, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Received response stating that we should submit demographic update via https://swhp.org/forms/html/demographic-Update-Form.html  Request submitted:  \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 125c3a8b-5205-47a4-80f6-82a3d12c4451\"  It has been attached for reference in group task as our contract is a facility one.  ', NULL, NULL, '2021-04-07 16:15:25', '2021-04-07 16:15:25'),
(24042, 9057, 22371, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent Following email to PRSupport@firstcare.com Sub: Additional location status request - RHC -Scott & White  Hello, We submitted a request for the addition of a location for the following group:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-25 14:04:57', '2021-05-25 14:04:57'),
(24043, 1006, 22371, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent another f/u email @ PR SUPPORT PRSUPPORT@bswhealth.org:  Sub: Enrollment Query/Location Addition - RHC - Scott & White  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the location status for the following group and providers, the information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-06-11 16:24:14', '2021-06-11 16:24:14'),
(24044, 1006, 22371, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The location has been added to the facility contract, confirmation for approval and location are attached for reference in the main group task as this is a facility contract.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 14:30:05', '2021-06-23 14:30:05'),
(24045, 3046, 22372, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:54:56', '2021-03-16 15:54:56'),
(24046, 1006, 22372, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Received response stating that we should submit demographic update via https://swhp.org/forms/html/demographic-Update-Form.html  Request submitted:  \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 125c3a8b-5205-47a4-80f6-82a3d12c4451\"  It has been attached for reference in group task as our contract is a facility one.  ', NULL, NULL, '2021-04-07 16:15:29', '2021-04-07 16:15:29'),
(24047, 9057, 22372, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent Following email to PRSupport@firstcare.com Sub: Additional location status request - RHC -Scott & White  Hello, We submitted a request for the addition of a location for the following group:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-25 14:05:10', '2021-05-25 14:05:10'),
(24048, 1006, 22372, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent another f/u email @ PR SUPPORT PRSUPPORT@bswhealth.org:  Sub: Enrollment Query/Location Addition - RHC - Scott & White  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the location status for the following group and providers, the information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-06-11 16:24:11', '2021-06-11 16:24:11'),
(24049, 1006, 22372, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The location has been added to the facility contract, confirmation for approval and location are attached for reference in the main group task as this is a facility contract.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 14:30:07', '2021-06-23 14:30:07'),
(24050, 3046, 22373, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:54:58', '2021-03-16 15:54:58'),
(24051, 1006, 22373, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Received response stating that we should submit demographic update via https://swhp.org/forms/html/demographic-Update-Form.html  Request submitted:  \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 125c3a8b-5205-47a4-80f6-82a3d12c4451\"  It has been attached for reference in group task as our contract is a facility one.  ', NULL, NULL, '2021-04-07 16:15:33', '2021-04-07 16:15:33'),
(24052, 9057, 22373, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent Following email to PRSupport@firstcare.com Sub: Additional location status request - RHC -Scott & White  Hello, We submitted a request for the addition of a location for the following group:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-25 14:05:19', '2021-05-25 14:05:19'),
(24053, 1006, 22373, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent another f/u email @ PR SUPPORT PRSUPPORT@bswhealth.org:  Sub: Enrollment Query/Location Addition - RHC - Scott & White  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the location status for the following group and providers, the information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-06-11 16:23:15', '2021-06-11 16:23:15'),
(24054, 1006, 22373, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The location has been added to the facility contract, confirmation for approval and location are attached for reference in the main group task as this is a facility contract.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 14:30:10', '2021-06-23 14:30:10'),
(24055, 3046, 22374, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:54:59', '2021-03-16 15:54:59'),
(24056, 1006, 22374, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Received response stating that we should submit demographic update via https://swhp.org/forms/html/demographic-Update-Form.html  Request submitted:  \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 125c3a8b-5205-47a4-80f6-82a3d12c4451\"  It has been attached for reference in group task as our contract is a facility one.  ', NULL, NULL, '2021-04-07 16:15:37', '2021-04-07 16:15:37'),
(24057, 9057, 22374, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent Following email to PRSupport@firstcare.com Sub: Additional location status request - RHC -Scott & White  Hello, We submitted a request for the addition of a location for the following group:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-25 14:05:28', '2021-05-25 14:05:28'),
(24058, 1006, 22374, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent another f/u email @ PR SUPPORT PRSUPPORT@bswhealth.org:  Sub: Enrollment Query/Location Addition - RHC - Scott & White  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the location status for the following group and providers, the information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-06-11 16:23:12', '2021-06-11 16:23:12'),
(24059, 1006, 22374, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The location has been added to the facility contract, confirmation for approval and location are attached for reference in the main group task as this is a facility contract.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 14:30:13', '2021-06-23 14:30:13'),
(24060, 3046, 22375, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:55:01', '2021-03-16 15:55:01'),
(24061, 1006, 22375, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Received response stating that we should submit demographic update via https://swhp.org/forms/html/demographic-Update-Form.html  Request submitted:  \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 125c3a8b-5205-47a4-80f6-82a3d12c4451\"  It has been attached for reference in group task as our contract is a facility one.  ', NULL, NULL, '2021-04-07 16:15:42', '2021-04-07 16:15:42'),
(24062, 9057, 22375, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent Following email to PRSupport@firstcare.com Sub: Additional location status request - RHC -Scott & White  Hello, We submitted a request for the addition of a location for the following group:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-25 14:05:35', '2021-05-25 14:05:35'),
(24063, 1006, 22375, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent another f/u email @ PR SUPPORT PRSUPPORT@bswhealth.org:  Sub: Enrollment Query/Location Addition - RHC - Scott & White  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the location status for the following group and providers, the information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-06-11 16:23:09', '2021-06-11 16:23:09'),
(24064, 1006, 22375, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The location has been added to the facility contract, confirmation for approval and location are attached for reference in the main group task as this is a facility contract.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 14:30:17', '2021-06-23 14:30:17'),
(24065, 3046, 22376, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:55:04', '2021-03-16 15:55:04'),
(24066, 1006, 22376, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Received response stating that we should submit demographic update via https://swhp.org/forms/html/demographic-Update-Form.html  Request submitted:  \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 125c3a8b-5205-47a4-80f6-82a3d12c4451\"  It has been attached for reference in group task as our contract is a facility one.  ', NULL, NULL, '2021-04-07 16:15:47', '2021-04-07 16:15:47'),
(24067, 9057, 22376, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent Following email to PRSupport@firstcare.com Sub: Additional location status request - RHC -Scott & White  Hello, We submitted a request for the addition of a location for the following group:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-25 14:04:13', '2021-05-25 14:04:13'),
(24068, 1006, 22376, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent another f/u email @ PR SUPPORT PRSUPPORT@bswhealth.org:  Sub: Enrollment Query/Location Addition - RHC - Scott & White  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the location status for the following group and providers, the information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-06-11 16:23:06', '2021-06-11 16:23:06'),
(24069, 1006, 22376, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The location has been added to the facility contract, confirmation for approval and location are attached for reference in the main group task as this is a facility contract.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 14:30:19', '2021-06-23 14:30:19'),
(24070, 3046, 22377, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:55:10', '2021-03-16 15:55:10'),
(24071, 3040, 22377, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Email sent to: SWHPRegion4@bswhealth.org  Subject: Contract Information Request || Statcare Minor Emergency Clinic || Group & Providers || Scott & White ||  Greetings,   Hope you are doing well. Can you please advise me the type of contract for the below mentioned practice and I wanted to verify the locations that all of the four locations are updated under the contract.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quantetry Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  --', NULL, NULL, '2021-03-31 14:00:54', '2021-03-31 14:00:54'),
(24072, 1006, 22377, NULL, '2021-04-14 00:00:00.000', 'In Process', 'Received response stating that we should submit demographic update via https://swhp.org/forms/html/demographic-Update-Form.html  Request submitted:  \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 125c3a8b-5205-47a4-80f6-82a3d12c4451\"  It has been attached for reference in group task as our contract is a facility one. ', NULL, NULL, '2021-04-07 16:13:57', '2021-04-07 16:13:57'),
(24073, 9057, 22377, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent Following email to PRSupport@firstcare.com Sub: Additional location status request - RHC -Scott & White  Hello, We submitted a request for the addition of a location for the following group:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-25 14:06:04', '2021-05-25 14:06:04'),
(24074, 1006, 22377, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent another f/u email @ PR SUPPORT PRSUPPORT@bswhealth.org:  Sub: Enrollment Query/Location Addition - RHC - Scott & White  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the location status for the following group and providers, the information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-06-11 16:23:02', '2021-06-11 16:23:02'),
(24075, 1006, 22377, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The location has been added to the facility contract, confirmation for approval and location are attached for reference in the main group task as this is a facility contract.   Eff: 01/01/2021', NULL, NULL, '2021-06-23 14:29:18', '2021-06-23 14:29:18'),
(24076, 3046, 22378, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:57:38', '2021-03-16 15:57:38'),
(24077, 1006, 22378, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted LOI & W9 for addition location to Urgentcare contract. Sent email @ pdsdallas@aetna.com ', NULL, NULL, '2021-03-25 17:33:31', '2021-03-25 17:33:31'),
(24078, 9057, 22378, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to pdsdallas@aetna.com  Sub: Additional location status request - RHC - First Health  Hello, We submitted a request for the addition of a location for the following group:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TXIN# 46-0575924  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you ', NULL, NULL, '2021-05-25 10:45:21', '2021-05-25 10:45:21'),
(24079, 9057, 22378, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to: pdsdallas@aetna.com Sub: Additional location status request - RHC - First Health  Hello, We submitted a request for additional location to our urgent care contract under the following group  and providers.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provide Details Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415     Provider 3: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 4: Provider Name: Trevino, Rose Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :5 Provider Name: Ayarzagoitia, Patrick  Provider NPI#   1649568239 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :6 Provider Name: Mason, Traci Provider NPI#   1497127831 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :7 Provider Name: Svatek, Maegan Provider NPI#   1639670250 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider:8 Provider Name: Capupus, Mari Provider NPI#   NPI: 1740517945 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider:9 Provider Name: Rogers, Petina Provider NPI#   1801443916 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Kindly provide the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-26 13:05:48', '2021-05-26 13:05:48'),
(24080, 3040, 22378, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com  Subject: Additional location status request - RHC - First Health  Hello,   I wanted to get an update on the status of this request, please get back to me as soon as possible.  Thank you! ', NULL, NULL, '2021-06-15 16:30:59', '2021-06-15 16:30:59'),
(24081, 11056, 22378, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email received from : BharathB@aetna.com  Sub : Additional location status request - RHC - First Health  Hi Brad,  Please share practice location phone and Fax numbers so that we can proceed further.  Regards, Bharath  Email sent to : BharathB@aetna.com  Sub : Additional location status request - RHC - First Health  Hi Bharath,  Hope you are doing well. Here is the information you asked for about the practice.  Practice Detail: Practice Name : Statcare Minor Emergency Clinic Practice Phone : 361-516-0800 Practice Fax : 361-516-0855   If you need any further information feel free to contact me. Waiting to hear from you soon. Thank you! ', NULL, NULL, '2021-07-01 14:53:48', '2021-07-01 14:53:48'),
(24082, 1006, 22378, NULL, '2021-07-14 00:00:00.000', 'In Process', 'We received the following reply from Bharath, Bollu BharathB@aetna.com:  Sub: Additional location status request - RHC - First Health  \"Hi Brad,  Following up on the below email. Please assist  Regards, Bharath\"  Replied:   \"Hello Bollu,   Sure thing, here\'s the information: Address: 500 E CAESAR, KINGSVILLE, TX 78363   Phone# 361-516-0800 Fax# 361-516-0855  Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone#  361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-07-07 08:51:41', '2021-07-07 08:51:41'),
(24083, 1006, 22378, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & pdsdallas@aetna.com:  Sub: Additional location status request - RHC - First Health  \"Hello Bollu,   I appreciate the update, from what I can see from the First Health directory there seems to have been some confusion.   We want all of the following mentioned practice addresses listed under all of the given providers:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Name: Rose Trevino NPI# 1437174794  Provider Name: Katherine Rabagos NPI# 1134415631  Provider Name: Mary Gonzalez NPI# 1952713083  Provider Name: William Francis NPI# 1457994436  Provider Name: Juan Capupus NPI# 1891168597  Provider Name: Maegan Svatek NPI# 1639670250  Provider Name: Petina Rogers NPI# 1801443916  Provider Name: Traci Mason NPI# 1497127831  Provider Name: Mari Capupus NPI# 1740517945  Provider Name: Patrick Ayarzagoitia NPI# 1649568239  Please let me know if you need anything to get these updated.  Thank you.\"', NULL, NULL, '2021-08-17 17:29:09', '2021-08-17 17:29:09'),
(24084, 11056, 22378, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : pdsdallas@aetna.com>  Sub : Fwd: Additional location status request - RHC - First Health  Good evening!  Hope all is well with you. I want all of the following mentioned practice addresses listed under all of the given providers. Please update me with the latest credentialing status of these providers too.  Practice Details: Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Details: Provider Name: Rose Trevino NPI# 1437174794  Provider Name: Katherine Rabagos NPI# 1134415631  Provider Name: Mary Gonzalez NPI# 1952713083  Provider Name: William Francis NPI# 1457994436  Provider Name: Juan Capupus NPI# 1891168597  Provider Name: Maegan Svatek NPI# 1639670250  Provider Name: Petina Rogers NPI# 1801443916  Provider Name: Traci Mason NPI# 1497127831  Provider Name: Mari Capupus NPI# 1740517945  Provider Name: Patrick Ayarzagoitia NPI# 1649568239  If you have any questions or concerns or require any documents or information, please contact me without any hesitation. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:26:27', '2021-09-21 16:26:27'),
(24085, 11056, 22378, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com  Sub : Fwd: Additional location status request - RHC - First Health  Hi,  All the Providers has been added with the given locations.   Thank You,  Phani ', NULL, NULL, '2021-10-01 14:40:25', '2021-10-01 14:40:25');
