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
(27066, 3040, 22773, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group under the below locations. Can you please send me the roster.    Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-24 16:10:17', '2021-05-24 16:10:17'),
(27067, 3040, 22773, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Greetings,   Thank you so much for the roster. I wanted to add the below mentioned providers in additional locations under our group. Can you please advise the process?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.\\  Thank you  ', NULL, NULL, '2021-06-11 11:01:13', '2021-06-11 11:01:13'),
(27068, 3040, 22773, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Hello,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations under our group.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060      Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-29 12:50:00', '2021-06-29 12:50:00'),
(27069, 3040, 22773, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Latrice_Thomas@bcbstx.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Hello Latrice,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060       Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-19 10:54:00', '2021-07-19 10:54:00'),
(27070, 11056, 22773, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com   &   latrice_thomas@bcbstx.com  Sub : Fwd: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Good morning Latrice!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations. Please respond to us soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 10:22:50', '2021-08-13 10:22:50'),
(27071, 3040, 22773, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Additional Locations || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS ||  Greetings!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-09-07 10:15:43', '2021-09-07 10:15:43'),
(27072, 10057, 22773, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :  tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our groups under the below locations. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 PAUL, SIGI	1033623616 Joseph, Molly	1396380077 Jacob, Jaya	1194336149  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 13:28:25', '2021-10-18 13:28:25'),
(27073, 10057, 22773, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Hello,  I wanted to know the enrollment status for group NUCC and for IVUC providers under the mentioned TIN number.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Brown, Brittany	1275163537 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Jacob, Jaya	1194336149 George, Jeemol	1497219067  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 13:19:03', '2021-11-18 13:19:03'),
(27074, 10057, 22773, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: txproviderupdatesubmission@bcbstx.com  Sub : Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Good afternoon,  I have researched your request and listed the provider’s record numbers linked to the Tax ID below.   Provider Name	Provider record #	779 Normandy	16272 Imperial Valley John, Jeny	8PU638	Yes	Yes Joseph, Molly	8PR752	Yes	No Brown, Brittany	8MF387	Yes	No Thomas, Cini	8LW737	Yes	No Stephen, Ani	8MC701	Yes	No Rauf, Abdur	8CU663	Yes	No Kourouma , Odette Tiranke	8ME162	Yes	No Joseph, Vibitha	8MH707	Yes	No Jacob, Jaya	8PR751	Yes	No George, Jeemol	8ML243	Yes	No  All of the providers listed show the Normandy location as their primary service address.  However, the providers I indicated \"No\" in the column above do not have the Imperial Valley address listed as an additional location.  To add this address to these providers’ records, please submit a Demographic Change Request form via the following link information:   https://www.bcbstx.com/forms/provider/update_info.html Click on the link for Demographic Change Form - https://hcscproviderintake.secure.force.com/TXDemographUpdate  For any questions regarding network contracting, credentialing, network or PAR effective dates or status requests, please contact your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number) and fax contact methods.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-11-23 10:42:53', '2021-11-23 10:42:53'),
(27075, 10057, 22773, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Thank you for submitting the form.  Your case number:03211019  Your request may take up to 30 days to complete. Once completed, a notification will be sent to the email address submitted with the Demographic Change Request Form.  Please close the tab using X (Close) Button.', NULL, NULL, '2021-12-03 13:42:40', '2021-12-03 13:42:40'),
(27076, 10057, 22773, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : Carol_DelaO@bcbstx.com  Sub : PHI- Provider Roster - Normandy Urgent Care  Hello Steve –  Please find attach provider roster for provider.  Please review and let me know if you have any questions.  Thank you.  Carol DeLaO, Network Management Consultant  BlueCross BlueShield of Texas', NULL, NULL, '2021-12-10 11:02:06', '2021-12-10 11:02:06'),
(27077, 10057, 22773, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : Noemi_Diaz@bcbstx.com, connie_traylor@bcbstx.com carol_delao@bcbstx.com & txproviderupdatesubmission@bcbstx.com  Sub : Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Greetings!  Hope this email finds you in good health. I want to know about the below mentioned remaining providers who need to be added with Imperial Valley Urgent Care Center location.  Also, how long will it take to receive a group contract for Imperial Valley Urgent Care Center & Normandy Urgent Care Center?  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Kourouma , Odette Tiranke	1134525868 Jacob, Jaya	1194336149 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  If you get a chance, please get back to me. Wishing you a happy weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:26:16', '2021-12-17 10:26:16'),
(27078, 10057, 22773, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Received From : Connie_Traylor@bcbstx.com & Noemi_Diaz@bcbstx.com  Sub : Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Hello,  Latrice, please see below request.  Thanks.', NULL, NULL, '2021-12-27 10:50:09', '2021-12-27 10:50:09'),
(27079, 20067, 22773, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: connie_traylor@bcbstx.com,  Noemi_Diaz@bcbstx.com, carol_delao@bcbstx.com & txproviderupdatesubmission@bcbstx.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Good afternoon,  Hope all is well with you. Any updates on the previously mentioned request?  I would also like to know the updates on case Number# 03279654  Looking Forward to hearing from you.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-10 14:10:11', '2022-01-10 14:10:11'),
(27080, 20067, 22773, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: marina_machuca@bcbstx.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645   Hello! The below-mentioned providers are not in the BCBSTX Provider Directory. Can you please provide me with a copy of the contract or welcome letter?  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI	Location Jaya Jacob	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Odette Kourouma	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Ancy Kurian	1316558935	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Ancy Kurian	1316558935	779 Normandy St Ste 114 Houston, TX 77015-3441  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 17:30:02', '2022-01-18 17:30:02'),
(27081, 20067, 22773, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: marina_machuca@bcbstx.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  I have requested copies of the Credentialing Approval letters for George Jeemol, Vibitha A. Jospeh, Odette T. Kourouma and Jaya Jacob.   Any V. Kurian credentialing is still in process.    Thank you  Marina', NULL, NULL, '2022-01-27 15:20:10', '2022-01-27 15:20:10'),
(27082, 20067, 22773, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: marina_machuca@bcbstx.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645    Good Afternoon Marina! Hope this email finds you in good health. Thanks for the update, kindly send me the letters once you received them.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-02-02 14:55:13', '2022-02-02 14:55:13'),
(27083, 20067, 22773, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: marina_machuca@bcbstx.com  Sub:Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645   I sent you the letters on 1/24/22.     Group# 0032WN – TAX ID# 270796429 does have Par Plan and every time a new provider gets added to this TAX ID# the Par Plan is automatically added.     Thank you  Marina', NULL, NULL, '2022-03-01 17:43:02', '2022-03-01 17:43:02'),
(27084, 20067, 22773, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, txproviderupdatesubmission@bcbstx.com, marina_machuca@bcbstx.com    Sub: Enrollment Status || NUCC & IVUC || Group & Providers || BCBS ||   Hello,  Hope you are doing great. Can you please confirm for me that the listed locations are linked to the provider\'s profile?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Ancy Kurian	1407171077	779 Normandy St Ste 114 Houston , TX 77015-3441 Ancy Kurian	1407171077	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Odette Kourouma	1134525868	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Vibitha Joseph	1952931560	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jeemol George	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Thank you,', NULL, NULL, '2022-03-22 17:22:56', '2022-03-22 17:22:56'),
(27085, 22077, 22773, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: TXProviderUpdateSubmission@bcbstx.com  Subject: Re: Enrollment Status || NUCC & IVUC || Group & Providers || BCBS || : Case Number - 03723317  Hi,  I would like to know the enrollment status for the following providers,  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Primary & Billing Location	799 Normandy St Ste 114 Houston, TX 77015-3441 Provider Name	NPI	Location Ancy Kurian	1316558935	799 Normandy St Ste 114 Houston, TX 77015-3441 Ancy Kurian	1316558935	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Looking forward to hearing from you,  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 14:55:52', '2022-04-14 14:55:52'),
(27086, 22077, 22773, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email received from: txintaketeampiermailbox@bcbstx.com  Subject: BCBS of Texas Inquiry Received: Enrollment Status || NUCC & IVUC || Group & Providers || BCBS || : Case Number - 03886132  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 03886132.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.  As of Jan. 18, 2022, , please use the Provider Data Management module in Availity ®  or our Demographic Change Form  to update your demographic information or to attest to your data. To enable us to meet the two-day provider update requirement defined under the Consolidated Appropriations Act , we will no longer accept provider demographic updates via email, phone or fax. Any demographic updates requested through these channels will be rejected and closed. Facilities should continue to use the Demographic Change Form . Learn more about updating your information .  To apply to join our networks or to add a provider to your current group, individuals and medical groups/clinics should use the Provider Onboarding Form . Learn more about applying to join our networks , including information for facilities.  We welcome your continued correspondence for non-demographic change purposes. If you have opted out of electronic communications, please continue to send correspondence, including demographic updates, via US Mail.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2022-04-14 15:08:34', '2022-04-14 15:08:34'),
(27087, 3046, 22774, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:17:26', '2021-03-17 16:17:26'),
(27088, 3040, 22774, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group under the below locations. Can you please send me the roster.    Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-24 16:10:20', '2021-05-24 16:10:20'),
(27089, 3040, 22774, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Greetings,   Thank you so much for the roster. I wanted to add the below mentioned providers in additional locations under our group. Can you please advise the process?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.\\  Thank you  ', NULL, NULL, '2021-06-11 11:00:48', '2021-06-11 11:00:48'),
(27090, 3040, 22774, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Hello,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations under our group.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060      Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-29 12:50:02', '2021-06-29 12:50:02'),
(27091, 3040, 22774, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Latrice_Thomas@bcbstx.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Hello Latrice,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060       Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-19 10:53:59', '2021-07-19 10:53:59'),
(27092, 11056, 22774, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com   &   latrice_thomas@bcbstx.com  Sub : Fwd: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Good morning Latrice!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations. Please respond to us soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 10:16:56', '2021-08-13 10:16:56'),
(27093, 3040, 22774, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Additional Locations || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS ||  Greetings!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-09-07 10:15:45', '2021-09-07 10:15:45'),
(27094, 10057, 22774, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :  tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our groups under the below locations. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 PAUL, SIGI	1033623616 Joseph, Molly	1396380077 Jacob, Jaya	1194336149  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 13:28:18', '2021-10-18 13:28:18'),
(27095, 10057, 22774, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Hello,  I wanted to know the enrollment status for group NUCC and for IVUC providers under the mentioned TIN number.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Brown, Brittany	1275163537 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Jacob, Jaya	1194336149 George, Jeemol	1497219067  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 13:18:55', '2021-11-18 13:18:55'),
(27096, 10057, 22774, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: txproviderupdatesubmission@bcbstx.com  Sub : Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Good afternoon,  I have researched your request and listed the provider’s record numbers linked to the Tax ID below.   Provider Name	Provider record #	779 Normandy	16272 Imperial Valley John, Jeny	8PU638	Yes	Yes Joseph, Molly	8PR752	Yes	No Brown, Brittany	8MF387	Yes	No Thomas, Cini	8LW737	Yes	No Stephen, Ani	8MC701	Yes	No Rauf, Abdur	8CU663	Yes	No Kourouma , Odette Tiranke	8ME162	Yes	No Joseph, Vibitha	8MH707	Yes	No Jacob, Jaya	8PR751	Yes	No George, Jeemol	8ML243	Yes	No  All of the providers listed show the Normandy location as their primary service address.  However, the providers I indicated \"No\" in the column above do not have the Imperial Valley address listed as an additional location.  To add this address to these providers’ records, please submit a Demographic Change Request form via the following link information:   https://www.bcbstx.com/forms/provider/update_info.html Click on the link for Demographic Change Form - https://hcscproviderintake.secure.force.com/TXDemographUpdate  For any questions regarding network contracting, credentialing, network or PAR effective dates or status requests, please contact your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number) and fax contact methods.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-11-23 10:42:47', '2021-11-23 10:42:47'),
(27097, 10057, 22774, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Thank you for submitting the form.  Your case number:03210966  Your request may take up to 30 days to complete. Once completed, a notification will be sent to the email address submitted with the Demographic Change Request Form.  Please close the tab using X (Close) Button.', NULL, NULL, '2021-12-03 13:32:09', '2021-12-03 13:32:09'),
(27098, 10057, 22774, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : Carol_DelaO@bcbstx.com  Sub : PHI- Provider Roster - Normandy Urgent Care  Hello Steve –  Please find attach provider roster for provider.  Please review and let me know if you have any questions.  Thank you.  Carol DeLaO, Network Management Consultant  BlueCross BlueShield of Texas', NULL, NULL, '2021-12-10 11:02:00', '2021-12-10 11:02:00'),
(27099, 10057, 22774, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : Noemi_Diaz@bcbstx.com, connie_traylor@bcbstx.com carol_delao@bcbstx.com & txproviderupdatesubmission@bcbstx.com  Sub : Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Greetings!  Hope this email finds you in good health. I want to know about the below mentioned remaining providers who need to be added with Imperial Valley Urgent Care Center location.  Also, how long will it take to receive a group contract for Imperial Valley Urgent Care Center & Normandy Urgent Care Center?  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Kourouma , Odette Tiranke	1134525868 Jacob, Jaya	1194336149 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  If you get a chance, please get back to me. Wishing you a happy weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:26:07', '2021-12-17 10:26:07'),
(27100, 10057, 22774, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Received From : Connie_Traylor@bcbstx.com & Noemi_Diaz@bcbstx.com  Sub : Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Hello,  Latrice, please see below request.  Thanks.', NULL, NULL, '2021-12-27 10:50:04', '2021-12-27 10:50:04'),
(27101, 20067, 22774, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: connie_traylor@bcbstx.com,  Noemi_Diaz@bcbstx.com, carol_delao@bcbstx.com & txproviderupdatesubmission@bcbstx.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Good afternoon,  Hope all is well with you. Any updates on the previously mentioned request?  I would also like to know the updates on case Number# 03279654  Looking Forward to hearing from you.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-10 14:09:44', '2022-01-10 14:09:44'),
(27102, 20067, 22774, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: marina_machuca@bcbstx.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645   Hello! The below-mentioned providers are not in the BCBSTX Provider Directory. Can you please provide me with a copy of the contract or welcome letter?  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI	Location Jaya Jacob	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Odette Kourouma	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Ancy Kurian	1316558935	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Ancy Kurian	1316558935	779 Normandy St Ste 114 Houston, TX 77015-3441  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 17:29:53', '2022-01-18 17:29:53'),
(27103, 20067, 22774, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: marina_machuca@bcbstx.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  I have requested copies of the Credentialing Approval letters for George Jeemol, Vibitha A. Jospeh, Odette T. Kourouma and Jaya Jacob.   Any V. Kurian credentialing is still in process.    Thank you  Marina', NULL, NULL, '2022-01-27 15:20:04', '2022-01-27 15:20:04'),
(27104, 20067, 22774, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: marina_machuca@bcbstx.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645    Good Afternoon Marina! Hope this email finds you in good health. Thanks for the update, kindly send me the letters once you received them.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-02-02 14:55:20', '2022-02-02 14:55:20'),
(27105, 20067, 22774, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: marina_machuca@bcbstx.com  Sub:Fwd: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645   I sent you the letters on 1/24/22.     Group# 0032WN – TAX ID# 270796429 does have Par Plan and every time a new provider gets added to this TAX ID# the Par Plan is automatically added.     Thank you  Marina', NULL, NULL, '2022-03-01 17:42:56', '2022-03-01 17:42:56'),
(27106, 20067, 22774, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Check status through BCBSTX Credentialing status check  Your application has been approved. COMPLETION OF THE CREDENTIALING PROCESS DOES NOT MEAN THAT YOU ARE A CONTRACTED PROVIDER. Please await notification via letter or email', NULL, NULL, '2022-03-01 17:50:49', '2022-03-01 17:50:49');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(27107, 20067, 22774, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_Houston@bcbstx.com, txproviderupdatesubmission@bcbstx.com, marina_machuca@bcbstx.com    Sub: Enrollment Status || NUCC & IVUC || Group & Providers || BCBS ||   Hello,  Hope you are doing great. Can you please confirm for me that the listed locations are linked to the provider\'s profile?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Ancy Kurian	1407171077	779 Normandy St Ste 114 Houston , TX 77015-3441 Ancy Kurian	1407171077	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Odette Kourouma	1134525868	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Vibitha Joseph	1952931560	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jeemol George	1497219067	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Thank you,', NULL, NULL, '2022-03-22 17:22:47', '2022-03-22 17:22:47'),
(27108, 3046, 22775, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:17:38', '2021-03-17 16:17:38'),
(27109, 3040, 22775, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group under the below locations. Can you please send me the roster.    Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-24 16:10:24', '2021-05-24 16:10:24'),
(27110, 3040, 22775, NULL, '2021-06-18 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 311863', NULL, NULL, '2021-06-11 12:53:43', '2021-06-11 12:53:43'),
(27111, 3040, 22775, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in BCBS for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-29 12:57:03', '2021-06-29 12:57:03'),
(27112, 3040, 22775, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email rcvd from: TXProviderUpdateSubmission@bcbstx.com  Subject: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Good afternoon, I have researched your request and listed the information below.  Group:  Normandy Urgent Care Center PA  Sigi Paul Provider Record # 8PR750  Jaya Jacob Provider Record # 8PR751  Molly Joseph Provider Record # 8PR752  The application is still in process, but both addresses are set to be added to all three provider records. ', NULL, NULL, '2021-07-19 11:02:26', '2021-07-19 11:02:26'),
(27113, 3040, 22775, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: txproviderupdatesubmission@bcbstx.com, latrice_thomas@bcbstx.com  Subject: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in BCBS for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-07-19 11:03:53', '2021-07-19 11:03:53'),
(27114, 11056, 22775, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com   &   latrice_thomas@bcbstx.com  Sub : Fwd: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Good morning Latrice!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations. Please respond to us soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 10:16:50', '2021-08-13 10:16:50'),
(27115, 11056, 22775, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com   &   latrice_thomas@bcbstx.com  Sub : Fwd: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Good morning Latrice!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations. Please respond to us soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 10:22:19', '2021-08-13 10:22:19'),
(27116, 3040, 22775, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email rcvd from: txproviderupdatesubmission@bcbstx.com  Subject: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Good afternoon, I have researched your request and listed the information below.  Group:  Normandy Urgent Care Center PA  Sigi Paul Provider Record # 8PR750  Jaya Jacob Provider Record # 8PR751  Molly Joseph Provider Record # 8PR752  The application is still in process, but both addresses are set to be added to all three provider records.  For any questions regarding network contracting, credentialing, network effective dates or status requests, please reach out to your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number), fax, and email contact methods. Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-09-07 09:19:48', '2021-09-07 09:19:48'),
(27117, 10057, 22775, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :  tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our groups under the below locations. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 PAUL, SIGI	1033623616 Joseph, Molly	1396380077 Jacob, Jaya	1194336149  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 13:28:11', '2021-10-18 13:28:11'),
(27118, 10057, 22775, NULL, '2021-10-27 00:00:00.000', 'Approved', 'Email Received From : marina_machuca@bcbstx.com  Sub : Case# 03011196  Effective Date : 09/01/2021  This is in response to your inquiry on the enrollment status for some providers being added to Normandy Urgent Care Center TAX ID# 270796429.  Please know that whenever you submit a Provider Onboarding Form, a Case# is assigned.  There is a Case Status Checker tool available on our website under the Provider Tab - Network Participation - \"Check the Status of your Application\".  You can enter the Case# and it will give you the status.    https://hcscproviderintake.secure.force.com/CaseStatusRedirectPage  I have also attached a copy of the Group Roster.  Thank you Marina Machuca', NULL, NULL, '2021-10-20 09:47:36', '2021-10-20 09:47:36'),
(27119, 10057, 22775, NULL, '2021-11-15 00:00:00.000', 'Approved', 'Email Received From : marina_machuca@bcbstx.com  Sub : Case# 03011196  Effective Date : 08/10/2021  This is in response to your inquiry on the enrollment status for some providers being added to Normandy Urgent Care Center TAX ID# 270796429.  Please know that whenever you submit a Provider Onboarding Form, a Case# is assigned.  There is a Case Status Checker tool available on our website under the Provider Tab - Network Participation - \"Check the Status of your Application\".  You can enter the Case# and it will give you the status.    https://hcscproviderintake.secure.force.com/CaseStatusRedirectPage  I have also attached a copy of the Group Roster.  Thank you Marina Machuca', NULL, NULL, '2021-11-08 10:45:28', '2021-11-08 10:45:28'),
(27120, 3046, 22776, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:17:58', '2021-03-17 16:17:58'),
(27121, 3040, 22776, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group under the below locations. Can you please send me the roster.    Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-24 16:10:31', '2021-05-24 16:10:31'),
(27122, 3040, 22776, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Provider enrolled with BCBS. Please see attachment  ', NULL, NULL, '2021-06-11 09:34:49', '2021-06-11 09:34:49'),
(27123, 3046, 22777, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:18:08', '2021-03-17 16:18:08'),
(27124, 3040, 22777, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group under the below locations. Can you please send me the roster.    Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-24 16:10:35', '2021-05-24 16:10:35'),
(27125, 3040, 22777, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Greetings,   Thank you so much for the roster. I wanted to add the below mentioned providers in additional locations under our group. Can you please advise the process?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.\\  Thank you  ', NULL, NULL, '2021-06-11 10:57:54', '2021-06-11 10:57:54'),
(27126, 3040, 22777, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Hello,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations under our group.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060      Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-29 12:49:31', '2021-06-29 12:49:31'),
(27127, 3040, 22777, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Latrice_Thomas@bcbstx.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Hello Latrice,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060       Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-19 10:53:58', '2021-07-19 10:53:58'),
(27128, 11056, 22777, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com   &   latrice_thomas@bcbstx.com  Sub : Fwd: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Good morning Latrice!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations. Please respond to us soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 10:16:52', '2021-08-13 10:16:52'),
(27129, 11056, 22777, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com   &   latrice_thomas@bcbstx.com  Sub : Fwd: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Good morning Latrice!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations. Please respond to us soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 10:22:00', '2021-08-13 10:22:00'),
(27130, 3040, 22777, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Additional Locations || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS ||  Greetings!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-09-07 10:15:41', '2021-09-07 10:15:41'),
(27131, 10057, 22777, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :  tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our groups under the below locations. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 PAUL, SIGI	1033623616 Joseph, Molly	1396380077 Jacob, Jaya	1194336149  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 13:28:00', '2021-10-18 13:28:00'),
(27132, 10057, 22777, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Hello,  I wanted to know the enrollment status for group NUCC and for IVUC providers under the mentioned TIN number.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Brown, Brittany	1275163537 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Jacob, Jaya	1194336149 George, Jeemol	1497219067  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 13:18:49', '2021-11-18 13:18:49'),
(27133, 10057, 22777, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: txproviderupdatesubmission@bcbstx.com  Sub : Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Good afternoon,  I have researched your request and listed the provider’s record numbers linked to the Tax ID below.   Provider Name	Provider record #	779 Normandy	16272 Imperial Valley John, Jeny	8PU638	Yes	Yes Joseph, Molly	8PR752	Yes	No Brown, Brittany	8MF387	Yes	No Thomas, Cini	8LW737	Yes	No Stephen, Ani	8MC701	Yes	No Rauf, Abdur	8CU663	Yes	No Kourouma , Odette Tiranke	8ME162	Yes	No Joseph, Vibitha	8MH707	Yes	No Jacob, Jaya	8PR751	Yes	No George, Jeemol	8ML243	Yes	No  All of the providers listed show the Normandy location as their primary service address.  However, the providers I indicated \"No\" in the column above do not have the Imperial Valley address listed as an additional location.  To add this address to these providers’ records, please submit a Demographic Change Request form via the following link information:   https://www.bcbstx.com/forms/provider/update_info.html Click on the link for Demographic Change Form - https://hcscproviderintake.secure.force.com/TXDemographUpdate  For any questions regarding network contracting, credentialing, network or PAR effective dates or status requests, please contact your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number) and fax contact methods.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-11-23 10:42:42', '2021-11-23 10:42:42'),
(27134, 10057, 22777, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Thank you for submitting the form.  Your case number:03210894  Your request may take up to 30 days to complete. Once completed, a notification will be sent to the email address submitted with the Demographic Change Request Form.  Please close the tab using X (Close) Button.', NULL, NULL, '2021-12-03 13:21:53', '2021-12-03 13:21:53'),
(27135, 10057, 22777, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Email Received From : Carol_DelaO@bcbstx.com  Sub : PHI- Provider Roster - Normandy Urgent Care  Hello Steve –  Please find attach provider roster for provider.  Please review and let me know if you have any questions.  Thank you.  Carol DeLaO, Network Management Consultant  BlueCross BlueShield of Texas', NULL, NULL, '2021-12-10 11:01:53', '2021-12-10 11:01:53'),
(27136, 3046, 22778, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:18:26', '2021-03-17 16:18:26'),
(27137, 3040, 22778, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group under the below locations. Can you please send me the roster.    Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-24 16:10:39', '2021-05-24 16:10:39'),
(27138, 3040, 22778, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Greetings,   Thank you so much for the roster. I wanted to add the below mentioned providers in additional locations under our group. Can you please advise the process?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.\\  Thank you  ', NULL, NULL, '2021-06-11 11:00:32', '2021-06-11 11:00:32'),
(27139, 3040, 22778, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Hello,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations under our group.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060      Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-29 12:49:53', '2021-06-29 12:49:53'),
(27140, 3040, 22778, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Latrice_Thomas@bcbstx.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Hello Latrice,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060       Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-19 10:53:58', '2021-07-19 10:53:58'),
(27141, 11056, 22778, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com   &   latrice_thomas@bcbstx.com  Sub : Fwd: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Good morning Latrice!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations. Please respond to us soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 10:16:32', '2021-08-13 10:16:32');
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
(27142, 3040, 22778, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Additional Locations || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS ||  Greetings!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-09-07 10:15:42', '2021-09-07 10:15:42'),
(27143, 10057, 22778, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :  tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our groups under the below locations. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 PAUL, SIGI	1033623616 Joseph, Molly	1396380077 Jacob, Jaya	1194336149  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 13:27:52', '2021-10-18 13:27:52'),
(27144, 10057, 22778, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Hello,  I wanted to know the enrollment status for group NUCC and for IVUC providers under the mentioned TIN number.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Brown, Brittany	1275163537 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Jacob, Jaya	1194336149 George, Jeemol	1497219067  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 13:18:43', '2021-11-18 13:18:43'),
(27145, 10057, 22778, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: txproviderupdatesubmission@bcbstx.com  Sub : Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Good afternoon,  I have researched your request and listed the provider’s record numbers linked to the Tax ID below.   Provider Name	Provider record #	779 Normandy	16272 Imperial Valley John, Jeny	8PU638	Yes	Yes Joseph, Molly	8PR752	Yes	No Brown, Brittany	8MF387	Yes	No Thomas, Cini	8LW737	Yes	No Stephen, Ani	8MC701	Yes	No Rauf, Abdur	8CU663	Yes	No Kourouma , Odette Tiranke	8ME162	Yes	No Joseph, Vibitha	8MH707	Yes	No Jacob, Jaya	8PR751	Yes	No George, Jeemol	8ML243	Yes	No  All of the providers listed show the Normandy location as their primary service address.  However, the providers I indicated \"No\" in the column above do not have the Imperial Valley address listed as an additional location.  To add this address to these providers’ records, please submit a Demographic Change Request form via the following link information:   https://www.bcbstx.com/forms/provider/update_info.html Click on the link for Demographic Change Form - https://hcscproviderintake.secure.force.com/TXDemographUpdate  For any questions regarding network contracting, credentialing, network or PAR effective dates or status requests, please contact your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number) and fax contact methods.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-11-23 10:42:35', '2021-11-23 10:42:35'),
(27146, 10057, 22778, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Thank you for submitting the form.  Your case number:03210377  Your request may take up to 30 days to complete. Once completed, a notification will be sent to the email address submitted with the Demographic Change Request Form.  Please close the tab using X (Close) Button.', NULL, NULL, '2021-12-03 12:04:11', '2021-12-03 12:04:11'),
(27147, 10057, 22778, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Email Received From : Carol_DelaO@bcbstx.com  Sub : PHI- Provider Roster - Normandy Urgent Care  Hello Steve –  Please find attach provider roster for provider.  Please review and let me know if you have any questions.  Thank you.  Carol DeLaO, Network Management Consultant  BlueCross BlueShield of Texas', NULL, NULL, '2021-12-10 09:48:35', '2021-12-10 09:48:35'),
(27148, 3046, 22779, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:18:36', '2021-03-17 16:18:36'),
(27149, 3040, 22779, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group under the below locations. Can you please send me the roster.    Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-24 16:10:44', '2021-05-24 16:10:44'),
(27150, 3040, 22779, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Greetings,   Thank you so much for the roster. I wanted to add the below mentioned providers in additional locations under our group. Can you please advise the process?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.\\  Thank you  ', NULL, NULL, '2021-06-11 11:00:19', '2021-06-11 11:00:19'),
(27151, 3040, 22779, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Hello,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations under our group.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060      Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-29 12:49:51', '2021-06-29 12:49:51'),
(27152, 3040, 22779, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Latrice_Thomas@bcbstx.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Hello Latrice,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060       Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-19 10:53:57', '2021-07-19 10:53:57'),
(27153, 11056, 22779, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com   &   latrice_thomas@bcbstx.com  Sub : Fwd: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Good morning Latrice!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations. Please respond to us soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 10:16:13', '2021-08-13 10:16:13'),
(27154, 3040, 22779, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Additional Locations || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS ||  Greetings!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-09-07 10:15:42', '2021-09-07 10:15:42'),
(27155, 10057, 22779, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :  tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our groups under the below locations. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 PAUL, SIGI	1033623616 Joseph, Molly	1396380077 Jacob, Jaya	1194336149  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 13:27:43', '2021-10-18 13:27:43'),
(27156, 10057, 22779, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Hello,  I wanted to know the enrollment status for group NUCC and for IVUC providers under the mentioned TIN number.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Brown, Brittany	1275163537 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Jacob, Jaya	1194336149 George, Jeemol	1497219067  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 13:18:37', '2021-11-18 13:18:37'),
(27157, 10057, 22779, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: txproviderupdatesubmission@bcbstx.com  Sub : Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Good afternoon,  I have researched your request and listed the provider’s record numbers linked to the Tax ID below.   Provider Name	Provider record #	779 Normandy	16272 Imperial Valley John, Jeny	8PU638	Yes	Yes Joseph, Molly	8PR752	Yes	No Brown, Brittany	8MF387	Yes	No Thomas, Cini	8LW737	Yes	No Stephen, Ani	8MC701	Yes	No Rauf, Abdur	8CU663	Yes	No Kourouma , Odette Tiranke	8ME162	Yes	No Joseph, Vibitha	8MH707	Yes	No Jacob, Jaya	8PR751	Yes	No George, Jeemol	8ML243	Yes	No  All of the providers listed show the Normandy location as their primary service address.  However, the providers I indicated \"No\" in the column above do not have the Imperial Valley address listed as an additional location.  To add this address to these providers’ records, please submit a Demographic Change Request form via the following link information:   https://www.bcbstx.com/forms/provider/update_info.html Click on the link for Demographic Change Form - https://hcscproviderintake.secure.force.com/TXDemographUpdate  For any questions regarding network contracting, credentialing, network or PAR effective dates or status requests, please contact your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number) and fax contact methods.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-11-23 10:42:29', '2021-11-23 10:42:29'),
(27158, 10057, 22779, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Thank you for submitting the form.  Your case number:03210336  Your request may take up to 30 days to complete. Once completed, a notification will be sent to the email address submitted with the Demographic Change Request Form.  Please close the tab using X (Close) Button.', NULL, NULL, '2021-12-03 11:59:50', '2021-12-03 11:59:50'),
(27159, 10057, 22779, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Email Received From : Carol_DelaO@bcbstx.com  Sub : PHI- Provider Roster - Normandy Urgent Care  Hello Steve –  Please find attach provider roster for provider.  Please review and let me know if you have any questions.  Thank you.  Carol DeLaO, Network Management Consultant  BlueCross BlueShield of Texas', NULL, NULL, '2021-12-10 10:37:57', '2021-12-10 10:37:57'),
(27160, 1006, 22780, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:18:47', '2021-03-17 16:18:47'),
(27161, 1006, 22780, NULL, '2021-05-24 00:00:00.000', 'Initiated', 'Enrollment request submitted via the online portal.   Reference Number :	21137001290 ', NULL, NULL, '2021-05-17 15:12:27', '2021-05-17 15:12:27'),
(27162, 3040, 22780, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare Railroad.', NULL, NULL, '2021-06-07 17:43:28', '2021-06-07 17:43:28'),
(27163, 1006, 22781, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:18:48', '2021-03-17 16:18:48'),
(27164, 1006, 22781, NULL, '2021-05-24 00:00:00.000', 'Initiated', 'Enrollment request submitted via the online portal.   Reference Number :	21137001293 ', NULL, NULL, '2021-05-17 15:13:41', '2021-05-17 15:13:41'),
(27165, 3040, 22781, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare Railroad.', NULL, NULL, '2021-06-07 17:43:23', '2021-06-07 17:43:23'),
(27166, 3046, 22782, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:18:59', '2021-03-17 16:18:59'),
(27167, 3040, 22782, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group under the below locations. Can you please send me the roster.    Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-24 16:10:48', '2021-05-24 16:10:48'),
(27168, 3040, 22782, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Greetings,   Thank you so much for the roster. I wanted to add the below mentioned providers in additional locations under our group. Can you please advise the process?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.\\  Thank you  ', NULL, NULL, '2021-06-11 11:01:00', '2021-06-11 11:01:00'),
(27169, 3040, 22782, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Hello,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations under our group.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060      Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-29 12:49:58', '2021-06-29 12:49:58'),
(27170, 3040, 22782, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Latrice_Thomas@bcbstx.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 02490405  Hello Latrice,   Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060       Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-07-19 10:53:56', '2021-07-19 10:53:56'),
(27171, 11056, 22782, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : Provider_Relations_Houston@bcbstx.com, tx_standard_contracting_team@bcbstx.com   &   latrice_thomas@bcbstx.com  Sub : Fwd: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02591023  Good morning Latrice!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations. Please respond to us soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 10:16:02', '2021-08-13 10:16:02'),
(27172, 3040, 22782, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com  Subject: Additional Locations || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || BCBS ||  Greetings!  Hope you are doing well. I wanted to add the below mentioned providers in additional locations in BCBS in our group under the highlighted below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Provider 2:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 6:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 7: Provider Name: George, Jeemol Provider NPI# 1497219067 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 8:   Provider Name:Jacob, Jaya Provider NPI# 1194336149 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-09-07 10:15:43', '2021-09-07 10:15:43'),
(27173, 10057, 22782, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :  tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our groups under the below locations. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 PAUL, SIGI	1033623616 Joseph, Molly	1396380077 Jacob, Jaya	1194336149  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-18 13:27:25', '2021-10-18 13:27:25'),
(27174, 10057, 22782, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com, Noemi_Diaz@bcbstx.com  Sub : Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Hello,  I wanted to know the enrollment status for group NUCC and for IVUC providers under the mentioned TIN number.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Brown, Brittany	1275163537 Thomas, Cini	1134777238 Stephen, Ani	1588959118 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Jacob, Jaya	1194336149 George, Jeemol	1497219067  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 13:18:30', '2021-11-18 13:18:30'),
(27175, 10057, 22782, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: txproviderupdatesubmission@bcbstx.com  Sub : Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS || : Case Number - 03164645  Good afternoon,  I have researched your request and listed the provider’s record numbers linked to the Tax ID below.   Provider Name	Provider record #	779 Normandy	16272 Imperial Valley John, Jeny	8PU638	Yes	Yes Joseph, Molly	8PR752	Yes	No Brown, Brittany	8MF387	Yes	No Thomas, Cini	8LW737	Yes	No Stephen, Ani	8MC701	Yes	No Rauf, Abdur	8CU663	Yes	No Kourouma , Odette Tiranke	8ME162	Yes	No Joseph, Vibitha	8MH707	Yes	No Jacob, Jaya	8PR751	Yes	No George, Jeemol	8ML243	Yes	No  All of the providers listed show the Normandy location as their primary service address.  However, the providers I indicated \"No\" in the column above do not have the Imperial Valley address listed as an additional location.  To add this address to these providers’ records, please submit a Demographic Change Request form via the following link information:   https://www.bcbstx.com/forms/provider/update_info.html Click on the link for Demographic Change Form - https://hcscproviderintake.secure.force.com/TXDemographUpdate  For any questions regarding network contracting, credentialing, network or PAR effective dates or status requests, please contact your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number) and fax contact methods.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-11-23 10:42:23', '2021-11-23 10:42:23'),
(27176, 10057, 22782, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Thank you for submitting the form.  Your case number:03210272  Your request may take up to 30 days to complete. Once completed, a notification will be sent to the email address submitted with the Demographic Change Request Form.  Please close the tab using X (Close) Button.', NULL, NULL, '2021-12-03 11:52:54', '2021-12-03 11:52:54'),
(27177, 10057, 22782, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Email Received From : Carol_DelaO@bcbstx.com  Sub : PHI- Provider Roster - Normandy Urgent Care  Hello Steve –  Please find attach provider roster for provider.  Please review and let me know if you have any questions.  Thank you.  Carol DeLaO, Network Management Consultant  BlueCross BlueShield of Texas', NULL, NULL, '2021-12-10 10:35:43', '2021-12-10 10:35:43'),
(27178, 3046, 22783, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:19:12', '2021-03-17 16:19:12'),
(27179, 3040, 22783, NULL, '2021-05-31 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, provider_relations_houston@bcbstx.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers for our group under the below locations. Can you please send me the roster.    Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-24 16:10:52', '2021-05-24 16:10:52'),
(27180, 3040, 22783, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Provider added under the location. Please see attachment. ', NULL, NULL, '2021-06-11 09:57:45', '2021-06-11 09:57:45'),
(27181, 1006, 22784, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:20:12', '2021-03-17 16:20:12'),
(27182, 3040, 22784, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:09:54', '2021-05-28 14:09:54');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(27183, 3040, 22784, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:49', '2021-06-17 09:06:49'),
(27184, 3040, 22784, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:03', '2021-06-17 09:07:03'),
(27185, 3040, 22784, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:51', '2021-07-06 09:22:51'),
(27186, 11056, 22784, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days 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, '2021-08-11 10:35:09', '2021-08-11 10:35:09'),
(27187, 3040, 22784, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:13:18', '2021-08-18 15:13:18'),
(27188, 10057, 22784, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:46:11', '2021-10-08 11:46:11'),
(27189, 10057, 22784, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:13:19', '2021-11-19 18:13:19'),
(27190, 10057, 22784, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Please let me know the updated status for the below mentioned request.  Thanks & Regards,', NULL, NULL, '2021-12-01 13:46:03', '2021-12-01 13:46:03'),
(27191, 10057, 22784, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon Michele,  Thank you for reaching out and providing the updated information. I have filled out both provider forms and email on the mentioned email address.  Meanwhile if you need any other details please let me know.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:58:35', '2021-12-08 10:58:35'),
(27192, 10057, 22784, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com, MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Please let me know the updated status for the below mentioned request.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:35:54', '2021-12-14 11:35:54'),
(27193, 10057, 22784, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  The request hasn’t been assigned for processing at this time.   Please allow time for the intake coordinator to process the request.', NULL, NULL, '2021-12-21 11:01:19', '2021-12-21 11:01:19'),
(27194, 10057, 22784, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thank you for your response. Please let me know once you get any update.  Regards,', NULL, NULL, '2021-12-28 15:05:49', '2021-12-28 15:05:49'),
(27195, 20067, 22784, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning, Hope this Email finds you well. Any update on the below-mentioned request.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 12:16:08', '2022-01-12 12:16:08'),
(27196, 20067, 22784, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Jaya Jacob - The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.     Jeena Abraham -  The provider was loaded effective 12/1/2017 under all plans – welcome letter sent previously.     Thank You,', NULL, NULL, '2022-01-12 12:41:17', '2022-01-12 12:41:17'),
(27197, 20067, 22784, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thanks for the update,  What about Brittany Brown NPI: 1275163537', NULL, NULL, '2022-01-12 12:43:25', '2022-01-12 12:43:25'),
(27198, 20067, 22784, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:  Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Hi Michele! Hope you are doing great. Any update on the previous request.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 17:46:59', '2022-01-18 17:46:59'),
(27199, 20067, 22784, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Good Morning,    Thank you for your inquiry.   There hasn’t been any updates.  The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.', NULL, NULL, '2022-01-27 18:05:14', '2022-01-27 18:05:14'),
(27200, 20067, 22784, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good afternoon!  Hope you are doing well. I would like to know the enrollment status of the below-mentioned provider with the mentioned locations.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Brittany Brown	1275163537  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 17:23:31', '2022-02-02 17:23:31'),
(27201, 20067, 22784, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to:  Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || Molina Health ||  Hey Michele!  Hope all is well with you. I would like to add the secondary location under the below-mentioned providers.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Brittany Brown	1275163537  Thank you,', NULL, NULL, '2022-03-01 14:40:15', '2022-03-01 14:40:15'),
(27202, 20067, 22784, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Good Afternoon!  Hope this email finds you in good health. I want the welcome letter for Jeny John.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493   Thank you,', NULL, NULL, '2022-03-09 14:32:12', '2022-03-09 14:32:12'),
(27203, 20067, 22784, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Contract Request || NUCC & IVUC || Ancy Kurian || Molina Health ||  Good Afternoon!  Please see the attached contract request for Ancy Kurian along with W9 for both locations.  Thank you,', NULL, NULL, '2022-03-10 14:09:29', '2022-03-10 14:09:29'),
(27204, 20067, 22784, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Contract Request || NUCC & IVUC || Ancy Kurian || Molina Health ||  Good Afternoon!  Hope you had a great weekend. Kindly update me about the current credentialing status for Ancy Kurian: 1316558935  Thank you,', NULL, NULL, '2022-03-21 15:36:50', '2022-03-21 15:36:50'),
(27205, 22077, 22784, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Contract Request || NUCC & IVUC || Ancy Kurian || Molina Health ||  Hi,  I would like to know the enrollment process for the provider Ancy Kurian.  I am looking forward to your kind response. Have a great day!  Thanks & Regards, Alex. ', NULL, NULL, '2022-04-15 10:59:08', '2022-04-15 10:59:08'),
(27206, 19067, 22784, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email received from: Sharon.Washington@molinahealthcare.com  Subject: Missing provider contract-#179917    Hi,     Just following up with how Molina should proceed with the response provided that provider (Kurian) does not show to have been requested for contracting with Molina under Normandy. I’ve attached a copy of your group roster. If interested in contracting this provider, please complete and return the attached CRF form and return with a current W-9.     Thank you,        Sharon Washington | Manager, Provider Services | Harris/Jefferson/Bexar/Northeast  Sharon.Washington@Molinahealthcare.com  Mobile: 281-768-0662', NULL, NULL, '2022-04-18 10:58:55', '2022-04-18 10:58:55'),
(27207, 19067, 22784, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email sent to: mhtcontractrequest@molinahealthcare.com  Subject: Contract Request Form || NUCC || Ancy Kurian || Molina   Hello,  Attached is the CRF for our provider, Ancy Kurian.  Kindly start her credentialing process as we are already late on this process and don\'t hesitate to reach out if you have any questions or concerns.  Thanks,', NULL, NULL, '2022-04-18 11:16:30', '2022-04-18 11:16:30'),
(27208, 1006, 22785, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:20:13', '2021-03-17 16:20:13'),
(27209, 3040, 22785, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:11:50', '2021-05-28 14:11:50'),
(27210, 3040, 22785, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:46', '2021-06-17 09:06:46'),
(27211, 3040, 22785, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:01', '2021-06-17 09:07:01'),
(27212, 3040, 22785, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:50', '2021-07-06 09:22:50'),
(27213, 3040, 22785, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:34', '2021-07-26 15:03:34'),
(27214, 11056, 22785, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good morning!  Record # 179917  Hope you are doing well. I am facing an issue regarding the providers mentioned below. I can\'t find the providers on the directory for the additional locations of Longpoint Medical Center & Imperial Valley Urgent Care Center. All of them are showing only for the location of the Normandy Urgent Care centre. Please assist us soon related to the additional locations.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 09:51:23', '2021-08-11 09:51:23'),
(27215, 3040, 22785, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,   Hope you are doing well. Please note I checked the above mentioned providers on the Molina Healthcare provider directory but I couldn\'t find the providers overthere. Would it be possible that you can send me the any confirmation stated that the providers participating under the below locations.   Waiting for your reply.   Thank you ', NULL, NULL, '2021-08-18 14:58:27', '2021-08-18 14:58:27'),
(27216, 10057, 22785, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:45:52', '2021-10-08 11:45:52'),
(27217, 10057, 22785, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:13:13', '2021-11-19 18:13:13'),
(27218, 10057, 22785, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.  Please see the status for each provider below.  Jaya Jacob – There is no request on file.  Please submit a contract request with valid W9 to MHTContractRequest@Molinahealthcare.com.  Jeena Abraham - There is no request on file.  Please submit a contract request with valid W9 to MHTContractRequest@Molinahealthcare.com.  Vibitha Joseph -  The provider was added under the group effective 7/15/2020.    Please see a copy of the welcome letter.  Julie Rose - The provider was added under the group effective 11/1/2020 under additional locations and under the group effective 9/1/20.    Please see a copy of the welcome letter.  Brittany Brown – The provider was added under the group effective 9/15/2020 .  Please see a copy of the welcome letter.  Glory Abraham - The provider was added under the group effective 7/15/2020.    Please see a copy of the welcome letter.', NULL, NULL, '2021-11-24 15:54:59', '2021-11-24 15:54:59'),
(27219, 10057, 22785, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon Michele,  Thank you for reaching out and providing the updated information. I have filled out both provider forms and email on the mentioned email address.  Meanwhile if you need any other details please let me know.  Thanks & Regards,', NULL, NULL, '2021-11-24 15:57:59', '2021-11-24 15:57:59'),
(27220, 10057, 22785, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Please let me know the updated status for the below mentioned request.  Thanks & Regards,', NULL, NULL, '2021-12-01 13:45:58', '2021-12-01 13:45:58'),
(27221, 10057, 22785, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon Michele,  Thank you for reaching out and providing the updated information. I have filled out both provider forms and email on the mentioned email address.  Meanwhile if you need any other details please let me know.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:58:23', '2021-12-08 10:58:23'),
(27222, 10057, 22785, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com, MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Please let me know the updated status for the below mentioned request.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:35:49', '2021-12-14 11:35:49'),
(27223, 10057, 22785, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  The request hasn’t been assigned for processing at this time.   Please allow time for the intake coordinator to process the request.', NULL, NULL, '2021-12-21 11:01:13', '2021-12-21 11:01:13'),
(27224, 10057, 22785, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Molina Provider Contract Update # 185460 - 185463  Good Afternoon,  The provider Jeena Abraham was loaded eff 12/1/17 under all plans ( Medicaid, Dual MMP, Marketplace and Medicare).  Please see a copy of the welcome letter sent in 2017.  The provider listed under all 3 locations.  - Molina ID #’s  Medicaid & Marketplace plans ID # - QMP000005310637  Medicare plan ID #  - QMP000005462770  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-12-21 14:22:25', '2021-12-21 14:22:25'),
(27225, 1006, 22786, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:20:14', '2021-03-17 16:20:14'),
(27226, 3040, 22786, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:11:53', '2021-05-28 14:11:53'),
(27227, 3040, 22786, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:44', '2021-06-17 09:06:44'),
(27228, 3040, 22786, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:59', '2021-06-17 09:06:59');
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
(27229, 3040, 22786, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:49', '2021-07-06 09:22:49'),
(27230, 3040, 22786, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:22', '2021-07-26 15:03:22'),
(27231, 11056, 22786, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days 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, '2021-08-11 10:16:39', '2021-08-11 10:16:39'),
(27232, 3040, 22786, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:06', '2021-08-18 15:07:06'),
(27233, 10057, 22786, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:44:56', '2021-10-08 11:44:56'),
(27234, 10057, 22786, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:26:24', '2021-11-15 10:26:24'),
(27235, 1006, 22787, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:20:15', '2021-03-17 16:20:15'),
(27236, 3040, 22787, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:11:55', '2021-05-28 14:11:55'),
(27237, 3040, 22787, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:41', '2021-06-17 09:06:41'),
(27238, 3040, 22787, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:49', '2021-07-06 09:22:49'),
(27239, 3040, 22787, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:23', '2021-07-26 15:03:23'),
(27240, 11056, 22787, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days 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, '2021-08-11 10:15:55', '2021-08-11 10:15:55'),
(27241, 3040, 22787, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:07', '2021-08-18 15:07:07'),
(27242, 10057, 22787, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:44:30', '2021-10-08 11:44:30'),
(27243, 10057, 22787, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:25:28', '2021-11-15 10:25:28'),
(27244, 1006, 22788, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:20:16', '2021-03-17 16:20:16'),
(27245, 3040, 22788, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:11:58', '2021-05-28 14:11:58'),
(27246, 3040, 22788, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:39', '2021-06-17 09:06:39'),
(27247, 3040, 22788, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:48', '2021-07-06 09:22:48'),
(27248, 11056, 22788, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days 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, '2021-08-11 10:23:25', '2021-08-11 10:23:25'),
(27249, 10057, 22788, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status about the request for provider locations.  Provider Name	NPI Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189   Please feel free to reach out to us for any further questions.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:03:55', '2021-10-06 14:03:55'),
(27250, 10057, 22788, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:13:07', '2021-11-19 18:13:07'),
(27251, 10057, 22788, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.  Please see the status for each provider below.  Jaya Jacob – There is no request on file.  Please submit a contract request with valid W9 to MHTContractRequest@Molinahealthcare.com.  Jeena Abraham - There is no request on file.  Please submit a contract request with valid W9 to MHTContractRequest@Molinahealthcare.com.  Vibitha Joseph -  The provider was added under the group effective 7/15/2020.    Please see a copy of the welcome letter.  Julie Rose - The provider was added under the group effective 11/1/2020 under additional locations and under the group effective 9/1/20.    Please see a copy of the welcome letter.  Brittany Brown – The provider was added under the group effective 9/15/2020 .  Please see a copy of the welcome letter.  Glory Abraham - The provider was added under the group effective 7/15/2020.    Please see a copy of the welcome letter.', NULL, NULL, '2021-11-24 15:54:53', '2021-11-24 15:54:53'),
(27252, 10057, 22788, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon Michele,  Thank you for reaching out and providing the updated information. I have filled out both provider forms and email on the mentioned email address.  Meanwhile if you need any other details please let me know.  Thanks & Regards,', NULL, NULL, '2021-11-24 15:56:27', '2021-11-24 15:56:27'),
(27253, 10057, 22788, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Please let me know the updated status for the below mentioned request.  Thanks & Regards,', NULL, NULL, '2021-12-01 13:45:53', '2021-12-01 13:45:53'),
(27254, 10057, 22788, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon Michele,  Thank you for reaching out and providing the updated information. I have filled out both provider forms and email on the mentioned email address.  Meanwhile if you need any other details please let me know.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:57:43', '2021-12-08 10:57:43'),
(27255, 10057, 22788, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com, MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Please let me know the updated status for the below mentioned request.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:35:41', '2021-12-14 11:35:41'),
(27256, 10057, 22788, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  The request hasn’t been assigned for processing at this time.   Please allow time for the intake coordinator to process the request.', NULL, NULL, '2021-12-21 11:01:08', '2021-12-21 11:01:08'),
(27257, 10057, 22788, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thank you for your response. Please let me know once you get any update.  Regards,', NULL, NULL, '2021-12-28 15:05:44', '2021-12-28 15:05:44'),
(27258, 20067, 22788, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning, Hope this Email finds you well. Any update on the below-mentioned request.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 12:15:51', '2022-01-12 12:15:51'),
(27259, 20067, 22788, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Jaya Jacob - The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.     Jeena Abraham -  The provider was loaded effective 12/1/2017 under all plans – welcome letter sent previously.     Thank You,', NULL, NULL, '2022-01-12 12:40:39', '2022-01-12 12:40:39'),
(27260, 20067, 22788, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thanks for the update,  What about Brittany Brown NPI: 1275163537', NULL, NULL, '2022-01-12 12:42:51', '2022-01-12 12:42:51'),
(27261, 20067, 22788, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:  Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Hi Michele! Hope you are doing great. Any update on the previous request.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 17:46:53', '2022-01-18 17:46:53'),
(27262, 20067, 22788, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Good Morning,    Thank you for your inquiry.   There hasn’t been any updates.  The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.', NULL, NULL, '2022-01-27 18:05:23', '2022-01-27 18:05:23'),
(27263, 20067, 22788, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good afternoon!  Hope you are doing well. I would like to know the enrollment status of the below-mentioned provider with the mentioned locations.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Brittany Brown	1275163537  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 17:23:17', '2022-02-02 17:23:17'),
(27264, 20067, 22788, NULL, '2022-03-03 00:00:00.000', 'Approved', 'Email received from: Michele.Thomas-Martin@MolinaHealthcare.com  Sub: Molina Provider Contract Update # 187393  Provider:  Jeny John, Jaya Jacob     Good Afternoon,     Please see the attached welcome letter for the above providers.  The providers have been loded in the billing system effective 3/15/2022.  The providers may start seeing Molina members in network effective 3/15/2022.     Thank You,   ', NULL, NULL, '2022-02-24 17:10:15', '2022-02-24 17:10:15'),
(27265, 1006, 22789, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:20:17', '2021-03-17 16:20:17'),
(27266, 3040, 22789, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:01', '2021-05-28 14:12:01'),
(27267, 3040, 22789, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:37', '2021-06-17 09:06:37');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(27268, 3040, 22789, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:47', '2021-07-06 09:22:47'),
(27269, 3040, 22789, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:25', '2021-07-26 15:03:25'),
(27270, 11056, 22789, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from :  Michele.Thomas-Martin@molinahealthcare.com  Sub  :  RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Odette Kourouma – The request has been sent to credentialing for processing.  Thank You,  Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2021-08-11 09:07:14', '2021-08-11 09:07:14'),
(27271, 3040, 22789, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:09', '2021-08-18 15:07:09'),
(27272, 10057, 22789, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:43:00', '2021-10-08 11:43:00'),
(27273, 10057, 22789, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:30:48', '2021-11-15 10:30:48'),
(27274, 1006, 22790, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:20:18', '2021-03-17 16:20:18'),
(27275, 3040, 22790, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:03', '2021-05-28 14:12:03'),
(27276, 3040, 22790, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:33', '2021-06-17 09:06:33'),
(27277, 3040, 22790, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:47', '2021-07-06 09:22:47'),
(27278, 3040, 22790, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:28', '2021-07-26 15:03:28'),
(27279, 11056, 22790, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days 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, '2021-08-11 10:13:55', '2021-08-11 10:13:55'),
(27280, 3040, 22790, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:12', '2021-08-18 15:07:12'),
(27281, 10057, 22790, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:42:44', '2021-10-08 11:42:44'),
(27282, 10057, 22790, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:31:59', '2021-11-15 10:31:59'),
(27283, 1006, 22791, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:20:19', '2021-03-17 16:20:19'),
(27284, 3040, 22791, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:06', '2021-05-28 14:12:06'),
(27285, 3040, 22791, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:31', '2021-06-17 09:06:31'),
(27286, 3040, 22791, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:46', '2021-07-06 09:22:46'),
(27287, 3040, 22791, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:20', '2021-07-26 15:03:20'),
(27288, 11056, 22791, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from :  Michele.Thomas-Martin@molinahealthcare.com  Sub  :  RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  James Piccione – The request has been sent to credentialing under Emergency Medicine.  Thank You,  Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2021-08-11 09:10:02', '2021-08-11 09:10:02'),
(27289, 3040, 22791, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:04', '2021-08-18 15:07:04'),
(27290, 12062, 22791, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Received email from Michele.Thomas-Martin@molinahealthcare.com on AUG 19,2021;  Subject: RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,   Thank you for your inquiry.  Please see the status updates listed below.   Provider 1:   Provider Name: Stephen, Ani – The request under final step, the request has been sent for loading in the billing system.  Please allow 2-4 weeks for processing. Provider NPI# 1588959118   Provider 2:   Provider Name: Piccione JR, James M – I’m waiting on response to the email submitted 8/4/21 - Thank you for submitting the contract request to add the provider as Emergency Medicine.   Please confirm if the provider will only be seeing patients in Urgent Care outpatient setting.   Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini Philip – The request complete, the request has been loaded under all plans and locations effective 9/1/2021.  Please see the attached welcome letter. Provider NPI# 1841755956   Provider 4:   Provider Name: Fernandus, Limy - The request under final step, the request has been sent for loading in the billing system.  Please allow 2-4 weeks for processing. Provider NPI# 1972005189   Provider 5:   Provider Name: Kourouma , Odette Tiranke – The request is under credentialing.  Please allow a few more weeks for the credentialing application to process. Provider NPI# 1134525868   Provider 6:   Provider Name: Thomas, Cini - The request under final step, the request has been sent for loading in the billing system.  Please allow 2-4 weeks for processing. Provider NPI# 1134777238   Provider 7:   Provider Name: PAUL, SIGI - The request under final step, the request has been sent for loading in the billing system.  Please allow 2-4 weeks for processing. Provider NPI# 1033623616   Thank You,', NULL, NULL, '2021-09-17 13:06:56', '2021-09-17 13:06:56'),
(27291, 12062, 22791, NULL, '2021-09-24 00:00:00.000', 'In Process', 'RESPONDED TO EMAIL ON SEPTEMBER 15,2021;  TO:Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Dear Michele,  Please find my response in green highlighted below;  Provider 2:   Provider Name: Piccione JR, James M – I’m waiting on response to the email submitted 8/4/21 - Thank you for submitting the contract request to add the provider as Emergency Medicine.   Please confirm if the provider will only be seeing patients in Urgent Care outpatient setting.  The provider will only see patients in urgent care. ', NULL, NULL, '2021-09-17 13:11:10', '2021-09-17 13:11:10'),
(27292, 12062, 22791, NULL, '2021-09-24 00:00:00.000', 'In Process', 'RECEIVED EMAIL ON SEPTEMBER 17,2021  FROM:Michele.Thomas-Martin@molinahealthcare.com  Subject: RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Record # 179982  Good Morning,  Thank you for your response.   The contract request has been sent to credentialing for processing.  Please allow 30 days for credentialing to process the request.  Thank You,  Michele Thomas-Martin  Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com  Your Extended Family ', NULL, NULL, '2021-09-17 13:14:49', '2021-09-17 13:14:49'),
(27293, 10057, 22791, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Michele,  Hope you are doing well. Could you please update me with the current status of James Piccione request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-08 11:46:15', '2021-11-08 11:46:15'),
(27294, 10057, 22791, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.  The request for James Piccione has been loaded in the billing system effective 11/1/21.  Please see the attached welcome letter.  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:46:49', '2021-11-15 10:46:49'),
(27295, 1006, 22792, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:20:20', '2021-03-17 16:20:20'),
(27296, 3040, 22792, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:08', '2021-05-28 14:12:08'),
(27297, 3040, 22792, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:29', '2021-06-17 09:06:29'),
(27298, 3040, 22792, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:45', '2021-07-06 09:22:45'),
(27299, 11056, 22792, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good morning!  Record # 179917  Hope you are doing well. I am facing an issue regarding the providers mentioned below. I can\'t find the providers on the directory for the additional locations of Longpoint Medical Center & Imperial Valley Urgent Care Center. All of them are showing only for the location of the Normandy Urgent Care centre. Please assist us soon related to the additional locations.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 09:25:52', '2021-08-11 09:25:52'),
(27300, 3040, 22792, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Email rcvd from: Michele.Thomas-Martin@molinahealthcare.com  Subject: RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Record # 179917  Good Morning,  Thank you for submitting the roster.  The request to add the below providers under all locations was previously submitted 7/6/21.   The request is complete all of the providers listed below have been added under all 3 locations  effective 7/15/21.   Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  ', NULL, NULL, '2021-08-17 16:53:39', '2021-08-17 16:53:39'),
(27301, 1006, 22793, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:20:21', '2021-03-17 16:20:21');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(27302, 3040, 22793, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:10', '2021-05-28 14:12:10'),
(27303, 3040, 22793, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:27', '2021-06-17 09:06:27'),
(27304, 3040, 22793, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:45', '2021-07-06 09:22:45'),
(27305, 3040, 22793, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:18', '2021-07-26 15:03:18'),
(27306, 11056, 22793, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days 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, '2021-08-11 10:08:49', '2021-08-11 10:08:49'),
(27307, 3040, 22793, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:02', '2021-08-18 15:07:02'),
(27308, 10057, 22793, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:42:06', '2021-10-08 11:42:06'),
(27309, 10057, 22793, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:17:44', '2021-11-15 10:17:44'),
(27310, 1006, 22794, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:20:22', '2021-03-17 16:20:22'),
(27311, 3040, 22794, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:12:14', '2021-05-28 14:12:14'),
(27312, 3040, 22794, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:25', '2021-06-17 09:06:25'),
(27313, 3040, 22794, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:44', '2021-07-06 09:22:44'),
(27314, 3040, 22794, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:27', '2021-07-26 15:03:27'),
(27315, 11056, 22794, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days 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, '2021-08-11 10:10:09', '2021-08-11 10:10:09'),
(27316, 3040, 22794, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:10', '2021-08-18 15:07:10'),
(27317, 10057, 22794, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:41:48', '2021-10-08 11:41:48'),
(27318, 10057, 22794, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:23:30', '2021-11-15 10:23:30'),
(27319, 1006, 22795, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:22:29', '2021-03-17 16:22:29'),
(27320, 3040, 22795, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:20:27', '2021-05-28 16:20:27'),
(27321, 3040, 22795, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-18 08:51:01', '2021-06-18 08:51:01'),
(27322, 3040, 22795, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:24', '2021-07-06 11:57:24'),
(27323, 11056, 22795, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:32:11', '2021-08-09 12:32:11'),
(27324, 3040, 22795, NULL, '2021-08-30 00:00:00.000', 'In Process', 'I had a word with Multiplan representative and she said the group request is still pending. ', NULL, NULL, '2021-08-23 14:29:55', '2021-08-23 14:29:55'),
(27325, 10057, 22795, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Evening!  Hope this email finds you well. I want to inquire about the updated enrollment status of the following providers and practices for the Multiplan.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Abraham, Jeena	1467901587 Kourouma , Odette Tiranke	1134525868 Fernandus, Limy	1972005189 Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493  Looking forward to your response. Have a great evening!  Thanks & Regards,', NULL, NULL, '2021-10-07 16:54:30', '2021-10-07 16:54:30'),
(27326, 10057, 22795, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:33:47', '2021-11-22 09:33:47'),
(27327, 10057, 22795, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:46:49', '2021-12-02 13:46:49'),
(27328, 10057, 22795, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:15:22', '2021-12-09 11:15:22'),
(27329, 10057, 22795, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:43:11', '2021-12-16 14:43:11'),
(27330, 10057, 22795, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:26:51', '2021-12-22 11:26:51'),
(27331, 10057, 22795, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:55:59', '2021-12-29 11:55:59'),
(27332, 20067, 22795, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:41:54', '2022-01-12 17:41:54'),
(27333, 20067, 22795, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 17:00:18', '2022-01-18 17:00:18'),
(27334, 20067, 22795, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Sub: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Good Evening!  Hope this email finds you well. I want to add the listed locations under mentioned providers attached are the W9 for both locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Ani Stephen	1588959118	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Ani Stephen	1588959118	779 Normandy St Ste 114 Houston , TX 77015-3441 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	779 Normandy St Ste 114 Houston , TX 77015-3441 Sigi Paul	1033623616	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Sigi Paul	1033623616	779 Normandy St Ste 114 Houston , TX 77015-3441 James Piccione JR	1356321509	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 James Piccione JR	1356321509	779 Normandy St Ste 114 Houston , TX 77015-3441    Thank you,', NULL, NULL, '2022-03-09 16:58:56', '2022-03-09 16:58:56'),
(27335, 22077, 22795, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: 	Re: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Hi,  Any update on the previously mentioned request?  I am looking forward to your kind response,  Thanks & regards, Alex. ', NULL, NULL, '2022-04-15 14:51:21', '2022-04-15 14:51:21'),
(27336, 1006, 22796, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:22:30', '2021-03-17 16:22:30'),
(27337, 3040, 22796, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:20:32', '2021-05-28 16:20:32'),
(27338, 3040, 22796, NULL, '2021-06-24 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-06-17 11:07:07', '2021-06-17 11:07:07'),
(27339, 1006, 22797, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:22:31', '2021-03-17 16:22:31'),
(27340, 3040, 22797, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:20:36', '2021-05-28 16:20:36'),
(27341, 3040, 22797, NULL, '2021-06-24 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment ', NULL, NULL, '2021-06-17 11:36:26', '2021-06-17 11:36:26'),
(27342, 1006, 22798, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:22:32', '2021-03-17 16:22:32');
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
(27343, 3040, 22798, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:20:40', '2021-05-28 16:20:40'),
(27344, 3040, 22798, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 11:49:32', '2021-06-17 11:49:32'),
(27345, 3040, 22798, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:23', '2021-07-06 11:57:23'),
(27346, 3040, 22798, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:04', '2021-07-27 16:42:04'),
(27347, 1006, 22798, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:31:14', '2021-08-03 10:31:14'),
(27348, 11056, 22798, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:32:01', '2021-08-09 12:32:01'),
(27349, 3040, 22798, NULL, '2021-08-30 00:00:00.000', 'In Process', 'I had a with Multiplan representative and she said the provider profile is not created so she will request to create a provider profile.   Case # 7660656', NULL, NULL, '2021-08-23 13:49:55', '2021-08-23 13:49:55'),
(27350, 12062, 22798, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Replied to a below email via fax; See attached file faxed.  From: noreplycustserv@multiplan.com Subject: Initial request for additional information regarding case number 7612872  Thank you for your inquiry. To expedite your request we will need additional information. For your convenience we have listed the required documents below and attached coversheet(s) to be used when faxing in your documents.  In order for us to complete your inquiry, we must receive all requested documentation by 09/02/2021 or your case will be closed. Once all documents are received, your case will be re-opened and researched in full.  Documentation Required	Additional Description	Status Misc Application Missing Materials	Jacob, Jaya - Professional liability insurance; Admitting privileges or other admitting arrangements with participating hospital	Not Received Thank you, Service Operations   ', NULL, NULL, '2021-09-23 16:30:50', '2021-09-23 16:30:50'),
(27351, 10057, 22798, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Evening!  Hope this email finds you well. I want to inquire about the updated enrollment status of the following providers and practices for the Multiplan.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Abraham, Jeena	1467901587 Kourouma , Odette Tiranke	1134525868 Fernandus, Limy	1972005189 Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493  Looking forward to your response. Have a great evening!  Thanks & Regards,', NULL, NULL, '2021-10-07 16:53:01', '2021-10-07 16:53:01'),
(27352, 10057, 22798, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:33:41', '2021-11-22 09:33:41'),
(27353, 10057, 22798, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:46:43', '2021-12-02 13:46:43'),
(27354, 10057, 22798, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:15:16', '2021-12-09 11:15:16'),
(27355, 10057, 22798, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:43:03', '2021-12-16 14:43:03'),
(27356, 10057, 22798, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:26:45', '2021-12-22 11:26:45'),
(27357, 10057, 22798, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:55:53', '2021-12-29 11:55:53'),
(27358, 20067, 22798, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:41:46', '2022-01-12 17:41:46'),
(27359, 20067, 22798, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 17:00:12', '2022-01-18 17:00:12'),
(27360, 20067, 22798, NULL, '2022-02-10 00:00:00.000', 'In Process', 'Application submitted through portal Case Number: 7901374    Submitter Name: Steve Albert Date of Submission: 02/03/2022    TIN: 27-0796429    Provider Name: Jacob, Jaya Group Name: Normandy Urgent Care Center Inquiry Type: Credentialing Status • Application Status    Priority: Standard', NULL, NULL, '2022-02-03 14:11:43', '2022-02-03 14:11:43'),
(27361, 20067, 22798, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Sub: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Good Evening!  Hope this email finds you well. I want to add the listed locations under mentioned providers attached are the W9 for both locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Ani Stephen	1588959118	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Ani Stephen	1588959118	779 Normandy St Ste 114 Houston , TX 77015-3441 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	779 Normandy St Ste 114 Houston , TX 77015-3441 Sigi Paul	1033623616	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Sigi Paul	1033623616	779 Normandy St Ste 114 Houston , TX 77015-3441 James Piccione JR	1356321509	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 James Piccione JR	1356321509	779 Normandy St Ste 114 Houston , TX 77015-3441    Thank you,', NULL, NULL, '2022-03-09 16:58:51', '2022-03-09 16:58:51'),
(27362, 22077, 22798, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: 	Re: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Hi,  Any update on the previously mentioned request?  I am looking forward to your kind response,  Thanks & regards, Alex. ', NULL, NULL, '2022-04-15 14:57:45', '2022-04-15 14:57:45'),
(27363, 1006, 22799, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:22:33', '2021-03-17 16:22:33'),
(27364, 3040, 22799, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:20:43', '2021-05-28 16:20:43'),
(27365, 3040, 22799, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 11:49:45', '2021-06-17 11:49:45'),
(27366, 3040, 22799, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:22', '2021-07-06 11:57:22'),
(27367, 3040, 22799, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:08', '2021-07-27 16:42:08'),
(27368, 1006, 22799, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:32:08', '2021-08-03 10:32:08'),
(27369, 11056, 22799, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:31:52', '2021-08-09 12:31:52'),
(27370, 3040, 22799, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:47:31', '2021-08-20 16:47:31'),
(27371, 1006, 22800, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:22:34', '2021-03-17 16:22:34'),
(27372, 3040, 22800, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:20:47', '2021-05-28 16:20:47'),
(27373, 3040, 22800, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 11:49:26', '2021-06-17 11:49:26'),
(27374, 3040, 22800, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:22', '2021-07-06 11:57:22'),
(27375, 3040, 22800, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:06', '2021-07-27 16:42:06'),
(27376, 1006, 22800, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:32:44', '2021-08-03 10:32:44'),
(27377, 11056, 22800, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:33:27', '2021-08-09 12:33:27'),
(27378, 3040, 22800, NULL, '2021-08-30 00:00:00.000', 'In Process', 'I had a with Multiplan representative and she said the provider profile is not created so she will request to create a provider profile.   Case # 7660656', NULL, NULL, '2021-08-23 13:49:54', '2021-08-23 13:49:54'),
(27379, 10057, 22800, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Evening!  Hope this email finds you well. I want to inquire about the updated enrollment status of the following providers and practices for the Multiplan.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Abraham, Jeena	1467901587 Kourouma , Odette Tiranke	1134525868 Fernandus, Limy	1972005189 Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493  Looking forward to your response. Have a great evening!  Thanks & Regards,', NULL, NULL, '2021-10-07 16:52:52', '2021-10-07 16:52:52'),
(27380, 10057, 22800, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:33:35', '2021-11-22 09:33:35'),
(27381, 10057, 22800, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:46:37', '2021-12-02 13:46:37'),
(27382, 10057, 22800, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:15:10', '2021-12-09 11:15:10'),
(27383, 10057, 22800, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:42:57', '2021-12-16 14:42:57'),
(27384, 10057, 22800, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:26:39', '2021-12-22 11:26:39'),
(27385, 10057, 22800, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:55:48', '2021-12-29 11:55:48'),
(27386, 20067, 22800, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:43:30', '2022-01-12 17:43:30'),
(27387, 20067, 22800, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 17:00:06', '2022-01-18 17:00:06'),
(27388, 20067, 22800, NULL, '2022-02-10 00:00:00.000', 'In Process', ' Application submitted through portal Case Number: 7901382    Submitter Name: Steve Albert Date of Submission: 02/03/2022    TIN: 27-0796429    Provider Name: PAUL, SIGI Group Name: Normandy Urgent Care Center Inquiry Type: Credentialing Status • Application Status    Priority: Standard', NULL, NULL, '2022-02-03 14:15:28', '2022-02-03 14:15:28'),
(27389, 20067, 22800, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Sub: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Good Evening!  Hope this email finds you well. I want to add the listed locations under mentioned providers attached are the W9 for both locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Ani Stephen	1588959118	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Ani Stephen	1588959118	779 Normandy St Ste 114 Houston , TX 77015-3441 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	779 Normandy St Ste 114 Houston , TX 77015-3441 Sigi Paul	1033623616	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Sigi Paul	1033623616	779 Normandy St Ste 114 Houston , TX 77015-3441 James Piccione JR	1356321509	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 James Piccione JR	1356321509	779 Normandy St Ste 114 Houston , TX 77015-3441    Thank you,', NULL, NULL, '2022-03-09 16:58:45', '2022-03-09 16:58:45'),
(27390, 22077, 22800, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: 	Re: Demographic Update || Normandy Urgent Care & Imperial Valley Urgent Care || Providers || Multiplan  Hi,  Any update on the previously mentioned request?  I am looking forward to your kind response,  Thanks & regards, Alex. ', NULL, NULL, '2022-04-15 14:57:07', '2022-04-15 14:57:07'),
(27391, 1006, 22801, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:22:35', '2021-03-17 16:22:35'),
(27392, 3040, 22801, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:20:52', '2021-05-28 16:20:52'),
(27393, 3040, 22801, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 11:49:16', '2021-06-17 11:49:16'),
(27394, 3040, 22801, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:21', '2021-07-06 11:57:21'),
(27395, 3040, 22801, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:05', '2021-07-27 16:42:05');
