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
(17237, 9057, 21251, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:13:20', '2021-05-25 16:13:20'),
(17238, 1006, 21251, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:22', '2021-06-11 16:44:22'),
(17239, 1006, 21251, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:34:17', '2021-06-30 09:34:17'),
(17240, 1006, 21251, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  The roster has been sent and is attached to the main group tasks.  ', NULL, NULL, '2021-08-09 16:51:08', '2021-08-09 16:51:08'),
(17241, 1006, 21251, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:50:48', '2021-08-24 14:50:48'),
(17242, 11056, 21251, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:08:38', '2021-09-21 16:08:38'),
(17243, 11056, 21251, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:51:14', '2021-10-01 12:51:14'),
(17244, 11056, 21251, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:51:32', '2021-10-18 15:51:32'),
(17245, 11056, 21251, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 11:57:19', '2021-10-26 11:57:19'),
(17246, 11056, 21251, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:38:57', '2021-11-11 14:38:57'),
(17247, 11056, 21251, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:39:28', '2021-11-11 14:39:28'),
(17248, 11056, 21251, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:04:22', '2021-12-02 16:04:22'),
(17249, 11056, 21251, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:11:20', '2021-12-16 14:11:20'),
(17250, 11056, 21251, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective date  Traci S Mason Np  Calallen - 6/1/2017 Staples - 6/1/2017   Refcode: 14725307  Please see the attachments ', NULL, NULL, '2021-12-21 15:02:58', '2021-12-21 15:02:58'),
(17251, 3046, 21252, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:53', '2021-03-15 16:03:53'),
(17252, 1006, 21252, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\"', NULL, NULL, '2021-04-08 18:05:04', '2021-04-08 18:05:04'),
(17253, 9057, 21252, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Dear Sir, We are facing problems while updating data in EMRB as the page setting didn\'t remain the same after adding status and notes. and we have to change the settings after each update', NULL, NULL, '2021-05-25 16:38:03', '2021-05-25 16:38:03'),
(17254, 1006, 21252, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:19', '2021-06-11 16:44:19'),
(17255, 1006, 21252, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com  Sub : RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Kindly inform me about the enrollment status of the new groups\' locations. The form has been filled out and faxed @ (608) 221-7535 Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Provider 2: Provider Name: Francis, William Provider NPI# 457994436 Provider 3: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Please respond to me soon.  Thank you!', NULL, NULL, '2021-06-30 11:03:26', '2021-06-30 11:03:26'),
(17256, 1006, 21252, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  The roster has been sent and is attached to the main group tasks.  ', NULL, NULL, '2021-08-09 16:51:04', '2021-08-09 16:51:04'),
(17257, 1006, 21252, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:50:52', '2021-08-24 14:50:52'),
(17258, 11056, 21252, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:08:43', '2021-09-21 16:08:43'),
(17259, 11056, 21252, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:51:08', '2021-10-01 12:51:08'),
(17260, 11056, 21252, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:51:37', '2021-10-18 15:51:37'),
(17261, 11056, 21252, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 11:57:27', '2021-10-26 11:57:27'),
(17262, 11056, 21252, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:38:49', '2021-11-11 14:38:49'),
(17263, 11056, 21252, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:04:49', '2021-12-02 16:04:49'),
(17264, 11056, 21252, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:09:57', '2021-12-16 14:09:57'),
(17265, 11056, 21252, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective dates   Katherine  Rabagos  CALALLEN - 6/1/2017 SPID     - 6/1/2017  Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 13:53:36', '2021-12-21 13:53:36'),
(17266, 3046, 21253, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:54', '2021-03-15 16:03:54'),
(17267, 1006, 21253, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\"', NULL, NULL, '2021-04-08 18:05:09', '2021-04-08 18:05:09'),
(17268, 9057, 21253, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:12:13', '2021-05-25 16:12:13'),
(17269, 1006, 21253, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:16', '2021-06-11 16:44:16'),
(17270, 1006, 21253, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:38:26', '2021-06-30 09:38:26'),
(17271, 1006, 21253, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  The roster has been sent and is attached to the main group tasks.  ', NULL, NULL, '2021-08-09 16:50:59', '2021-08-09 16:50:59'),
(17272, 1006, 21253, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:50:56', '2021-08-24 14:50:56'),
(17273, 11056, 21253, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:12:33', '2021-09-21 16:12:33'),
(17274, 11056, 21253, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:51:02', '2021-10-01 12:51:02'),
(17275, 11056, 21253, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:51:44', '2021-10-18 15:51:44'),
(17276, 11056, 21253, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 11:57:35', '2021-10-26 11:57:35'),
(17277, 11056, 21253, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:38:44', '2021-11-11 14:38:44'),
(17278, 11056, 21253, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:07:31', '2021-12-02 16:07:31'),
(17279, 11056, 21253, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:08:15', '2021-12-16 14:08:15'),
(17280, 11056, 21253, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:09:50', '2021-12-16 14:09:50'),
(17281, 11056, 21253, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective dates   Petina Rogers  KINGSVILLE - 6/1/2017 CALALLEN - 6/1/2017 SPID     - 6/1/2017  Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 14:02:50', '2021-12-21 14:02:50'),
(17282, 3046, 21254, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:56', '2021-03-15 16:03:56'),
(17283, 1006, 21254, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\"', NULL, NULL, '2021-04-08 18:05:13', '2021-04-08 18:05:13'),
(17284, 9057, 21254, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:11:18', '2021-05-25 16:11:18'),
(17285, 1006, 21254, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:13', '2021-06-11 16:44:13'),
(17286, 1006, 21254, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:37:19', '2021-06-30 09:37:19'),
(17287, 1006, 21254, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  The roster has been sent and is attached to the main group tasks.  ', NULL, NULL, '2021-08-09 16:50:53', '2021-08-09 16:50:53');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(17288, 1006, 21254, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:51:01', '2021-08-24 14:51:01'),
(17289, 11056, 21254, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:08:47', '2021-09-21 16:08:47'),
(17290, 11056, 21254, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:50:57', '2021-10-01 12:50:57'),
(17291, 11056, 21254, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:51:49', '2021-10-18 15:51:49'),
(17292, 11056, 21254, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 11:57:42', '2021-10-26 11:57:42'),
(17293, 11056, 21254, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:37:37', '2021-11-11 14:37:37'),
(17294, 11056, 21254, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 15:49:24', '2021-12-02 15:49:24'),
(17295, 11056, 21254, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:08:09', '2021-12-16 14:08:09'),
(17296, 11056, 21254, NULL, '2021-12-30 00:00:00.000', 'In Process', '	 Email sent to: JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope this email finds you well. You haven\'t gotten back to me on this. I am still waiting for the updates on the enrollment updates.  Please respond to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-23 16:07:59', '2021-12-23 16:07:59'),
(17297, 19067, 21254, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly get back to us once you have time.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:42:00', '2022-01-10 17:42:00'),
(17298, 19067, 21254, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad', NULL, NULL, '2022-01-26 17:36:01', '2022-01-26 17:36:01'),
(17299, 19067, 21254, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Subject: 	RE: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare    Hello!     This is the current status based on my last response to Claims Med Inc.  The information was provided on 12/23/21 and 1/13/22.   ', NULL, NULL, '2022-02-11 16:59:30', '2022-02-11 16:59:30'),
(17300, 19067, 21254, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Can I get the welcome kit for the providers who got affected?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:45:43', '2022-02-21 17:45:43'),
(17301, 19067, 21254, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello,  I haven\'t received the welcome letter for the providers. Kindly provide us with the welcome kit.  Thanks, ', NULL, NULL, '2022-03-15 17:57:44', '2022-03-15 17:57:44'),
(17302, 22077, 21254, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Enrollment Query || RHC || Providers || Tricare  Hi,  I would like to know the enrollment process for the following providers with the below-mentioned providers,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & Billing Location	500 E Caesar, Kingsville, TX 78363 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382 Patrick Ayarzagoitia	1649568239	6646 S. Staples St. 122, Corpus Christi, TX 78413 Katherine Rabagos	1134415631	6646 S. Staples St. 122, Corpus Christi, TX 78413 Petina Rogers	1801443916	6646 S. Staples St. 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	6646 S. Staples St. 122, Corpus Christi, TX 78413 Maegan Svatek	1639670250	3817 South Padre Island Drive, Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill, Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive, Corpus Christi, TX 78415 Traci Mason	1497127831	500 E Caesar, Kingsville, TX 78363  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-08 11:09:44', '2022-04-08 11:09:44'),
(17303, 22077, 21254, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Location added through the portal', NULL, NULL, '2022-04-25 08:09:39', '2022-04-25 08:09:39'),
(17304, 3046, 21255, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:03:58', '2021-03-15 16:03:58'),
(17305, 1006, 21255, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\"', NULL, NULL, '2021-04-08 18:05:17', '2021-04-08 18:05:17'),
(17306, 9057, 21255, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:10:46', '2021-05-25 16:10:46'),
(17307, 1006, 21255, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:43:57', '2021-06-11 16:43:57'),
(17308, 1006, 21255, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:35:59', '2021-06-30 09:35:59'),
(17309, 1006, 21255, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  The roster has been sent and is attached to the main group tasks.  ', NULL, NULL, '2021-08-09 16:50:48', '2021-08-09 16:50:48'),
(17310, 1006, 21255, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:51:04', '2021-08-24 14:51:04'),
(17311, 11056, 21255, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:08:52', '2021-09-21 16:08:52'),
(17312, 11056, 21255, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:50:51', '2021-10-01 12:50:51'),
(17313, 11056, 21255, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:51:56', '2021-10-18 15:51:56'),
(17314, 11056, 21255, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 11:57:47', '2021-10-26 11:57:47'),
(17315, 11056, 21255, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:36:39', '2021-11-11 14:36:39'),
(17316, 11056, 21255, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 15:53:07', '2021-12-02 15:53:07'),
(17317, 11056, 21255, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:07:43', '2021-12-16 14:07:43'),
(17318, 11056, 21255, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:07:58', '2021-12-16 14:07:58'),
(17319, 11056, 21255, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective date  Rose P Trevino Pa  Kingsville - 6/1/2017 Calallen - 6/1/2017 Staples - 6/1/2017   Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 15:10:25', '2021-12-21 15:10:25'),
(17320, 3046, 21256, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:39:30', '2021-03-15 16:39:30'),
(17321, 1006, 21256, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:18:23', '2021-03-31 15:18:23'),
(17322, 3046, 21257, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:41:18', '2021-03-15 16:41:18'),
(17323, 1006, 21257, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:18:44', '2021-03-31 15:18:44'),
(17324, 3046, 21258, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:41:20', '2021-03-15 16:41:20'),
(17325, 1006, 21258, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:18:48', '2021-03-31 15:18:48'),
(17326, 3046, 21259, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:41:22', '2021-03-15 16:41:22'),
(17327, 1006, 21259, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:18:52', '2021-03-31 15:18:52'),
(17328, 3046, 21260, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:41:22', '2021-03-15 16:41:22'),
(17329, 1006, 21260, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:18:56', '2021-03-31 15:18:56'),
(17330, 3046, 21261, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:41:24', '2021-03-15 16:41:24'),
(17331, 1006, 21261, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:19:00', '2021-03-31 15:19:00'),
(17332, 3046, 21262, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:41:25', '2021-03-15 16:41:25'),
(17333, 1006, 21262, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:19:04', '2021-03-31 15:19:04'),
(17334, 3046, 21263, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:41:27', '2021-03-15 16:41:27'),
(17335, 1006, 21263, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:19:08', '2021-03-31 15:19:08'),
(17336, 3046, 21264, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:41:29', '2021-03-15 16:41:29'),
(17337, 1006, 21264, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:19:16', '2021-03-31 15:19:16'),
(17338, 3046, 21265, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:41:31', '2021-03-15 16:41:31'),
(17339, 1006, 21265, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:19:21', '2021-03-31 15:19:21'),
(17340, 3046, 21266, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:41:49', '2021-03-15 16:41:49'),
(17341, 1006, 21266, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:19:25', '2021-03-31 15:19:25'),
(17342, 3046, 21267, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:45:04', '2021-03-15 16:45:04'),
(17343, 3040, 21267, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:51:14', '2021-04-07 13:51:14'),
(17344, 9057, 21267, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:01:59', '2021-05-26 15:01:59'),
(17345, 1006, 21267, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:07:02', '2021-06-15 17:07:02'),
(17346, 1006, 21267, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:07', '2021-07-20 10:30:07'),
(17347, 1006, 21267, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:06:22', '2021-08-17 17:06:22'),
(17348, 1006, 21267, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:31:20', '2021-09-01 15:31:20'),
(17349, 11056, 21267, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:08:38', '2021-09-22 12:08:38'),
(17350, 11056, 21267, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:09:04', '2021-09-29 17:09:04'),
(17351, 11056, 21267, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:19:48', '2021-10-12 14:19:48'),
(17352, 11056, 21267, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:49:12', '2021-10-20 12:49:12'),
(17353, 11056, 21267, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:25:00', '2021-11-10 17:25:00'),
(17354, 11056, 21267, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:31:58', '2021-11-19 17:31:58'),
(17355, 11056, 21267, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:51:08', '2021-12-01 12:51:08'),
(17356, 11056, 21267, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:36:29', '2021-12-16 16:36:29'),
(17357, 11056, 21267, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:36:58', '2021-12-23 15:36:58'),
(17358, 19067, 21267, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:06:37', '2022-01-10 18:06:37'),
(17359, 19067, 21267, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:21:03', '2022-01-26 17:21:03'),
(17360, 19067, 21267, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:55:58', '2022-02-11 14:55:58'),
(17361, 19067, 21267, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:34:00', '2022-02-21 17:34:00'),
(17362, 19067, 21267, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:48:54', '2022-03-15 17:48:54'),
(17363, 22077, 21267, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:51:35', '2022-04-22 14:51:35'),
(17364, 3046, 21268, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:45:06', '2021-03-15 16:45:06'),
(17365, 3040, 21268, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:51:30', '2021-04-07 13:51:30');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(17366, 9057, 21268, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:02:15', '2021-05-26 15:02:15'),
(17367, 1006, 21268, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:07:34', '2021-06-15 17:07:34'),
(17368, 1006, 21268, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:22', '2021-07-20 10:30:22'),
(17369, 1006, 21268, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:06:18', '2021-08-17 17:06:18'),
(17370, 1006, 21268, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:31:23', '2021-09-01 15:31:23'),
(17371, 11056, 21268, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:08:45', '2021-09-22 12:08:45'),
(17372, 11056, 21268, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:09:11', '2021-09-29 17:09:11'),
(17373, 11056, 21268, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:09:11', '2021-09-29 17:09:11'),
(17374, 11056, 21268, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:19:54', '2021-10-12 14:19:54'),
(17375, 11056, 21268, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:49:19', '2021-10-20 12:49:19'),
(17376, 11056, 21268, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:24:53', '2021-11-10 17:24:53'),
(17377, 11056, 21268, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:32:18', '2021-11-19 17:32:18'),
(17378, 11056, 21268, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:51:16', '2021-12-01 12:51:16'),
(17379, 11056, 21268, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:36:34', '2021-12-16 16:36:34'),
(17380, 11056, 21268, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:36:52', '2021-12-23 15:36:52'),
(17381, 19067, 21268, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:06:31', '2022-01-10 18:06:31'),
(17382, 19067, 21268, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:20:56', '2022-01-26 17:20:56'),
(17383, 19067, 21268, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:55:53', '2022-02-11 14:55:53'),
(17384, 19067, 21268, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:33:47', '2022-02-21 17:33:47'),
(17385, 19067, 21268, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:48:48', '2022-03-15 17:48:48'),
(17386, 22077, 21268, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:51:03', '2022-04-22 14:51:03'),
(17387, 3046, 21269, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:45:08', '2021-03-15 16:45:08'),
(17388, 3040, 21269, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:51:48', '2021-04-07 13:51:48'),
(17389, 9057, 21269, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:02:25', '2021-05-26 15:02:25'),
(17390, 1006, 21269, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:07:37', '2021-06-15 17:07:37'),
(17391, 1006, 21269, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:34', '2021-07-20 10:30:34'),
(17392, 1006, 21269, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:06:13', '2021-08-17 17:06:13'),
(17393, 1006, 21269, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:31:26', '2021-09-01 15:31:26'),
(17394, 11056, 21269, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:08:51', '2021-09-22 12:08:51'),
(17395, 11056, 21269, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:09:19', '2021-09-29 17:09:19'),
(17396, 11056, 21269, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:20:00', '2021-10-12 14:20:00'),
(17397, 11056, 21269, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:49:25', '2021-10-20 12:49:25'),
(17398, 11056, 21269, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:24:47', '2021-11-10 17:24:47'),
(17399, 11056, 21269, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:32:24', '2021-11-19 17:32:24'),
(17400, 11056, 21269, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:51:22', '2021-12-01 12:51:22'),
(17401, 11056, 21269, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:36:43', '2021-12-16 16:36:43'),
(17402, 11056, 21269, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:36:45', '2021-12-23 15:36:45'),
(17403, 19067, 21269, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:06:24', '2022-01-10 18:06:24'),
(17404, 19067, 21269, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:20:50', '2022-01-26 17:20:50'),
(17405, 19067, 21269, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:55:42', '2022-02-11 14:55:42'),
(17406, 19067, 21269, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:33:42', '2022-02-21 17:33:42'),
(17407, 19067, 21269, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:48:42', '2022-03-15 17:48:42'),
(17408, 22077, 21269, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:50:53', '2022-04-22 14:50:53'),
(17409, 3046, 21270, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:45:09', '2021-03-15 16:45:09'),
(17410, 3040, 21270, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:52:16', '2021-04-07 13:52:16'),
(17411, 9057, 21270, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:02:31', '2021-05-26 15:02:31'),
(17412, 1006, 21270, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:07:41', '2021-06-15 17:07:41'),
(17413, 1006, 21270, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:48', '2021-07-20 10:30:48'),
(17414, 1006, 21270, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:06:08', '2021-08-17 17:06:08'),
(17415, 1006, 21270, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:31:29', '2021-09-01 15:31:29'),
(17416, 11056, 21270, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:08:56', '2021-09-22 12:08:56'),
(17417, 11056, 21270, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:09:24', '2021-09-29 17:09:24'),
(17418, 11056, 21270, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:20:40', '2021-10-12 14:20:40'),
(17419, 11056, 21270, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:49:32', '2021-10-20 12:49:32'),
(17420, 11056, 21270, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:24:42', '2021-11-10 17:24:42'),
(17421, 11056, 21270, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:32:31', '2021-11-19 17:32:31'),
(17422, 11056, 21270, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:51:27', '2021-12-01 12:51:27'),
(17423, 11056, 21270, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:36:49', '2021-12-16 16:36:49'),
(17424, 11056, 21270, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:36:40', '2021-12-23 15:36:40'),
(17425, 19067, 21270, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:06:17', '2022-01-10 18:06:17'),
(17426, 19067, 21270, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:20:44', '2022-01-26 17:20:44'),
(17427, 19067, 21270, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:55:36', '2022-02-11 14:55:36'),
(17428, 19067, 21270, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:33:36', '2022-02-21 17:33:36'),
(17429, 19067, 21270, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:48:37', '2022-03-15 17:48:37'),
(17430, 22077, 21270, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:50:42', '2022-04-22 14:50:42'),
(17431, 3046, 21271, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:45:10', '2021-03-15 16:45:10'),
(17432, 3040, 21271, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:52:32', '2021-04-07 13:52:32'),
(17433, 9057, 21271, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:02:39', '2021-05-26 15:02:39'),
(17434, 1006, 21271, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:07:44', '2021-06-15 17:07:44'),
(17435, 1006, 21271, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:31:02', '2021-07-20 10:31:02'),
(17436, 1006, 21271, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:06:03', '2021-08-17 17:06:03'),
(17437, 1006, 21271, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:31:32', '2021-09-01 15:31:32');
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
(17438, 11056, 21271, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:09:01', '2021-09-22 12:09:01'),
(17439, 11056, 21271, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:09:30', '2021-09-29 17:09:30'),
(17440, 11056, 21271, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:20:48', '2021-10-12 14:20:48'),
(17441, 11056, 21271, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:49:38', '2021-10-20 12:49:38'),
(17442, 11056, 21271, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:24:36', '2021-11-10 17:24:36'),
(17443, 11056, 21271, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:32:38', '2021-11-19 17:32:38'),
(17444, 11056, 21271, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:51:33', '2021-12-01 12:51:33'),
(17445, 11056, 21271, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:36:53', '2021-12-16 16:36:53'),
(17446, 11056, 21271, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:36:32', '2021-12-23 15:36:32'),
(17447, 19067, 21271, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:06:11', '2022-01-10 18:06:11'),
(17448, 19067, 21271, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:20:35', '2022-01-26 17:20:35'),
(17449, 19067, 21271, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:55:30', '2022-02-11 14:55:30'),
(17450, 19067, 21271, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:33:31', '2022-02-21 17:33:31'),
(17451, 19067, 21271, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:48:32', '2022-03-15 17:48:32'),
(17452, 22077, 21271, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:50:30', '2022-04-22 14:50:30'),
(17453, 3046, 21272, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:45:12', '2021-03-15 16:45:12'),
(17454, 3040, 21272, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:52:52', '2021-04-07 13:52:52'),
(17455, 9057, 21272, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:02:45', '2021-05-26 15:02:45'),
(17456, 1006, 21272, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:07:47', '2021-06-15 17:07:47'),
(17457, 1006, 21272, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:31:59', '2021-07-20 10:31:59'),
(17458, 1006, 21272, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:05:50', '2021-08-17 17:05:50'),
(17459, 1006, 21272, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:31:35', '2021-09-01 15:31:35'),
(17460, 11056, 21272, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:09:06', '2021-09-22 12:09:06'),
(17461, 11056, 21272, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:09:36', '2021-09-29 17:09:36'),
(17462, 11056, 21272, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:20:54', '2021-10-12 14:20:54'),
(17463, 11056, 21272, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:49:44', '2021-10-20 12:49:44'),
(17464, 11056, 21272, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:24:31', '2021-11-10 17:24:31'),
(17465, 11056, 21272, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:32:43', '2021-11-19 17:32:43'),
(17466, 11056, 21272, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:51:38', '2021-12-01 12:51:38'),
(17467, 11056, 21272, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:36:58', '2021-12-16 16:36:58'),
(17468, 11056, 21272, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:36:26', '2021-12-23 15:36:26'),
(17469, 19067, 21272, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:06:04', '2022-01-10 18:06:04'),
(17470, 19067, 21272, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:20:29', '2022-01-26 17:20:29'),
(17471, 19067, 21272, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:55:24', '2022-02-11 14:55:24'),
(17472, 19067, 21272, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:33:26', '2022-02-21 17:33:26'),
(17473, 19067, 21272, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:48:27', '2022-03-15 17:48:27'),
(17474, 22077, 21272, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:50:19', '2022-04-22 14:50:19'),
(17475, 3046, 21273, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:45:14', '2021-03-15 16:45:14'),
(17476, 3040, 21273, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:53:10', '2021-04-07 13:53:10'),
(17477, 9057, 21273, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:02:51', '2021-05-26 15:02:51'),
(17478, 1006, 21273, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:07:50', '2021-06-15 17:07:50'),
(17479, 1006, 21273, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:32:12', '2021-07-20 10:32:12'),
(17480, 1006, 21273, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:01:58', '2021-08-17 17:01:58'),
(17481, 1006, 21273, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:31:38', '2021-09-01 15:31:38'),
(17482, 11056, 21273, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:09:13', '2021-09-22 12:09:13'),
(17483, 11056, 21273, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:09:43', '2021-09-29 17:09:43'),
(17484, 11056, 21273, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:21:00', '2021-10-12 14:21:00'),
(17485, 11056, 21273, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:49:53', '2021-10-20 12:49:53'),
(17486, 11056, 21273, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:24:25', '2021-11-10 17:24:25'),
(17487, 11056, 21273, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:32:49', '2021-11-19 17:32:49'),
(17488, 11056, 21273, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:51:45', '2021-12-01 12:51:45'),
(17489, 11056, 21273, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:37:02', '2021-12-16 16:37:02'),
(17490, 11056, 21273, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:36:20', '2021-12-23 15:36:20'),
(17491, 19067, 21273, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:05:59', '2022-01-10 18:05:59'),
(17492, 19067, 21273, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:20:23', '2022-01-26 17:20:23'),
(17493, 19067, 21273, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:55:19', '2022-02-11 14:55:19'),
(17494, 19067, 21273, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:33:22', '2022-02-21 17:33:22'),
(17495, 19067, 21273, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:48:22', '2022-03-15 17:48:22'),
(17496, 22077, 21273, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:49:57', '2022-04-22 14:49:57'),
(17497, 3046, 21274, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:45:16', '2021-03-15 16:45:16'),
(17498, 3040, 21274, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:53:28', '2021-04-07 13:53:28'),
(17499, 9057, 21274, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:02:58', '2021-05-26 15:02:58'),
(17500, 1006, 21274, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:07:53', '2021-06-15 17:07:53'),
(17501, 1006, 21274, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:32:26', '2021-07-20 10:32:26'),
(17502, 1006, 21274, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:01:46', '2021-08-17 17:01:46'),
(17503, 1006, 21274, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:31:41', '2021-09-01 15:31:41'),
(17504, 11056, 21274, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:09:19', '2021-09-22 12:09:19'),
(17505, 11056, 21274, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:09:49', '2021-09-29 17:09:49'),
(17506, 11056, 21274, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:21:14', '2021-10-12 14:21:14'),
(17507, 11056, 21274, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:50:01', '2021-10-20 12:50:01'),
(17508, 11056, 21274, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:24:18', '2021-11-10 17:24:18'),
(17509, 11056, 21274, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:32:54', '2021-11-19 17:32:54'),
(17510, 11056, 21274, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:51:52', '2021-12-01 12:51:52');
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
(17511, 11056, 21274, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:37:07', '2021-12-16 16:37:07'),
(17512, 11056, 21274, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:36:14', '2021-12-23 15:36:14'),
(17513, 19067, 21274, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:05:52', '2022-01-10 18:05:52'),
(17514, 19067, 21274, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:20:16', '2022-01-26 17:20:16'),
(17515, 19067, 21274, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:55:12', '2022-02-11 14:55:12'),
(17516, 19067, 21274, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:33:17', '2022-02-21 17:33:17'),
(17517, 19067, 21274, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:48:15', '2022-03-15 17:48:15'),
(17518, 22077, 21274, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:49:28', '2022-04-22 14:49:28'),
(17519, 3046, 21275, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:45:18', '2021-03-15 16:45:18'),
(17520, 3040, 21275, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:53:46', '2021-04-07 13:53:46'),
(17521, 9057, 21275, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:03:05', '2021-05-26 15:03:05'),
(17522, 1006, 21275, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:07:55', '2021-06-15 17:07:55'),
(17523, 1006, 21275, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:32:40', '2021-07-20 10:32:40'),
(17524, 1006, 21275, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:01:39', '2021-08-17 17:01:39'),
(17525, 1006, 21275, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:31:45', '2021-09-01 15:31:45'),
(17526, 11056, 21275, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:09:26', '2021-09-22 12:09:26'),
(17527, 11056, 21275, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:09:55', '2021-09-29 17:09:55'),
(17528, 11056, 21275, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:21:21', '2021-10-12 14:21:21'),
(17529, 11056, 21275, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:21:46', '2021-10-12 14:21:46'),
(17530, 11056, 21275, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:50:08', '2021-10-20 12:50:08'),
(17531, 11056, 21275, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:24:12', '2021-11-10 17:24:12'),
(17532, 11056, 21275, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:33:00', '2021-11-19 17:33:00'),
(17533, 11056, 21275, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:33:41', '2021-11-19 17:33:41'),
(17534, 11056, 21275, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:51:58', '2021-12-01 12:51:58'),
(17535, 11056, 21275, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:37:12', '2021-12-16 16:37:12'),
(17536, 11056, 21275, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:36:07', '2021-12-23 15:36:07'),
(17537, 19067, 21275, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:05:43', '2022-01-10 18:05:43'),
(17538, 19067, 21275, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:20:10', '2022-01-26 17:20:10'),
(17539, 19067, 21275, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:55:08', '2022-02-11 14:55:08'),
(17540, 19067, 21275, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:33:12', '2022-02-21 17:33:12'),
(17541, 19067, 21275, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:48:11', '2022-03-15 17:48:11'),
(17542, 22077, 21275, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:49:07', '2022-04-22 14:49:07'),
(17543, 3046, 21276, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:45:20', '2021-03-15 16:45:20'),
(17544, 3040, 21276, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:54:04', '2021-04-07 13:54:04'),
(17545, 9057, 21276, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:03:13', '2021-05-26 15:03:13'),
(17546, 1006, 21276, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:07:58', '2021-06-15 17:07:58'),
(17547, 1006, 21276, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:32:56', '2021-07-20 10:32:56'),
(17548, 1006, 21276, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:01:34', '2021-08-17 17:01:34'),
(17549, 1006, 21276, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:31:47', '2021-09-01 15:31:47'),
(17550, 11056, 21276, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:09:41', '2021-09-22 12:09:41'),
(17551, 11056, 21276, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:10:00', '2021-09-29 17:10:00'),
(17552, 11056, 21276, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:21:53', '2021-10-12 14:21:53'),
(17553, 11056, 21276, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:50:15', '2021-10-20 12:50:15'),
(17554, 11056, 21276, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:24:07', '2021-11-10 17:24:07'),
(17555, 11056, 21276, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:33:46', '2021-11-19 17:33:46'),
(17556, 11056, 21276, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:52:04', '2021-12-01 12:52:04'),
(17557, 11056, 21276, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:37:18', '2021-12-16 16:37:18'),
(17558, 11056, 21276, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:36:02', '2021-12-23 15:36:02'),
(17559, 19067, 21276, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:05:36', '2022-01-10 18:05:36'),
(17560, 19067, 21276, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:20:05', '2022-01-26 17:20:05'),
(17561, 19067, 21276, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:55:02', '2022-02-11 14:55:02'),
(17562, 19067, 21276, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:33:07', '2022-02-21 17:33:07'),
(17563, 19067, 21276, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:48:05', '2022-03-15 17:48:05'),
(17564, 22077, 21276, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:48:33', '2022-04-22 14:48:33'),
(17565, 3046, 21277, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:45:23', '2021-03-15 16:45:23'),
(17566, 3040, 21277, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:48:25', '2021-04-07 13:48:25'),
(17567, 3040, 21277, NULL, '2021-04-16 00:00:00.000', 'In Process', 'I had a word with (Veronica) Superior Healthplan representative and she said we need to enroll the group and after that enroll the provider.   Ref: i53972195  ', NULL, NULL, '2021-04-09 14:15:44', '2021-04-09 14:15:44'),
(17568, 1006, 21277, NULL, '2021-06-10 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-06-03 11:58:24', '2021-06-03 11:58:24'),
(17569, 1006, 21277, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Received the following email from Superior @ Account Management - Corpus Christi AM.CorpusChristi@superiorhealthplan.com ​  Sub: [secure] RE: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health || ref#34556  \"Hello Adil,  To have the group enrolled with Superior Healthplan you would need to submit a request through our website. I have provided the link below. Every provider that will be participating and services members will need to also have a request submitted.  https://www.superiorhealthplan.com/providers/become-a-provider.html  Should you have any questions, please do let me know.  Thank you,  Patricia Torres Provider Account Manager II  SUPERIOR 711 N Carancahua Street, Ste. 600 Corpus Christi, Tx 78401 Toll-Free: 1-800-656-4817 Option 1, then Option 3 Fax: 1-866-683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthplan.com\"   Submitted enrollment via the superior website, attached form for reference in main group tasks.', NULL, NULL, '2021-06-15 17:03:59', '2021-06-15 17:03:59'),
(17570, 11056, 21277, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to :    AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status Query - Superior Health - Statcare Minor Emergency Clinic  Greetings,  Hope you are doing well. I want to inquire about the enrollment status of the group and providers. We have submitted the enrollment via the superior website on 06/15/2021. How long it will take to complete the credentialing process?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Please Respond soon. Waiting to hear from you soon. If you have any questions or concerns feel free to contact me.  Thank you!', NULL, NULL, '2021-07-01 15:43:43', '2021-07-01 15:43:43'),
(17571, 1006, 21277, NULL, '2021-07-12 00:00:00.000', 'In Process', 'We received the following reply from AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status Query - Superior Health - Statcare Minor Emergency Clinic  \"Good afternoon Ahmed  Can you kindly provide the following information so that way I can process your request  ·         Provider NPI#  ·         Provider TID#   Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs cid:image002.jpg@01D0C3DA.F54AEF00 711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 \"  Sent following reply to them:  \"Hello,  Sure thing, the group information is as follows:  Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904  The enrollment request was submitted back in June. Please let me know if it was received and is being processed.  Thank you.\"', NULL, NULL, '2021-07-05 16:33:41', '2021-07-05 16:33:41'),
(17572, 1006, 21277, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference. ', NULL, NULL, '2021-07-15 11:02:17', '2021-07-15 11:02:17'),
(17573, 1006, 21277, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:05:57', '2021-08-17 17:05:57'),
(17574, 1006, 21277, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:31:56', '2021-09-01 15:31:56'),
(17575, 11056, 21277, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:09:47', '2021-09-22 12:09:47'),
(17576, 11056, 21277, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:10:06', '2021-09-29 17:10:06'),
(17577, 11056, 21277, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:10:39', '2021-09-29 17:10:39'),
(17578, 11056, 21277, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:32:18', '2021-10-12 14:32:18'),
(17579, 11056, 21277, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:50:22', '2021-10-20 12:50:22'),
(17580, 11056, 21277, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:24:00', '2021-11-10 17:24:00'),
(17581, 11056, 21277, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:33:53', '2021-11-19 17:33:53');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(17582, 11056, 21277, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:49:24', '2021-12-01 12:49:24'),
(17583, 11056, 21277, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:37:24', '2021-12-16 16:37:24'),
(17584, 11056, 21277, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:35:56', '2021-12-23 15:35:56'),
(17585, 19067, 21277, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:05:28', '2022-01-10 18:05:28'),
(17586, 19067, 21277, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:19:59', '2022-01-26 17:19:59'),
(17587, 19067, 21277, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:54:57', '2022-02-11 14:54:57'),
(17588, 19067, 21277, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:33:01', '2022-02-21 17:33:01'),
(17589, 19067, 21277, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:48:00', '2022-03-15 17:48:00'),
(17590, 22077, 21277, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:41:06', '2022-04-22 14:41:06'),
(17591, 3046, 21278, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:48:07', '2021-03-15 16:48:07'),
(17592, 3040, 21278, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 14:57:38', '2021-04-08 14:57:38'),
(17593, 9057, 21278, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:50:56', '2021-05-26 15:50:56'),
(17594, 3040, 21278, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:28', '2021-06-15 17:01:28'),
(17595, 1006, 21278, NULL, '2021-06-30 00:00:00.000', 'In Process', 'Sent f/u and address addition email @ ccampos@trpnppo.com:  Sub: Group enrollment & address addition query   \"Hello Carlos,  I wanted to verify what the effective date of the following group is, also we wanted to add the following location under the group and the following provider as well:   Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Provider Name: Traci Mason NPI# 1497127831  Additional Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please let me know if you have any questions.  Thank you!\"', NULL, NULL, '2021-06-23 10:53:22', '2021-06-23 10:53:22'),
(17596, 1006, 21278, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ ccampos@trpnppo.com & providerrelations@trpnppo.com:   Sub: Group enrollment & address addition query  \"Hello Carlos,   I hope you\'re doing well, I wanted to check in on the status of this request. I would appreciate it if you could please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-08 17:24:49', '2021-07-08 17:24:49'),
(17597, 1006, 21278, NULL, '2021-07-20 00:00:00.000', 'In Process', 'We received the following update from ccampos@trpnppo.com:  Sub: RE: Group enrollment & address addition query  \"Hello Brad,   This group is Active, effective date 04/26/2016,   Provider Traci Mason is Active, effective date 01/01/2021,   Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com www.trpnppo.com\"  Replied with:   \"Hello Carlos,   I appreciate the update but the address mentioned is still not showing up under the provider or group on the TRPN provider directory, could you let me know when that will be updated?  Thank you!\"', NULL, NULL, '2021-07-13 08:36:39', '2021-07-13 08:36:39'),
(17598, 1006, 21278, NULL, '2021-08-31 00:00:00.000', 'Approved', 'All providers have been added to the group address. Approving task.   Eff: 04/26/2016', NULL, NULL, '2021-08-24 10:59:25', '2021-08-24 10:59:25'),
(17599, 3046, 21279, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:48:09', '2021-03-15 16:48:09'),
(17600, 3040, 21279, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 14:58:11', '2021-04-08 14:58:11'),
(17601, 3040, 21279, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:17', '2021-04-09 12:36:17'),
(17602, 9057, 21279, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:51:07', '2021-05-26 15:51:07'),
(17603, 3040, 21279, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:24', '2021-06-15 17:01:24'),
(17604, 1006, 21279, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:33:41', '2021-06-23 11:33:41'),
(17605, 3046, 21280, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:48:11', '2021-03-15 16:48:11'),
(17606, 3040, 21280, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 14:58:46', '2021-04-08 14:58:46'),
(17607, 3040, 21280, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:21', '2021-04-09 12:36:21'),
(17608, 9057, 21280, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:51:19', '2021-05-26 15:51:19'),
(17609, 3040, 21280, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:22', '2021-06-15 17:01:22'),
(17610, 1006, 21280, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:33:17', '2021-06-23 11:33:17'),
(17611, 3046, 21281, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:48:13', '2021-03-15 16:48:13'),
(17612, 3040, 21281, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 14:59:50', '2021-04-08 14:59:50'),
(17613, 3040, 21281, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:24', '2021-04-09 12:36:24'),
(17614, 9057, 21281, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:51:30', '2021-05-26 15:51:30'),
(17615, 3040, 21281, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:20', '2021-06-15 17:01:20'),
(17616, 1006, 21281, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:32:57', '2021-06-23 11:32:57'),
(17617, 3046, 21282, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:48:15', '2021-03-15 16:48:15'),
(17618, 3040, 21282, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:33:59', '2021-04-08 15:33:59'),
(17619, 3040, 21282, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:27', '2021-04-09 12:36:27'),
(17620, 9057, 21282, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:51:39', '2021-05-26 15:51:39'),
(17621, 3040, 21282, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:20', '2021-06-15 17:01:20'),
(17622, 1006, 21282, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:32:36', '2021-06-23 11:32:36'),
(17623, 3046, 21283, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:48:16', '2021-03-15 16:48:16'),
(17624, 3040, 21283, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:34:45', '2021-04-08 15:34:45'),
(17625, 3040, 21283, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:32', '2021-04-09 12:36:32'),
(17626, 9057, 21283, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:51:48', '2021-05-26 15:51:48'),
(17627, 3040, 21283, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:17', '2021-06-15 17:01:17'),
(17628, 1006, 21283, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:32:13', '2021-06-23 11:32:13'),
(17629, 3046, 21284, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:48:18', '2021-03-15 16:48:18'),
(17630, 3040, 21284, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:35:22', '2021-04-08 15:35:22'),
(17631, 3040, 21284, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:50:04', '2021-04-09 12:50:04');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(17632, 9057, 21284, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:51:59', '2021-05-26 15:51:59'),
(17633, 3040, 21284, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:15', '2021-06-15 17:01:15'),
(17634, 1006, 21284, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:31:50', '2021-06-23 11:31:50'),
(17635, 3046, 21285, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:48:20', '2021-03-15 16:48:20'),
(17636, 3040, 21285, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:35:53', '2021-04-08 15:35:53'),
(17637, 3040, 21285, NULL, '2021-04-16 00:00:00.000', 'New/Not Initiated', NULL, NULL, NULL, '2021-04-09 12:50:08', '2021-04-09 12:50:08'),
(17638, 3040, 21285, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:50:13', '2021-04-09 12:50:13'),
(17639, 9057, 21285, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:52:19', '2021-05-26 15:52:19'),
(17640, 3040, 21285, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:13', '2021-06-15 17:01:13'),
(17641, 1006, 21285, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:31:34', '2021-06-23 11:31:34'),
(17642, 3046, 21286, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:48:21', '2021-03-15 16:48:21'),
(17643, 3040, 21286, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:36:21', '2021-04-08 15:36:21'),
(17644, 3040, 21286, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:50:31', '2021-04-09 12:50:31'),
(17645, 9057, 21286, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:52:27', '2021-05-26 15:52:27'),
(17646, 3040, 21286, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:12', '2021-06-15 17:01:12'),
(17647, 1006, 21286, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:31:05', '2021-06-23 11:31:05'),
(17648, 3046, 21287, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:48:24', '2021-03-15 16:48:24'),
(17649, 3040, 21287, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:36:54', '2021-04-08 15:36:54'),
(17650, 3040, 21287, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:50:46', '2021-04-09 12:50:46'),
(17651, 9057, 21287, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:52:34', '2021-05-26 15:52:34'),
(17652, 3040, 21287, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:10', '2021-06-15 17:01:10'),
(17653, 1006, 21287, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:30:38', '2021-06-23 11:30:38'),
(17654, 3046, 21288, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:48:25', '2021-03-15 16:48:25'),
(17655, 3040, 21288, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:37:21', '2021-04-08 15:37:21'),
(17656, 3040, 21288, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:51:04', '2021-04-09 12:51:04'),
(17657, 9057, 21288, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:52:43', '2021-05-26 15:52:43'),
(17658, 3040, 21288, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:09', '2021-06-15 17:01:09'),
(17659, 1006, 21288, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:30:09', '2021-06-23 11:30:09'),
(17660, 3046, 21289, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:50:50', '2021-03-15 16:50:50'),
(17661, 1006, 21289, NULL, '2021-04-15 00:00:00.000', 'Not Eligible', 'The provider is no longer practicing with RHC.', NULL, NULL, '2021-04-08 18:05:33', '2021-04-08 18:05:33'),
(17662, 3046, 21290, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:56:27', '2021-03-15 16:56:27'),
(17663, 1006, 21290, NULL, '2021-04-15 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract.  Contract and welcome letter are attached on group task for reference. ', NULL, NULL, '2021-04-08 18:19:58', '2021-04-08 18:19:58'),
(17664, 3046, 21291, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 16:59:59', '2021-03-15 16:59:59'),
(17665, 3040, 21291, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Provider participating with UHC. ', NULL, NULL, '2021-04-08 09:01:22', '2021-04-08 09:01:22'),
(17666, 3046, 21292, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:00:01', '2021-03-15 17:00:01'),
(17667, 3040, 21292, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Provider participating with UHC.', NULL, NULL, '2021-04-08 09:05:52', '2021-04-08 09:05:52'),
(17668, 3046, 21293, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:00:06', '2021-03-15 17:00:06'),
(17669, 3040, 21293, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Additional Location || Statcare Minor Emergency Clinic || Providers || UMR ||  Greetings,  Hope you are doing well. I wanted to add the providers in the UHC for our group Statcare Minor Emergency Clinic under the below locations.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 3: Provider Name: Capupus, Mari Katrina  Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415       Provider 4: Provider Name: Gonzalez, Mary C  Provider NPI# 1952713083 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415          Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415                Provider 6: Provider Name: Rabagos, Katherine  Provider NPI#  1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413     Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 7: Provider Name: Svatek, Maegan  Provider NPI#  1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-08 09:28:11', '2021-04-08 09:28:11'),
(17670, 1006, 21293, NULL, '2021-05-18 00:00:00.000', 'Approved', 'The location has been added, approval and location confirmation are attached for reference. ', NULL, NULL, '2021-05-11 13:53:55', '2021-05-11 13:53:55'),
(17671, 1006, 21293, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'We received the following email from donotreplyemail@aperturecvo.com:  Sub; Important Credentialing Information Requested: MASON, TRACI SMITH - 8C3PT  \"Aperture Credentialing, LLC, a national credentials verification organization, has been contracted to handle primary source verification of your credentials.  Documentation needed to complete your credentialing application is missing, incomplete, or expired.  In order to continue the credentialing process with the Health Plan(s) requesting information, you will need to provide the requested information within three (3) business days from the date of this notice so that the processing of your application can be completed.  Health Plan(s) Requesting Information: United HealthCare of Houston  Credentials Request for: MASON, TRACI SMITH  Attention: Traci Mason Credentialing Contact  Information Requested: Please provide who admits on your behalf, or the name of the covering colleague, or hospitalist group name?  How to Respond: Fax:  Click on the Aperture Supporting Documentation website link below to download your custom fax coversheet and fax number to transmit information requested via fax. Online:  Click on the Aperture Supporting Documentation website link below to download specific forms, attach documentation, or provide a quick response for information requested.  NOTE: This email was sent from a notification-only email address that cannot accept incoming email.  Please do not reply to this message. The website link is custom to the provider and health plan specific to the Credentialing Information Request contained in this email.  Please do not submit other providers not listed in this email using this link. Please disregard this notice if you have already submitted your application or information requested. If you are using CAQH to upload supporting documentation, please allow up to two (2) business days for CAQH processing.  Once the documents are processed by CAQH, Aperture will be able to download that information. Aperture Supporting Documentation website: https://outreach.aperturecvo.com/445a83f7-ea0e-4a82-b59c-1b46e53d50b0\"  Replied with request information as Rolando Perez is her supervising physican. ', NULL, NULL, '2021-08-30 14:58:49', '2021-08-30 14:58:49'),
(17672, 11056, 21293, NULL, '2021-09-28 00:00:00.000', 'Revalidation', '	 Email sent to : networkhelp@uhc.com  Sub : Status Update of recredentialing - Traci Mason - UHC  Good evening!  Hope all is well with you. Please provide me with the recredentialing status for the below mentioned provider under the facility TIN. And also confirm if all of the locations are listed below that provider or not?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details:  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-21 17:12:25', '2021-09-21 17:12:25'),
(17673, 11056, 21293, NULL, '2021-10-01 00:00:00.000', 'Revalidation', 'Secure Message from david.c.cliff@optum.com', NULL, NULL, '2021-09-24 13:53:58', '2021-09-24 13:53:58'),
(17674, 11056, 21293, NULL, '2021-10-19 00:00:00.000', 'Revalidation', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from david.c.cliff@optum.com  Good Afternoon,  The provider is currently in a recredentialing process that is due 11/2021 (the CAQH application has been accessed and the recredentialing will complete before the end of 11/2021).  The only service locations loaded for this provider are  3817 S PADRE ISLAND DR CORPUS CHRISTI, TX 78415-2913 and 4042 RIVER HILL DR CORPUS CHRISTI, TX 78410-5606   David Cliff UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-10-12 10:59:31', '2021-10-12 10:59:31'),
(17675, 11056, 21293, NULL, '2021-10-25 00:00:00.000', 'Revalidation', 'Email sent to : networkhelp@uhc.com  Sub : Secure Message from david.c.cliff@optum.com  Good afternoon!  Hope this email finds you well. What about the other 2 mentioned below 1. Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 2. Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413', NULL, NULL, '2021-10-18 12:54:16', '2021-10-18 12:54:16'),
(17676, 11056, 21293, NULL, '2021-11-01 00:00:00.000', 'Revalidation', 'Email received from : networkhelp@uhc.com  Sub : RE: Secure Message from david.c.cliff@optum.com  The 500 E CAESAR  KINGSVILLE , TX 78363 and 6646 S. Staples St. # 122 Corpus Christi , TX 78413 are currently not loaded as service locations for this provider.  A request to add these locations would need to be submitted to our demographics group for processing   Request has been submitted', NULL, NULL, '2021-10-25 13:14:00', '2021-10-25 13:14:00'),
(17677, 11056, 21293, NULL, '2021-11-18 00:00:00.000', 'Revalidation', 'Email sent to: hpdemo@uhc.com,  networkhelp@uhc.com  Sub : Status Update of recredentialing - Traci Mason - UHC - Statcare Minor Emergency Clinic   Good afternoon!  Hope you are having a great day. Has the re-credentialing been completed of the provider, Traci Mason? Have all the below mention locations been listed under the provider?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Traci Mason	1497127831  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-11 13:58:54', '2021-11-11 13:58:54'),
(17678, 11056, 21293, NULL, '2021-11-23 00:00:00.000', 'Revalidated', 'Email received from: networkhelp@uhc.com  Sub : Secure Message from cameron_l_pickett@uhc.com  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry. I have included the product roster showing the demographic information, lines of business, and effective dates for the providers requested.      Additionally, if you are wanting the specific lines of business that the providers are linked to this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). Please see the attached handout for more information.    If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).    Please let us know if we can assist further.       Sincerely,       *--SecureDelivery--*    All locations are added. Please see the roster.', NULL, NULL, '2021-11-16 14:39:47', '2021-11-16 14:39:47'),
(17679, 3046, 21294, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:00:09', '2021-03-15 17:00:09'),
(17680, 3040, 21294, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Provider participating with UHC. ', NULL, NULL, '2021-04-08 09:39:47', '2021-04-08 09:39:47'),
(17681, 3046, 21295, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:00:11', '2021-03-15 17:00:11'),
(17682, 3040, 21295, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Request for Roster || Statcare Minor Emergency Clinic || Group & Providers || UHC ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 09:43:34', '2021-04-08 09:43:34'),
(17683, 3040, 21295, NULL, '2021-04-16 00:00:00.000', 'Approved', 'Provider Participating with UHC.', NULL, NULL, '2021-04-09 16:31:35', '2021-04-09 16:31:35'),
(17684, 3046, 21296, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:00:12', '2021-03-15 17:00:12'),
(17685, 3040, 21296, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Provider enrolled with UHC. ', NULL, NULL, '2021-04-08 09:56:54', '2021-04-08 09:56:54'),
(17686, 3046, 21297, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:00:16', '2021-03-15 17:00:16'),
(17687, 3040, 21297, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Request for Roster || Statcare Minor Emergency Clinic || Group & Providers || UHC ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 08:52:47', '2021-04-08 08:52:47'),
(17688, 1006, 21297, NULL, '2021-05-11 00:00:00.000', 'Approved', 'The group has been added to the mentioned address, approval and location confirmation is attached for reference. Eff: 12/22/2018', NULL, NULL, '2021-05-11 10:06:09', '2021-05-11 10:06:09'),
(17689, 3046, 21298, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:01:07', '2021-03-15 17:01:07'),
(17690, 3040, 21298, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Provider Participating with UHC.  ', NULL, NULL, '2021-04-08 08:56:36', '2021-04-08 08:56:36'),
(17691, 3040, 21299, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:03:20', '2021-03-15 17:03:20'),
(17692, 3040, 21299, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 031521C96', NULL, NULL, '2021-03-15 17:09:28', '2021-03-15 17:09:28'),
(17693, 3040, 21299, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: pif@multiplan.com  Subject: Re: Multiplan Request for Information for Ladot Healthcare LLC - State: TX - SEID: 2132021984  Hope you are doing well. Please advise me the enrollment status for the below mentioned group.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-05-06 13:36:23', '2021-05-06 13:36:23'),
(17694, 3040, 21299, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: barbara.downing@multiplan.com  Subject: Regarding Id 2132021984 - Ladot Healthcare LLC  Hello Barbara,   Group don\'t have CMS certified or Facility accreditations.   Thank you  ', NULL, NULL, '2021-05-25 16:21:39', '2021-05-25 16:21:39'),
(17695, 3040, 21299, NULL, '2021-06-01 00:00:00.000', 'New/Not Initiated', 'Email rcvd from: barbara.downing@multiplan.com  Subject: Regarding Id 2132021984 - Ladot Healthcare LLC  Good morning Adil,  MultiPlan received a nomination request for Ladot Healthcare LLC.  Can you tell me does this entity have CMS Certification or Facility accreditations?    I see the taxonomy shows this as 261QM1300X - Clinic/Center Multi-Specialty.  Thank you,  Barbara Downing Contracts & Development Provider Contracting Representative Barbara.downing@multiplan.com MultiPlan 25550 Commercentre Dr. Ste. 200 Lake Forest, CA 92630 Phone: (949) 672-1784', NULL, NULL, '2021-05-25 16:22:45', '2021-05-25 16:22:45'),
(17696, 1006, 21299, NULL, '2021-06-02 00:00:00.000', 'In Process', '', NULL, NULL, '2021-05-26 08:37:12', '2021-05-26 08:37:12'),
(17697, 1006, 21299, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Sent f/u email @ \"Downing, Barbara\" barbara.downing@multiplan.com,:  Sub: Re: Regarding Id 2132021984 - Ladot Healthcare LLC  \"Hello Barbara,   Please let me know if any further information is needed to process the request?  Thank you. \"', NULL, NULL, '2021-05-27 10:13:04', '2021-05-27 10:13:04'),
(17698, 1006, 21299, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Received the following reply from Barbara: \"MultiPlan will be sending out DocuSign agreement for the group shortly.  Thank you,  Barbara Downing  Contracts & Development  Provider Contracting Representative  Barbara.downing@multiplan.com  MultiPlan  25550 Commercentre Dr. Ste. 200  Lake Forest, CA 92630  Phone: (949) 672-1784\"  Contract received, signed, and sent back. Attached for reference. ', NULL, NULL, '2021-05-27 14:32:21', '2021-05-27 14:32:21'),
(17699, 1006, 21299, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Sent f/u email @ \"Downing, Barbara\" barbara.downing@multiplan.com & registrar@multiplan.com:  Sub: Re: Regarding Id 2132021984 - Ladot Healthcare LLC  \"Hello,   I wanted to get an update regarding the enrollment status for the following group and providers:  Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Provider Name: Atinuke Dada Provider NPI# 1154782720  Please get back to me as soon as possible. Thank you!\"', NULL, NULL, '2021-06-16 09:56:45', '2021-06-16 09:56:45');
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
(17700, 1006, 21299, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Opened new service case to verify enrollment status:   \"MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution.  If you have questions regarding this service case, please call Customer Service at the number listed below.  MultiPlan Inquiry 1-800-950-7040 and refer to the case number when speaking with our representative.  Viant Inquiry 1-800-877-1444 and refer to the case number when speaking with our representative.  Case Number: 7660238    Submitter Name: Brad Peterson Date of submission: 07/05/2021 \"', NULL, NULL, '2021-07-05 10:41:08', '2021-07-05 10:41:08'),
(17701, 11056, 21299, NULL, '2021-07-22 00:00:00.000', 'In Process', 'I had words with Miss Charlie. She informed me about the enrollment status of both the providers. She has notified us that the Malpractice limits for Atinuke need to be increased, as the minimum amount is $200,000 Per Occurrence & $600,000 Aggregate. For Mr. Dada enrollment, there is no application in their records sysytem.  We have emailed Mr. Dada about the Malpractice limit expansion. Waiting for his response.', NULL, NULL, '2021-07-15 13:24:07', '2021-07-15 13:24:07'),
(17702, 11056, 21299, NULL, '2021-07-22 00:00:00.000', 'In Process', 'The enrollment application is submitted again.  Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 071521O14', NULL, NULL, '2021-07-15 13:25:01', '2021-07-15 13:25:01'),
(17703, 11056, 21299, NULL, '2021-08-03 00:00:00.000', 'In Process', 'I have words with Sam at 1-800-950-7040. He provide me with the updates  OLADIPO application is in review for eligibility by Multiplan\'s Board. Atinuke application is in process. Ref code no. : 7660238   MLP of both the providers have been sent to appmissinginfo@multiplan.com for resolving the MLP- issue.', NULL, NULL, '2021-07-26 17:06:42', '2021-07-26 17:06:42'),
(17704, 11056, 21299, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : appmissinginfo@multiplan.com  Sub : MALPRACTICE OF THE PROVIDERS - LHC - MULTIPLAN  Good evening!  Hope all is well. Here are the Malpractices attached of both the providers. Please see the attachment. If you further need any document or info please let me know.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Details: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Eagerly, waiting for your response. Feel free to contact me if you have any questions or concerns.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-03 10:50:23', '2021-08-03 10:50:23'),
(17705, 11056, 21299, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : registrar@multiplan.com  Sub : MALPRACTICE OF THE PROVIDERS - LHC - 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://custservice.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, '2021-08-09 15:36:09', '2021-08-09 15:36:09'),
(17706, 11056, 21299, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to :  	appmissinginfo@multiplan.com, registrar  registrar@multiplan.com, barbara.downing@multiplan.com  Sub : MALPRACTICE OF THE PROVIDERS - LHC - MULTIPLAN  Good morning!  Hope you are doing well. I wanted to get an update regarding the enrollment status for the following group and providers mentioned below:  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Details: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider Name: Oladipo  Dada Provider NPI # : 1760700223  Eagerly, waiting for your response. Feel free to contact me if you have any questions or concerns.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-16 08:48:24', '2021-08-16 08:48:24'),
(17707, 11056, 21299, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email sent to : appmissinginfo@multiplan.com, registrar  registrar@multiplan.com, barbara.downing@multiplan.com  Sub : MALPRACTICE OF THE PROVIDERS - LHC - MULTIPLAN  Good morning!  Hope you are doing well. I wanted to get an update regarding the enrollment status for the following group and providers mentioned below:  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Details: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider Name: Oladipo  Dada Provider NPI # : 1760700223  Eagerly, waiting for your response. Feel free to contact me if you have any questions or concerns.  Thank you! Have a great weekend ahead! ', NULL, NULL, '2021-08-23 12:56:52', '2021-08-23 12:56:52'),
(17708, 11056, 21299, NULL, '2021-09-20 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : MALPRACTICE OF THE PROVIDERS - LHC - MULTIPLAN  Good morning!  Hope you are doing well. I wanted to get an update regarding the enrollment status for the following group and providers mentioned below:  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Details: Provider Name: Dada, Atinuke Provider NPI # : 1154782720  Provider Name: Oladipo  Dada Provider NPI # : 1760700223  Eagerly, waiting for your response. Feel free to contact me if you have any questions or concerns.  Thank you! Have a great weekend ahead!   Contacted to : JESSIKA N Ref code : 7660238 Atinuke\'s application closed because of Malpractice issue. Oladipo\'s application is in process.', NULL, NULL, '2021-09-13 17:07:12', '2021-09-13 17:07:12'),
(17709, 11056, 21299, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : nominations@multiplan.com  Sub : Multiplan Individual Agreement for Signature for Atinuke Dada MSN - State: TX - SEID: 210917195934  Dear Provider:  Thank you for your interest in participating in one or more of MultiPlan\'s provider networks.  An agreement for signature is enclosed and available to sign electronically by clicking the following link:  Individual Agreement We have included a sample fee schedule for your review.  Please note, the applicability of the SLCP State Law Coordinating Provisions is determined by your service location(s). Please refer to your State Law Provisions.  Once we have received the signed agreement, we will begin the credentialing process. You will be notified of your effective date upon acceptance into the network(s) and a fully executed copy of the agreement will be sent to you via DocuSign email  If you need to nominate additional providers then please submit your provider nomination request by clicking the following link:  Nominate Provider If you already participate in CAQH, we ask that you assist us with the following:  Authorize MultiPlan to access your CAQH Application Attest to your application within 90 days Complete your CAQH Application in its entirety If you do not participate in CAQH, you may initiate the process by clicking the following link:  CAQH If you have questions regarding this letter, please contact our Service Operations Department at 800-950-7040 from 8:30 a.m. to 5:30 p.m. ET. Service Operations can answer questions about your credentialing application, correct erroneous information submitted in your credentialing application, or report the status of your credentialing application. If you would like additional information about MultiPlan or the services we offer, please visit our website at www.multiplan.com.  Sincerely, Gloria Esplana Director, Network Contract Support', NULL, NULL, '2021-09-22 09:24:10', '2021-09-22 09:24:10'),
(17710, 11056, 21299, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email sent to : 	nominations@multiplan.com  Sub  : Multiplan Individual Agreement for Signature for Atinuke Dada MSN - State: TX - SEID: 210917195934  Good morning!  Hope this email finds you well. I have attested and authorised Multiplan to access CAQH application. The CAQH application is entirely completed of the provider,Atinuke Dada (CAQH: 15021030).  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-09-30 16:13:17', '2021-09-30 16:13:17'),
(17711, 11056, 21299, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Rep : Jane  D  Status : In process. Agreement has been received by them . In credentialing Dept.  take 60 days.  Ref code :  JaneD0843  Contact no. : 800-950-7040', NULL, NULL, '2021-10-06 08:44:11', '2021-10-06 08:44:11'),
(17712, 11056, 21299, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Rep : Natasha C  Status :   Oladipo : they received a contract and is in processing.  Atinuke : Contract received on sept 28 still in processing.   Ref code : Natashac1236', NULL, NULL, '2021-10-14 12:43:09', '2021-10-14 12:43:09'),
(17713, 11056, 21299, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep: Jeff N  Status: Atinuke is still in the process 09/28/2021 Oladipo is also in process 10/09/2021  Case no. : 7660238  Ref code : SEID of the providers   Contact no. : 800-950-7040', NULL, NULL, '2021-10-21 15:16:01', '2021-10-21 15:16:01'),
(17714, 11056, 21299, NULL, '2021-11-19 00:00:00.000', 'In Process', 'Rep:  Sarah N  Status:  Is under review. And with the contracting team   Ref code: 766203811122021Sarah', NULL, NULL, '2021-11-12 17:22:16', '2021-11-12 17:22:16'),
(17715, 11056, 21299, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Taylor M  Status: The provider is still in process. The complete case was started in the month of October. Working on it. It is in the credentialing process.  case no. : 7824454', NULL, NULL, '2021-11-24 14:49:01', '2021-11-24 14:49:01'),
(17716, 11056, 21299, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Rep: James D  Status : It is in the final process of credentialing.  Ref code: 7825718', NULL, NULL, '2021-11-29 12:58:37', '2021-11-29 12:58:37'),
(17717, 11056, 21299, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Rep: Amber C   Status: MLP expired. Credentialing has been stopped due to that. MLP needed to continue the process   Ref code: 7825718 ', NULL, NULL, '2021-12-08 14:50:17', '2021-12-08 14:50:17'),
(17718, 11056, 21299, NULL, '2021-12-20 00:00:00.000', 'Approved', 'Email received from: welcomepackets@multiplan.com  Sub: SECURE: MultiPlan Network Participation (13327468-15)  Dear Provider/Administrator,  Welcome! Your application has been processed, effective 11/29/2021  Please review the attached documents regarding the participation of Dada, Oladipo, MD, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information o A copy of your executed Participating Professional Agreement', NULL, NULL, '2021-12-13 15:26:00', '2021-12-13 15:26:00'),
(17719, 11056, 21299, NULL, '2021-12-20 00:00:00.000', 'Approved', 'Email received from: welcomepackets@multiplan.com  Sub: SECURE: MultiPlan Network Participation (13327468-15)  Dear Provider/Administrator,  Welcome! Your application has been processed, effective 11/29/2021  Please review the attached documents regarding the participation of Dada, Oladipo, MD, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information o A copy of your executed Participating Professional Agreement', NULL, NULL, '2021-12-13 15:26:02', '2021-12-13 15:26:02'),
(17720, 3046, 21311, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:25:41', '2021-03-15 17:25:41'),
(17721, 1006, 21311, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference.  ', NULL, NULL, '2021-03-25 14:14:38', '2021-03-25 14:14:38'),
(17722, 3046, 21312, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:25:43', '2021-03-15 17:25:43'),
(17723, 1006, 21312, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference.  ', NULL, NULL, '2021-03-25 14:13:43', '2021-03-25 14:13:43'),
(17724, 3046, 21313, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:28:16', '2021-03-15 17:28:16'),
(17725, 1006, 21313, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care contract with Aetna. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and directory/plans are also attached for reference.  ', NULL, NULL, '2021-03-25 14:16:43', '2021-03-25 14:16:43'),
(17726, 1006, 21314, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:31:19', '2021-03-15 17:31:19'),
(17727, 3040, 21314, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:18:28', '2021-04-21 08:18:28'),
(17728, 1019, 21314, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:44:14', '2021-10-25 10:44:14'),
(17729, 1006, 21315, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:31:22', '2021-03-15 17:31:22'),
(17730, 3040, 21315, NULL, '2021-04-28 00:00:00.000', 'Approved', 'I had a word with (Ashley) MBHP representative and she said the provider is participating in-network with MBHP.   Effective Date: 01/01/2020  Call Ref# 04/21/2021 6671296 ', NULL, NULL, '2021-04-21 08:11:35', '2021-04-21 08:11:35'),
(17731, 1006, 21316, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:31:23', '2021-03-15 17:31:23'),
(17732, 3040, 21316, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:18:41', '2021-04-21 08:18:41'),
(17733, 1006, 21317, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:31:25', '2021-03-15 17:31:25'),
(17734, 3040, 21317, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:21:03', '2021-04-21 08:21:03'),
(17735, 1006, 21318, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:31:26', '2021-03-15 17:31:26'),
(17736, 3040, 21318, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:19:08', '2021-04-21 08:19:08'),
(17737, 1006, 21319, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:31:28', '2021-03-15 17:31:28'),
(17738, 3040, 21319, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:18:51', '2021-04-21 08:18:51'),
(17739, 1019, 21319, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer with SNBCARE.', NULL, NULL, '2021-11-09 10:33:03', '2021-11-09 10:33:03'),
(17740, 3046, 21320, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:31:28', '2021-03-15 17:31:28'),
(17741, 1005, 21320, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-K has ancillary contract. No Need to credential the provider individually. Ref task LInk: http://app.emrbs.com/Credentials/Details/339', NULL, NULL, '2021-03-25 13:56:30', '2021-03-25 13:56:30'),
(17742, 3046, 21321, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:34:33', '2021-03-15 17:34:33'),
(17743, 1005, 21321, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-K has ancillary contract. No Need to credential the provider individually. Ref task LInk: http://app.emrbs.com/Credentials/Details/339', NULL, NULL, '2021-03-25 13:56:03', '2021-03-25 13:56:03'),
(17744, 3046, 21322, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:34:36', '2021-03-15 17:34:36'),
(17745, 1005, 21322, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-K has ancillary contract. No Need to credential the provider individually. Ref task LInk: http://app.emrbs.com/Credentials/Details/339', NULL, NULL, '2021-03-25 13:57:14', '2021-03-25 13:57:14'),
(17746, 3046, 21323, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:34:38', '2021-03-15 17:34:38'),
(17747, 1005, 21323, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-K has ancillary contract. No Need to credential the provider individually. Ref task LInk: http://app.emrbs.com/Credentials/Details/339', NULL, NULL, '2021-03-25 13:57:19', '2021-03-25 13:57:19'),
(17748, 3046, 21324, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:34:40', '2021-03-15 17:34:40'),
(17749, 1005, 21324, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-K has ancillary contract. No Need to credential the provider individually. Ref task LInk: http://app.emrbs.com/Credentials/Details/339', NULL, NULL, '2021-03-25 13:57:26', '2021-03-25 13:57:26'),
(17750, 3046, 21325, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:35:39', '2021-03-15 17:35:39'),
(17751, 1005, 21325, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-K has ancillary contract. No Need to credential the provider individually. Ref task LInk: http://app.emrbs.com/Credentials/Details/339', NULL, NULL, '2021-03-25 13:57:30', '2021-03-25 13:57:30'),
(17752, 3046, 21326, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:35:46', '2021-03-15 17:35:46'),
(17753, 1005, 21326, NULL, '2021-01-01 00:00:00.000', 'Approved', 'RHC-K has ancillary contract. No Need to credential the provider individually. Ref task LInk: http://app.emrbs.com/Credentials/Details/339', NULL, NULL, '2021-03-25 13:59:18', '2021-03-25 13:59:18'),
(17754, 3046, 21327, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:35:58', '2021-03-15 17:35:58'),
(17755, 1005, 21327, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-K has ancillary contract. No Need to credential the provider individually. Ref task LInk: http://app.emrbs.com/Credentials/Details/339', NULL, NULL, '2021-03-25 13:59:21', '2021-03-25 13:59:21'),
(17756, 3046, 21328, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:36:03', '2021-03-15 17:36:03'),
(17757, 1005, 21328, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-K has ancillary contract. No Need to credential the provider individually. Ref task LInk: http://app.emrbs.com/Credentials/Details/339', NULL, NULL, '2021-03-25 13:59:24', '2021-03-25 13:59:24'),
(17758, 3046, 21329, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:36:06', '2021-03-15 17:36:06'),
(17759, 1005, 21329, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-K has ancillary contract. No Need to credential the provider individually. Ref task LInk: http://app.emrbs.com/Credentials/Details/339', NULL, NULL, '2021-03-25 13:59:27', '2021-03-25 13:59:27'),
(17760, 3046, 21330, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:36:47', '2021-03-15 17:36:47'),
(17761, 1005, 21330, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-K has ancillary contract. No Need to credential the provider individually. Ref task LInk: http://app.emrbs.com/Credentials/Details/339', NULL, NULL, '2021-03-25 13:59:30', '2021-03-25 13:59:30'),
(17762, 3046, 21331, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:27', '2021-03-15 17:43:27'),
(17763, 1006, 21331, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:34:20', '2021-03-29 17:34:20'),
(17764, 3046, 21332, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:30', '2021-03-15 17:43:30'),
(17765, 1006, 21332, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:34:24', '2021-03-29 17:34:24'),
(17766, 3046, 21333, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:32', '2021-03-15 17:43:32'),
(17767, 1006, 21333, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:34:29', '2021-03-29 17:34:29'),
(17768, 3046, 21334, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:36', '2021-03-15 17:43:36'),
(17769, 1006, 21334, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:34:33', '2021-03-29 17:34:33'),
(17770, 3046, 21335, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:39', '2021-03-15 17:43:39'),
(17771, 1006, 21335, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:34:39', '2021-03-29 17:34:39'),
(17772, 3046, 21336, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:41', '2021-03-15 17:43:41'),
(17773, 1006, 21336, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:34:43', '2021-03-29 17:34:43'),
(17774, 3046, 21337, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:43', '2021-03-15 17:43:43'),
(17775, 1006, 21337, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:34:49', '2021-03-29 17:34:49'),
(17776, 3046, 21338, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:46', '2021-03-15 17:43:46'),
(17777, 1006, 21338, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:34:54', '2021-03-29 17:34:54'),
(17778, 3046, 21339, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:48', '2021-03-15 17:43:48'),
(17779, 1006, 21339, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:35:00', '2021-03-29 17:35:00'),
(17780, 3046, 21340, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:50', '2021-03-15 17:43:50'),
(17781, 1006, 21340, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:35:07', '2021-03-29 17:35:07'),
(17782, 1006, 21341, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:52', '2021-03-15 17:43:52'),
(17783, 1006, 21341, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Confirmed the effective date for the provider from Medicaid Provider line @ (401) 784-8100.   Mahreen Rashid Effective: 10/21/2019 Ref# 486147  Attached confirmation from the provider directory for reference. ', NULL, NULL, '2021-04-12 14:54:51', '2021-04-12 14:54:51'),
(17784, 1006, 21342, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:54', '2021-03-15 17:43:54'),
(17785, 1006, 21342, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Confirmed the effective date for the provider from Medicaid Provider line @ (401) 784-8100.   Peggy Pionke Effective: 04/01/2020 Ref# 486147  Attached confirmation from the provider directory for reference.  ', NULL, NULL, '2021-04-12 14:46:03', '2021-04-12 14:46:03'),
(17786, 1006, 21343, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:55', '2021-03-15 17:43:55'),
(17787, 1006, 21343, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Confirmed the effective date for the provider from Medicaid Provider line @ (401) 784-8100.   Fauzia Wali-Khan Effective: 03/01/2020 Ref# 486147  Attached confirmation from provider directory for reference. ', NULL, NULL, '2021-04-12 14:39:03', '2021-04-12 14:39:03'),
(17788, 1006, 21344, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:43:57', '2021-03-15 17:43:57'),
(17789, 1006, 21344, NULL, '2021-04-16 00:00:00.000', 'On Hold', 'The enrollment request is pending on the provider\'s RI PMHNP license to be issued. ', NULL, NULL, '2021-04-09 14:58:04', '2021-04-09 14:58:04'),
(17790, 1019, 21344, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:44:24', '2021-10-25 10:44:24'),
(17791, 1006, 21345, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:46:01', '2021-03-15 17:46:01'),
(17792, 1006, 21345, NULL, '2021-04-16 00:00:00.000', 'Approved', 'The group is enrolled with Medicare. Approval confirmation is attached for reference.   Eff: 07/29/2019 ID# U100591992', NULL, NULL, '2021-04-09 14:15:06', '2021-04-09 14:15:06'),
(17793, 1006, 21346, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:46:05', '2021-03-15 17:46:05'),
(17794, 1006, 21346, NULL, '2021-04-16 00:00:00.000', 'On Hold', 'The enrollment request is pending on the provider\'s RI PMHNP license to be issued.', NULL, NULL, '2021-04-09 14:46:25', '2021-04-09 14:46:25'),
(17795, 1019, 21346, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:44:41', '2021-10-25 10:44:41'),
(17796, 1006, 21347, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:46:06', '2021-03-15 17:46:06'),
(17797, 1006, 21347, NULL, '2021-04-16 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare. Approval confirmation is attached for reference.   Eff: 01/19/2020 ID# U400632949 ', NULL, NULL, '2021-04-09 14:17:28', '2021-04-09 14:17:28'),
(17798, 1006, 21348, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:46:08', '2021-03-15 17:46:08'),
(17799, 1006, 21348, NULL, '2021-04-16 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare. Approval confirmation is attached for reference.   Eff: 01/21/2020 ID# U400634311 ', NULL, NULL, '2021-04-09 14:37:19', '2021-04-09 14:37:19'),
(17800, 1006, 21349, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:46:09', '2021-03-15 17:46:09'),
(17801, 1006, 21349, NULL, '2021-04-16 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare. Approval confirmation is attached for reference.   Eff: 10/24/2019 ID# U400610408 ', NULL, NULL, '2021-04-09 14:39:26', '2021-04-09 14:39:26'),
(17802, 1006, 21350, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:47:52', '2021-03-15 17:47:52'),
(17803, 3040, 21350, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare. Approval confirmation is attached for reference.   Eff:01/12/2020	 ID# S400632499	', NULL, NULL, '2021-04-20 14:27:30', '2021-04-20 14:27:30'),
(17804, 1006, 21351, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:47:54', '2021-03-15 17:47:54'),
(17805, 3040, 21351, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare. Approval confirmation is attached for reference.   Eff: 05/13/2020 ID# S400654658', NULL, NULL, '2021-04-20 14:29:26', '2021-04-20 14:29:26'),
(17806, 1006, 21352, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:47:55', '2021-03-15 17:47:55'),
(17807, 3040, 21352, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare. Approval confirmation is attached for reference.   Eff: 01/21/2020 ID# S400634712', NULL, NULL, '2021-04-20 14:34:40', '2021-04-20 14:34:40'),
(17808, 1006, 21353, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:47:58', '2021-03-15 17:47:58'),
(17809, 3040, 21353, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare. Approval confirmation is attached for reference.   Eff: 08/05/2019 ID# S400592362', NULL, NULL, '2021-04-20 14:33:16', '2021-04-20 14:33:16'),
(17810, 1006, 21354, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:48:00', '2021-03-15 17:48:00'),
(17811, 3040, 21354, NULL, '2021-04-27 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare. Approval confirmation is attached for reference.   Eff: 02/24/2020 ID# S400638550', NULL, NULL, '2021-04-20 14:31:13', '2021-04-20 14:31:13'),
(17812, 3046, 21355, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:49:36', '2021-03-15 17:49:36'),
(17813, 1006, 21355, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 13:15:30', '2021-04-06 13:15:30'),
(17814, 3046, 21356, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:49:44', '2021-03-15 17:49:44'),
(17815, 1006, 21356, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 13:18:18', '2021-04-06 13:18:18'),
(17816, 1006, 21357, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:49:54', '2021-03-15 17:49:54'),
(17817, 1019, 21357, NULL, '2021-04-13 00:00:00.000', 'Initiated', 'Initiated thru Palmetto GBA portal online', NULL, NULL, '2021-04-06 16:49:42', '2021-04-06 16:49:42'),
(17818, 1019, 21357, NULL, '2021-04-20 00:00:00.000', 'Approved', 'PTAN has been active effective from 01/01/2021. see attachment for approval Also sent test email', NULL, NULL, '2021-04-13 13:34:53', '2021-04-13 13:34:53'),
(17819, 1006, 21358, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:49:58', '2021-03-15 17:49:58'),
(17820, 1019, 21358, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Initiated application thru portal', NULL, NULL, '2021-04-02 08:48:12', '2021-04-02 08:48:12'),
(17821, 1019, 21358, NULL, '2021-04-15 00:00:00.000', 'Approved', 'PTAN has been active effective from 01/01/2021. see attachment for approval Also sent test email', NULL, NULL, '2021-04-08 13:09:35', '2021-04-08 13:09:35'),
(17822, 3046, 21359, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:50:47', '2021-03-15 17:50:47'),
(17823, 1006, 21359, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 13:18:26', '2021-04-06 13:18:26'),
(17824, 3046, 21360, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:50:50', '2021-03-15 17:50:50'),
(17825, 1006, 21360, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 13:18:46', '2021-04-06 13:18:46'),
(17826, 3046, 21361, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:50:54', '2021-03-15 17:50:54'),
(17827, 1006, 21361, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 13:18:55', '2021-04-06 13:18:55'),
(17828, 3046, 21362, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:50:56', '2021-03-15 17:50:56'),
(17829, 1006, 21362, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 13:19:03', '2021-04-06 13:19:03'),
(17830, 3046, 21363, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:51:00', '2021-03-15 17:51:00'),
(17831, 1006, 21363, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 13:19:12', '2021-04-06 13:19:12'),
(17832, 3046, 21364, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:51:02', '2021-03-15 17:51:02'),
(17833, 1006, 21364, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 13:19:20', '2021-04-06 13:19:20'),
(17834, 3046, 21365, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:51:05', '2021-03-15 17:51:05'),
(17835, 1006, 21365, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 13:19:31', '2021-04-06 13:19:31'),
(17836, 3046, 21366, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:51:07', '2021-03-15 17:51:07'),
(17837, 1006, 21366, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 13:19:39', '2021-04-06 13:19:39'),
(17838, 3046, 21367, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:51:10', '2021-03-15 17:51:10'),
(17839, 1006, 21367, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 13:19:47', '2021-04-06 13:19:47'),
(17840, 1006, 21368, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:52:30', '2021-03-15 17:52:30'),
(17841, 1006, 21368, NULL, '2021-04-16 00:00:00.000', 'On Hold', 'The enrollment request is pending on the provider\'s RI PMHNP license to be issued. ', NULL, NULL, '2021-04-09 14:58:09', '2021-04-09 14:58:09'),
(17842, 1019, 21368, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:45:27', '2021-10-25 10:45:27'),
(17843, 1006, 21369, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 17:52:31', '2021-03-15 17:52:31'),
(17844, 1006, 21369, NULL, '2021-04-27 00:00:00.000', 'Initiated', 'Sent following email to Chuck @ John McGrew jmcgrew3@humana.com to verify when the provider was enrolled with Tricare:  Sub: Re: Affiliation Query  \"I apologize, I missed the following provider to see what their affiliation date is:  Provider Name: Fauzia Wali-Khan NPI# 1699761965  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-04-20 14:46:37', '2021-04-20 14:46:37'),
(17845, 1019, 21369, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:22:48', '2021-05-20 11:22:48'),
(17846, 1019, 21369, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:57:14', '2021-05-31 10:57:14');
