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
(1411, 11056, 214, NULL, '2021-08-21 00:00:00.000', 'Revalidation', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-13 15:35:50', '2021-08-13 15:35:50'),
(1412, 3040, 214, NULL, '2021-08-27 00:00:00.000', 'Revalidated', 'Provider is participating with Multiplan. For more details please see attachment. ', NULL, NULL, '2021-08-20 16:41:58', '2021-08-20 16:41:58'),
(1413, 3040, 214, NULL, '2021-08-27 00:00:00.000', 'Revalidated', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:45:46', '2021-08-20 16:45:46'),
(1414, 2027, 215, NULL, NULL, 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.', NULL, NULL, '2020-07-23 15:17:58', '2020-07-23 15:17:58'),
(1415, 2027, 215, NULL, NULL, 'In Process', 'From: txintaketeampiermailbox@bcbstx.com   Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638252.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-23 15:19:01', '2020-07-23 15:19:01'),
(1416, 2027, 215, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  May I know the current enrollment status of the below mentioned providers in all three locations of  (Valley Med Urgent Care): Providers	Provider NPI#	Group Name	Group Tax-ID Soto, Mayleen	1053818054	Valley Med Urgent Care 	81-5123542 Sy, Stanley P	1740231893	Valley Med Urgent Care 	81-5123542 Rodriguez, Cynthia	1124282553	Valley Med Urgent Care 	81-5123542  Thanks.', NULL, NULL, '2020-10-12 13:57:21', '2020-10-12 13:57:21'),
(1417, 2027, 215, NULL, '2020-10-20 00:00:00.000', 'In Process', 'May I know the current enrollment status of the below mentioned providers in all three locations of  (Valley Med Urgent Care): Providers	Provider NPI#	Group Name	Group Tax-ID Soto, Mayleen	1053818054	Valley Med Urgent Care 	81-5123542 Sy, Stanley P	1740231893	Valley Med Urgent Care 	81-5123542 Rodriguez, Cynthia	1124282553	Valley Med Urgent Care 	81-5123542  Thanks.', NULL, NULL, '2020-10-13 14:40:54', '2020-10-13 14:40:54'),
(1418, 2027, 215, NULL, '2020-10-30 00:00:00.000', 'Approved', 'Provider is showing linked with the insurance and the effective date is 4/10/2020. Screenshot from provider directory is attached.', NULL, NULL, '2020-10-23 12:10:24', '2020-10-23 12:10:24'),
(1419, 2027, 217, NULL, NULL, 'In Process', 'To: Jason.Hughes@amerigroup.com  Sub: Need Status Update Of Provider  Hello, Hope you are doing well, May i Know the enrollment status of the provider. Following are the details: Provider Name: Jose, Julie  Provider NPI# 1447883061 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429  Thanks.', NULL, NULL, '2020-06-30 15:30:29', '2020-06-30 15:30:29'),
(1420, 2027, 217, NULL, NULL, 'In Process', 'From: jason.hughes@amerigroup.com  To: mk@claimsmedinc.com  LOI received, but still pending', NULL, NULL, '2020-06-30 16:54:07', '2020-06-30 16:54:07'),
(1421, 2027, 217, NULL, NULL, 'In Process', 'To: txcredentialing@amerigroup.com  Actually we don\'t need an urgent care contract for this provider, we need a group contract. Kindly reply to me as soon as you get this email.  Thanks.', NULL, NULL, '2020-06-30 16:55:34', '2020-06-30 16:55:34'),
(1422, 2027, 217, NULL, NULL, 'In Process', 'From: txcredentialing@amerigroup.com  Credentialing received and still pending', NULL, NULL, '2020-07-06 12:58:40', '2020-07-06 12:58:40'),
(1423, 2027, 217, NULL, NULL, 'In Process', 'To: txcredentialing@amerigroup.com  How much time it will take to be completed', NULL, NULL, '2020-07-06 12:59:22', '2020-07-06 12:59:22'),
(1424, 2027, 217, NULL, NULL, 'In Process', 'From: txcredentialing@amerigroup.com  Usually 30-90 days from the time we get the LOI (volume determines time frame)', NULL, NULL, '2020-07-06 13:48:35', '2020-07-06 13:48:35'),
(1425, 2027, 217, NULL, '2020-08-20 00:00:00.000', 'In Process', 'To: jason.hughes@amerigroup.com  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Amerigroup)  Hello,  Hope you are doing great I have received a welcome letter for the provider Jose Jule-NPI#1447883061-Group-Normandy Urgent Care Center-Tax ID-27-0796429 from amerigroup by fax but when i checked through provider directory for this provider that how many plans he is allowed to accept i find only 1 plan so i want to know that if we want to add some more plans for this provider what will be the procedure. I am also attaching a screenshot for your reference.', NULL, NULL, '2020-08-13 12:04:45', '2020-08-13 12:04:45'),
(1426, 2027, 217, NULL, '2020-09-08 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Amerigroup)  May i know the current status of the provider mentioned below: Provider Name-Jose, Julie Provider NPI#1447883061 Group Name-Normandy Urgent Care Center Group Tax-ID-27-0796429  Thanks.', NULL, NULL, '2020-09-01 17:46:01', '2020-09-01 17:46:01'),
(1427, 2027, 217, NULL, '2020-09-09 00:00:00.000', 'Approved', 'Provider is in network now and effective date is 5/29/2020 screenshot is attached from provider directory', NULL, NULL, '2020-09-02 09:44:45', '2020-09-02 09:44:45'),
(1428, 2027, 220, NULL, '2020-09-09 00:00:00.000', 'In Process', 'To: CHC.Contracting@communityhealthchoice.org  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Community Health Choice)  May I know the current status of the provider mentioned below: Provider Name- Jose, Julie Provider NPI# 1447883061 Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429  Thanks.', NULL, NULL, '2020-09-02 16:43:10', '2020-09-02 16:43:10'),
(1429, 2027, 220, NULL, '2020-09-10 00:00:00.000', 'In Process', 'From: CHC.Contracting@communityhealthchoice.org  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Community Health Choice)  Good Morning Martin,     After careful review, we show the roster submitted for Julie Jose was incomplete. It is imperative that all fields are filled in or ‘N/A’ is entered where applicable otherwise, the add submission will be rejected.  Please re-submit complete roster for Julie Jose at your earliest opportunity to proceed with the request.   Thank you', NULL, NULL, '2020-09-03 12:28:59', '2020-09-03 12:28:59'),
(1430, 2027, 220, NULL, '2020-09-10 00:00:00.000', 'In Process', 'To: CHC.Contracting@communityhealthchoice.org  Please find the roster attached as per your request.  Thanks.', NULL, NULL, '2020-09-03 12:29:35', '2020-09-03 12:29:35'),
(1431, 2027, 220, NULL, '2020-10-19 00:00:00.000', 'In Process', 'This provider is showing in network with the insurance and the effective date is 8/28/2020. waiting for the welcome letter.', NULL, NULL, '2020-10-12 10:49:14', '2020-10-12 10:49:14'),
(1432, 2027, 220, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: wanda.henry@communityhealthchoice.org  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Community Health Choice)  Hello Wanda,  Can I have the welcome packet for the below mentioned provider as I have confirmed with (CHC) that this provider is showing in network. Details are mentioned below: Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks. ', NULL, NULL, '2020-10-12 10:54:00', '2020-10-12 10:54:00'),
(1433, 2027, 220, NULL, '2020-10-19 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 09/18/2020. Welcome letter is attached.', NULL, NULL, '2020-10-12 12:32:38', '2020-10-12 12:32:38'),
(1434, 2027, 221, NULL, NULL, 'In Process', 'To: 	PSSCentral@cigna.com  Sub: Need status update for the provider  Good afternoon,   Could you please tell us the current credentialing status of our provider. Details are as follows: Provider Name: Julie Jose NPI:1447883061 Group Name: Normandy Urgent Care Center PA TIN:27-0796429   Your timely response will be highly appreciated.   Thanks.', NULL, NULL, '2020-06-30 14:13:34', '2020-06-30 14:13:34'),
(1435, 2027, 221, NULL, NULL, 'In Process', 'From:  PSU Inquiry (Non-Claim) 9PSSCENT@cigna.com  Sub: RE: [External] Provider status request-Application Number: 12026198  Hello,     Thank you for contacting Cigna. Our records currently show that you are non-participating  for the TIN 27-0796429 . At this time, we are not showing any inquiries for participation. If you would like to start the application process, please contact the Provider Services Unit at 800.882.4462.     Sandra M  Provider Service Unit', NULL, NULL, '2020-07-15 17:11:01', '2020-07-15 17:11:01'),
(1436, 2027, 221, NULL, NULL, 'In Process', 'Call to insurance: Talk to the representative and submit the application on call now the application is in process and the application ref number is 12232601', NULL, NULL, '2020-07-15 17:13:06', '2020-07-15 17:13:06'),
(1437, 2027, 221, NULL, NULL, 'In Process', 'From: PSU Inquiry (Non-Claim) Cigna  Good Morning Martin,     Thank you for contacting Cigna.      We apologize for our delayed response. Our email volumes are higher than normal impacting our response times. We appreciate your patience.     Your application is currently in process and was started on 07152020. The credentialing/contracting process takes up to 90 business days. If you have any additional questions, please contact the Provider Services Unit at 800.882.4462.      Provider Name: JULIE JOSE  Tax ID: 270796429  Application Number: 12232601        Sincerely,  ConnectedCare PROVIDER OPERATIONS  Nicole L.  Provider Service Unit  T: 800.882.4462', NULL, NULL, '2020-07-20 09:15:29', '2020-07-20 09:15:29'),
(1438, 2027, 221, NULL, '2020-09-04 00:00:00.000', 'In Process', 'From: Michele.Wasson@cigna.com  Hello,     Thank you for submitting a credentialing application. At this time we are unable to proceed as an ancillary contract was found for the tax ID the above provider is joining.  Please bill under the ancillary contract and not the individual provider for claim processing.     Thank you', NULL, NULL, '2020-08-28 15:57:13', '2020-08-28 15:57:13'),
(1439, 2027, 221, NULL, '2020-09-04 00:00:00.000', 'Approved', 'From: Michele.Wasson@cigna.com  Hello,     Thank you for submitting a credentialing application. At this time we are unable to proceed as an ancillary contract was found for the tax ID the above provider is joining.  Please bill under the ancillary contract and not the individual provider for claim processing.     Thank you', NULL, NULL, '2020-08-28 15:58:11', '2020-08-28 15:58:11'),
(1440, 2027, 222, NULL, NULL, 'In Process', 'To: 	Laura.Bevin@aetna.com, DavisE11@aetna.com, PDSDallas@aetna.com  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(First Health)  May I know the current status of the application for the provider which we have submitted on 6/23/2020. Provider details are mentioned below: Provider Name: Jose, Julie   Provider NPI# 1447883061  Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429   I am attaching the application for your reference. Kindly look into this and reply to me as soon as you get it.  Thanks.', NULL, NULL, '2020-07-15 17:36:38', '2020-07-15 17:36:38'),
(1441, 2027, 222, NULL, NULL, 'In Process', 'To: bharathb@aetna.com  I have a list of providers mentioned below who are under Normandy Urgent Care Center. I want to know their status of application. Also if there\'s anything missing regarding their documents for the enrollment process please let me know and i have already submitted the online application form of aetna.  Providers	NPI#	Tax ID	Insurance Brown, Brittany	1275163537	27-0796429	First Health Chennemkara, Mini Philip	1841755956	27-0796429	First Health George, Jeemol	1497219067	27-0796429	First Health Jose, Julie	1447883061	27-0796429	First Health Joseph, Vibitha	1447883061	27-0796429	First Health Kourouma , Odette Tiranke	1134525868	27-0796429	First Health Piccione JR, James M	1356321509	27-0796429	First Health Stephen, Ani	1588959118	27-0796429	First Health Thomas, Cini	1134777238	27-0796429	First Health ', NULL, NULL, '2020-07-20 12:39:12', '2020-07-20 12:39:12'),
(1442, 2027, 222, NULL, '2020-09-29 00:00:00.000', 'In Process', 'online application has been submitted', NULL, NULL, '2020-09-22 15:30:42', '2020-09-22 15:30:42'),
(1443, 2027, 222, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: bharathb@aetna.com  May I know the current enrollment status of the below mentioned provider: Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks.  ', NULL, NULL, '2020-10-21 16:53:05', '2020-10-21 16:53:05'),
(1444, 2037, 222, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Follow up email sent to : bharathb@aetna.com', NULL, NULL, '2020-10-29 14:11:52', '2020-10-29 14:11:52'),
(1445, 2037, 222, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  ------------ Greetings, We have submitted online applications for the below mentioned providers for enrollment with first health.May I know if they have been received and are currently being processed? ProvidersProvider NPI#Group NameGroup Tax-IDBrown, Brittany1275163537Normandy Urgent Care Center27-0796429Chennemkara, Mini Philip1841755956Normandy Urgent Care Center27-0796429George, Jeemol1497219067Normandy Urgent Care Center27-0796429Jose, Julie1447883061Normandy Urgent Care Center27-0796429Joseph, Vibitha1952931560Normandy Urgent Care Center27-0796429Kourouma , Odette Tiranke1134525868Normandy Urgent Care Center27-0796429Piccione JR, James M1356321509Normandy Urgent Care Center27-0796429Stephen, Ani1588959118Normandy Urgent Care Center27-0796429Thomas, Cini1134777238Normandy Urgent Care Center27-0796429', NULL, NULL, '2020-11-13 16:51:21', '2020-11-13 16:51:21'),
(1446, 2037, 222, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Another Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com, ', NULL, NULL, '2020-11-20 11:00:09', '2020-11-20 11:00:09'),
(1447, 2037, 222, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Follow up email sent to bharathb@aetna.com', NULL, NULL, '2020-12-01 10:04:11', '2020-12-01 10:04:11'),
(1448, 2037, 222, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com', NULL, NULL, '2020-12-08 13:44:52', '2020-12-08 13:44:52'),
(1449, 2037, 222, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Follow up email sent to LakkakulaS@aetna.com', NULL, NULL, '2020-12-11 13:18:31', '2020-12-11 13:18:31'),
(1450, 3040, 222, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: 	AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers under both the locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany  Provide NPI# 1275163537   Provider Name: Chennemkara, Mini Philip  Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  If you need any additional information please feel to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-26 13:34:11', '2021-02-26 13:34:11'),
(1451, 3040, 222, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  This is a follow up email regarding the enrollment status for the below mentioned providers under both the locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 15:50:01', '2021-03-08 15:50:01'),
(1452, 3040, 222, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Follow up email sent to 	pdsdallas@aetna.com  Subject: Enroll Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. I had a word with a First Health representative and she advised me you need to credentialed the providers first with Aetna and after we can add the provider in First health.   In Aetna we already have an ancillary contract so still we need to credentialed the providers with Aetna.   Below are the practice details:   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-03-19 13:44:02', '2021-03-19 13:44:02'),
(1453, 3040, 222, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our provider is enrolled with First Health because First Health is the part of Aetna.   For Effective date please see group task. ', NULL, NULL, '2021-05-26 17:03:26', '2021-05-26 17:03:26'),
(1454, 2027, 226, NULL, NULL, 'In Process', 'To: Jamie.Llefi@molinahealthcare.com  Sub: Need status Update For Provider  Hello, Hope you are doing well, May i Know the status update of the provider. Following are the details: Provider Name:  Jose, Julie    Provider NPI#  1447883061   Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429 In the last follow up you have requested for the \"Contract Request Form\" which we have already sent to you. So kindly look into this and reply to me as soon as you get this email.  Thanks.', NULL, NULL, '2020-06-30 14:49:19', '2020-06-30 14:49:19'),
(1455, 2027, 226, NULL, NULL, 'In Process', 'From: KARMEN.GRAY@molinahealthcare.com  To: nucc@claimsmedinc.com  Good afternoon,     Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for Julie Jose to contract under TAX ID number 27-0796429.     I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.     Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.     Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com     Please see your designated Coordinators information below:     HARRIS  Michele Thomas Martin  Michele.Thomas-Martin@MolinaHealthcare.com  888-562-5442 x200042               Thank you,', NULL, NULL, '2020-07-01 15:12:26', '2020-07-01 15:12:26'),
(1456, 2027, 226, NULL, NULL, 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  Record # 167855     Provider: Julie Jose     Good Afternoon,     Thank you for your contract request.   Please provide the supervising physician name and NPI #.   The CAQH shows incomplete , please attest the CAQH application.     Thank You,', NULL, NULL, '2020-07-01 17:42:02', '2020-07-01 17:42:02'),
(1457, 2027, 226, NULL, NULL, 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  Hello, The supervising physician name and his npi are as follows: Supervising Physician Name: James M Piccione JR NPI# 1356321509 I have also attested the \"CAQH\" application which you have requested.  Thanks. ', NULL, NULL, '2020-07-01 17:42:47', '2020-07-01 17:42:47'),
(1458, 2027, 226, NULL, NULL, 'In Process', 'From: Mauricio.Chavez@molinahealthcare.com  Good morning,     I received a contract request for Julie Jose, NPI 1447883061 to under Columbus Urgent Care PA. I verified the Group NPI 1215330501 with TMHP under TPI @ 347139301 and the specialty is reflecting a physician group. When I verify the group NPI with NPPES the specialty is reflecting an urgent care. Please advise if you are wanting to contract the physician group or facility.     Thank you,', NULL, NULL, '2020-07-07 17:34:06', '2020-07-07 17:34:06'),
(1459, 2027, 226, NULL, '2020-08-17 00:00:00.000', 'In Process', 'From: Margaret.White@molinahealthcare.com  Sub: Approval Letter  August 3, 2020     Julie Jose, NP  779 Normandy St Ste 114  Houston, TX 77015        Dear Julie Jose, NP:     Your credentialing file was reviewed by the Molina Healthcare of Texas Credentialing Committee on 7/24/2020.  After careful consideration of the information in your file, I am pleased to inform you that the Committee has approved your credentialing application in the primary specialty of Nurse Practitioner - Family.     Upon execution of your contract with Molina, you will receive under separate cover, a letter informing you of your effective date as a contracted, participating network provider.  Until that time, Molina will reimburse you for services provided to Molina members at the out-of-network rate subject to Title I, Part 15, Chapter 353, Subchapter A, Rule  §353.4 of the Texas Administrative Code  (c) Reasonable reimbursement methodology.      For questions regarding the contracting process please contact Contract Coordination at: 855-322-4080 or email: TexasExpansionContracting@MolinaHealthCare.Com     For Molina’s authorization requirements please refer to the forms at the link below: https://www.molinahealthcare.com/providers/tx/medicaid/forms/pages/fuf.aspx     Thank you for your commitment to joining with Molina Healthcare in providing our members with the best quality health care possible.  We look forward to our continuing successful partnership.     Sincerely,       Lawrence O’Brien, MD  Medical Director  Molina Healthcare of Texas', NULL, NULL, '2020-08-10 17:17:30', '2020-08-10 17:17:30'),
(1460, 2027, 226, NULL, '2020-09-28 00:00:00.000', 'In Process', 'To: 	Margaret.White@molinahealthcare.com  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Molina Health)  May I know the current status of the below mentioned provider:  Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks. ', NULL, NULL, '2020-09-21 12:22:17', '2020-09-21 12:22:17'),
(1461, 2027, 226, NULL, '2020-10-01 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 09/01/2020', NULL, NULL, '2020-09-24 10:16:50', '2020-09-24 10:16:50'),
(1462, 3040, 228, NULL, '2021-06-28 00:00:00.000', 'Revalidation', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Both credentialing applications have been submitted for processing. Please allow 90 days for processing.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-06-21 10:45:30', '2021-06-21 10:45:30'),
(1463, 3040, 228, NULL, '2021-06-28 00:00:00.000', 'Revalidation', 'Email sent to: kmoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Please find the attached provider credentialing application form along with the documents as per you previous email requested.   If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-06-21 10:48:13', '2021-06-21 10:48:13'),
(1464, 3040, 228, NULL, '2021-06-28 00:00:00.000', 'Revalidation', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Both credentialing applications have been submitted for processing. Please allow 90 days for processing.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-06-21 10:48:19', '2021-06-21 10:48:19'),
(1465, 3040, 228, NULL, '2021-06-28 00:00:00.000', 'Revalidation', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Hope you are doing well. I wanted to add the additional locations for the below mentioned group and providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego Provider NPI# 1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 10:48:52', '2021-06-21 10:48:52'),
(1466, 3040, 228, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Email sent to: kmoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego Provider NPI# 1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-09 11:18:50', '2021-07-09 11:18:50'),
(1467, 3040, 228, NULL, '2021-09-16 00:00:00.000', 'Revalidation', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Karherine,   Hope you are doing well. Please find attached screenshot from Tricare provider portal for Garcia Homero and it\'s showing the \"Action Needed\". Can you please check & advise. Also I wanted to know the enrollment status for the another provider in Tricare under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC  Practice Tax ID# 81-5123542  Practice NPI# 1518404631  Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero (Showing on Provider portal \"Action Needed\") Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego (Advise the enrollment status) Provider NPI# 1568929800  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-09 15:25:36', '2021-09-09 15:25:36'),
(1468, 10057, 228, NULL, '2021-11-09 00:00:00.000', 'Revalidation', 'Email Sent To : 	KMoten4@humana.com  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Good Evening,  Hope this email finds you well. Please advise me with the enrollment status for the below mentioned providers in the Tricare for our group Valley Med Urgent Care PLLC under these locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Naranjo, Diego	1568929800 Garcia, Homero	1730564857  Looking forward to hearing from you soon.  Thanks & Regards', NULL, NULL, '2021-11-02 16:49:17', '2021-11-02 16:49:17'),
(1469, 10057, 228, NULL, '2021-11-30 00:00:00.000', 'Revalidation', 'Email Received From: ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Morning Steve,  Jacqueline Trenz can assist you with your request.    Brownsville and McAllen Texas is not in my area.  Thanks, Yvonne W. Wyatt,  Humana Military TRICARE Community Liaison II Houston/Galveston', NULL, NULL, '2021-11-23 17:35:43', '2021-11-23 17:35:43'),
(1470, 10057, 228, NULL, '2021-12-08 00:00:00.000', 'Revalidation', 'Email Sent To : ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Yvonne,  Thank you for the update. Have a great day!  Regards,', NULL, NULL, '2021-12-01 16:24:56', '2021-12-01 16:24:56'),
(1471, 10057, 228, NULL, '2021-12-16 00:00:00.000', 'Revalidation', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good morning,  NPI 1700960556  Not certified.  Please visit humanamilitary.com, click on Provider link, click on Forms. Locate appropriate certification application, complete and fax to WPS at number located on application.  Please allow 90 days for processing  NPI 1225617558 Credentialing is on hold. Application is missing the Certificate of Insurance (malpractice). Please see screenshot below to submit.  NPI 1659919702  Provider credentialing is complete effective 8/31/21. Prov is affiliated with Valley med, 2534 Boca Chica, Brownsville, TX Please use attached Provider Roster to request adding second & third location.  NPI 1568929800  Prov credentialing complete effect 8/31/21. Prov is affiliated with three locations listed.  NPI 1730564857  Prov credentialing complete effective 9/28/21. Prov is affiliated with three locations listed.  NPI 1245789502  Credentialing is on hold. Application is missing the Certificate of Insurance (malpractice) and work history. Email request sent 6/9/21  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-09 10:34:43', '2021-12-09 10:34:43'),
(1472, 10057, 228, NULL, '2021-12-21 00:00:00.000', 'Revalidation', 'Email Sent To : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Greetings!  Hope you are doing well. Can I get a quick response to the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-14 13:39:56', '2021-12-14 13:39:56'),
(1473, 10057, 228, NULL, '2021-12-28 00:00:00.000', 'Revalidation', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello,  Any update on the below request. This is my SECOND REMINDER. Please get back to me with the latest update ASAP.  Regards,', NULL, NULL, '2021-12-21 13:40:02', '2021-12-21 13:40:02'),
(1474, 10057, 228, NULL, '2022-01-04 00:00:00.000', 'Revalidation', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,  1) Juan Hernandez - We cannot move further on his application due to not having received his malpractice insurance certificate. Please see below.  2) Jeniece Wert – please see the attached Provider Roster to submit a request, to add a secondary & tertiary location.  Please email to HGBProviderRosters@humana.com.  3) Homero Garcia – provider profile is complete.  I have submitted a request to my data team to update the directory.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-28 15:30:05', '2021-12-28 15:30:05'),
(1475, 20067, 228, NULL, '2022-01-20 00:00:00.000', 'Revalidation', 'Email sent to: jtrenz@humana.com  Sub:  Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon, Hope this email finds you in good health. I would like to know the enrollment status of the below mentioned providers.  Group Name: Valley Med Urgent Care PLLC Tax ID: 81-5123542 Group NPI: 1518404631  Provider 1: Garcia Homero NPI: 17303564857 Location:  2534 Boca Chica Blvd Brownsville, TX 78521-3496  Provider 2: Teresa Saavedra NPI:1255676151 Location 1:  800 E Alton Gloor Blvd Brownsville, TX 78526-4248 Location 2: 101 E. Expressway 83, Suite #170  McAllen, TX 78501-1166  Your early response will be highly appreciated.  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-13 14:19:46', '2022-01-13 14:19:46'),
(1476, 20067, 228, NULL, '2022-01-20 00:00:00.000', 'Revalidation', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,     Final status information on  Homero Garcia NPI 1730564857:  Credentialing approved on 9/28/2021. Provider is network and affiliated to  Valley Med Urgent Care at three locations -  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Final status information on  Teresa Saavedra NPI 1255676151:  Provider has been credentialed since 9/14/2020 due  to prior affiliation.  Provider is network and currently affiliated to  Valley Med Urgent Care at three locations:  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2022-01-13 16:36:03', '2022-01-13 16:36:03'),
(1477, 20067, 228, NULL, '2022-01-20 00:00:00.000', 'Revalidation', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon, Thanks for the update. Can you please provide me with their welcome kits?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-13 16:40:41', '2022-01-13 16:40:41'),
(1478, 20067, 228, NULL, '2022-01-25 00:00:00.000', 'Revalidation', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad ', NULL, NULL, '2022-01-18 14:10:16', '2022-01-18 14:10:16'),
(1479, 20067, 228, NULL, '2022-02-23 00:00:00.000', 'Revalidation', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good afternoon,     TRICARE does not send Welcome Kits or Letters.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE', NULL, NULL, '2022-02-16 17:31:14', '2022-02-16 17:31:14'),
(1480, 20067, 228, NULL, '2022-03-09 00:00:00.000', 'Revalidated', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   ood afternoon,     Final status information on  Homero Garcia NPI 1730564857:  Credentialing approved on 9/28/2021. Provider is network and affiliated to  Valley Med Urgent Care at three locations -  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Final status information on  Teresa Saavedra NPI 1255676151:  Provider has been credentialed since 9/14/2020 due  to prior affiliation.  Provider is network and currently affiliated to  Valley Med Urgent Care at three locations:  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East ', NULL, NULL, '2022-03-02 16:43:20', '2022-03-02 16:43:20'),
(1481, 1006, 229, NULL, NULL, 'Approved', 'Received following email from Multiplan:  \"Dear Provider: Welcome! Your application has been processed, effective 5/27/2020 and we are pleased to have you join MultiPlan as a participating provider in our provider networks. please see your provider agreement(s) and/or amendment(s) for specific network participation. (Note that you may participate with MultiPlan under multiple agreements.)\"', NULL, NULL, '2020-06-09 14:26:08', '2020-06-09 14:26:08'),
(1482, 2027, 230, NULL, NULL, 'In Process', 'To: 	MHTContractrequest@molinahealthcare.com  Sub: Need Status Update Of Provider Glory Abraham  Hello,    Hope you are doing great, I want to know about the current status of the provider.  Following are the details:  Provider Name: Glory Abraham  NPI# 1194206490  Group Name:Normandy Urgent Care Center  Tax ID: 27-0796429  Thanks.', NULL, NULL, '2020-06-18 12:29:16', '2020-06-18 12:29:16'),
(1483, 2027, 230, NULL, NULL, 'In Process', 'To: TexasExpansionContracting@molinahealthcare.com  Sub: Need Status Update For Provider Glory Abraham  Hello, Hope you are doing well, We have received the Confirmation email by this id: Margaret.White@molinahealthcare.com regarding credentialing application of this provider Glory Abraham and in that email you have said that this application is already approved, But still we didn\'t receive the welcome letter and the issue date. Kindly look into this matter and reply as soon as possible. Following are the details of the provider: Provider Name: Glory Abraham   Provider NPI# 1194206490 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429  Thanks.', NULL, NULL, '2020-06-25 17:08:16', '2020-06-25 17:08:16'),
(1484, 2027, 230, NULL, NULL, 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  Sub: (Abraham, Glory)-(Normandy Urgent Care Center)-(Molina Health)  Hello, Hope you are doing well, We have received the Confirmation email by this id: Margaret.White@molinahealthcare.com regarding credentialing application of this provider Glory Abraham and in that email you have said that this application is already approved, But still we didn\'t receive the welcome letter and the issue date. Kindly look into this matter and reply as soon as possible. Following are the details of the provider: Provider Name: Glory Abraham   Provider NPI# 1194206490 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429  Thanks.', NULL, NULL, '2020-07-14 17:35:12', '2020-07-14 17:35:12'),
(1485, 2027, 230, NULL, NULL, 'Approved', 'From: Michele.Thomas-Martin@molinahealthcare.com  Record # 166471 & 165924     Provider: Glory Abraham & Vibitha Joseph     Good Afternoon,     Thank you for your inquiry.  The provider has been loaded in the billing system under all plans effective 7/15/2020.  Please see the attached welcome letters.      Thank You,', NULL, NULL, '2020-07-15 12:52:48', '2020-07-15 12:52:48'),
(1486, 2028, 231, NULL, NULL, 'In Process', 'TO:  SHP.NetworkDevelopment@superiorhealthplan.com , Jillyan.Galindo@superiorhealthplan.com SUB: RE: Need Credentialing Status   Good afternoon,  Could you please tell us the current credentialing status of our provider.  Details are as follows:  Provider Name: Julie Jose  NPI:1447883061  Group Name: Normandy Urgent Care Center PA  TIN:27-0796429     Your timely response will be highly appreciated.     Thank you', NULL, NULL, '2020-06-29 09:28:39', '2020-06-29 09:28:39'),
(1487, 2027, 231, NULL, NULL, 'In Process', 'From: SHP.NetworkDevelopment@superiorhealthplan.com  To: ma@claimsmedinc.com  Hello,     We received your completed application on (6/2/20).  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.     Thank you,  Sasha Henry', NULL, NULL, '2020-06-29 09:45:35', '2020-06-29 09:45:35'),
(1488, 2027, 231, NULL, NULL, 'In Process', 'To: SHP.NetworkDevelopment@superiorhealthplan.com, Jillyan.Galindo@superiorhealthplan.com  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Superior Health)  Sub: Hello, Hope you are doing great, I want to know about the current status of the provider Jose, Julie. Following are the details: Group Name: Normandy Urgent Care Center   Provider NPI: 1447883061   Group Tax ID: 27-0796429      Thanks.', NULL, NULL, '2020-07-31 11:39:05', '2020-07-31 11:39:05'),
(1489, 2027, 231, NULL, '2020-09-28 00:00:00.000', 'In Process', 'To: SHP.NetworkDevelopment@superiorhealthplan.com Daniel.Velez@superiorhealthplan.com  Sub: (Providers)-(Normandy Urgent Care Center)-(Superior Health)  May I know the current status of the below mentioned providers:  Provider Name	Provider NPI#	Group Name	Group Tax ID George, Jeemol	1497219067	Normandy Urgent Care Center	27-0796429 Jose, Julie	1447883061	Normandy Urgent Care Center	27-0796429  Thanks.', NULL, NULL, '2020-09-21 12:13:00', '2020-09-21 12:13:00'),
(1490, 2027, 231, NULL, '2020-09-30 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good Afternoon Martin     I hope you are doing well. I wanted to follow-up regarding your request below, please see the updates in the Notes column.  Jose, Julie  1447883061  Normandy Urgent Care Center  27-0796429  This provider is still in credentialing approaching the par(in network stage) and should be finished up soon. Please continue to allow time for processing and follow-up next month with an update.  Should you have any additional questions please let us know.     Have a great rest of the day!     Thanks   ', NULL, NULL, '2020-09-23 10:06:31', '2020-09-23 10:06:31'),
(1491, 2027, 231, NULL, '2020-10-13 00:00:00.000', 'Approved', 'Provider is now showing linked with insurance and effective date is 11/01/2020', NULL, NULL, '2020-10-06 14:05:38', '2020-10-06 14:05:38'),
(1492, 2027, 232, NULL, NULL, 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Texas Children Health Plan -TCHP)  Hello, We have sent you the LOI and form W9 on our company\'s letterhead which you have requested to add the individual provider in the existing group as a network provider. May i know the completion  time of this request.  Thanks. ', NULL, NULL, '2020-07-07 12:49:13', '2020-07-07 12:49:13'),
(1493, 2027, 232, NULL, '2020-10-06 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  May I know the current status of the below mentioned provider: Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks.', NULL, NULL, '2020-09-29 13:34:08', '2020-09-29 13:34:08'),
(1494, 2037, 232, NULL, '2020-11-05 00:00:00.000', 'In Process', 'Follow up email sent:  ----------------- May I know the current status of the below mentioned provider:  Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks.', NULL, NULL, '2020-10-22 17:12:44', '2020-10-22 17:12:44'),
(1495, 2037, 232, NULL, '2020-11-24 00:00:00.000', 'In Process', 'Need to allow more time: --------------------- Alanis, Juanita Oct 23, 2020, 8:43 AM (3 days ago) to me  Good morning Sherry,  The credentialing process can take up to 90 days.  Thank you.     Juanita Alanis  Provider Relations ', NULL, NULL, '2020-10-26 15:15:14', '2020-10-26 15:15:14');
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
(1496, 2037, 232, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Received PIFs filled out and submitted back to \"tchpnetworkmanagement@texaschildrens.org\" with IVUC as the secondary Location.= and request.', NULL, NULL, '2020-11-13 14:41:38', '2020-11-13 14:41:38'),
(1497, 2037, 232, NULL, '2020-12-08 00:00:00.000', 'In Process', 'PIF\'s Submitted need to allow more time.', NULL, NULL, '2020-11-25 13:08:32', '2020-11-25 13:08:32'),
(1498, 2037, 232, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent for the submitted PIF', NULL, NULL, '2020-12-08 14:51:12', '2020-12-08 14:51:12'),
(1499, 1006, 232, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Sent a follow-up email to TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org for an updated status of enrollment. ', NULL, NULL, '2020-12-15 18:12:04', '2020-12-15 18:12:04'),
(1500, 2037, 232, NULL, '2021-01-07 00:00:00.000', 'In Process', 'PIF submitted on 11/03/2020 Need to allow more time ', NULL, NULL, '2020-12-29 16:47:14', '2020-12-29 16:47:14'),
(1501, 1006, 232, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Received the following reply from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  \"Provider Name: Julie Jose –in process\" ', NULL, NULL, '2021-01-29 09:38:16', '2021-01-29 09:38:16'),
(1502, 1006, 232, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Carter, Krisheena J.\" kjcarter@texaschildrens.org regarding the status of the PIF forms that were submitted on 11/13/2020 for the provider.  ', NULL, NULL, '2021-02-16 17:16:18', '2021-02-16 17:16:18'),
(1503, 1006, 232, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Received the following response from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  \"Provider Name: Julie Jose in process NPI# 1447883061 (TCHP use- 20210122034394201)\"', NULL, NULL, '2021-02-19 15:18:58', '2021-02-19 15:18:58'),
(1504, 3040, 232, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: 	TXCredentialing@amerigroup.com  Subject: Provider Enrollment Status - Normandy Urgent Care Center  Greetings,  Please advise me the enrollment status for the following providers under our group as their enrollment requests have been in process since the start of last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-01 12:56:03', '2021-03-01 12:56:03'),
(1505, 3040, 232, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Provider Enrollment Status || Normandy Urgent Care Center || TCHP ||   Greetings,  Please advise me the enrollment status for the following providers under our group as their enrollment requests have been in process since last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-01 13:00:17', '2021-03-01 13:00:17'),
(1506, 3040, 232, NULL, '2021-03-25 00:00:00.000', 'Approved', 'Email rcvd from: axhartma@texaschildrens.org  Subject: TCHP Welcome Letter - Julie Jose, NP - Normandy Urgent Care Center PA - Imperial Valley Dr. and Normandy St.  Good Afternoon,  Welcome to TCHP. Julie Jose, NP is now participating with Texas Children’s Health Plan under Normandy Urgent Care Center PA. Attached you will find a welcome letter with an effective date for all contracted products as well as the contact information for your Provider Relations Representative.  Please reach out to your PR Rep or the main Contracting Department phone line at (832) 828-1063 with any questions.  Thank you,  Anna Hartmann Contract Specialist Texas Children\'s Health Plan *: axhartma@texaschildrens.org (: (832) 828-1063', NULL, NULL, '2021-03-18 12:40:54', '2021-03-18 12:40:54'),
(1507, 2027, 233, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-07-14 14:42:51', '2020-07-14 14:42:51'),
(1508, 2027, 233, NULL, '2020-09-24 00:00:00.000', 'Initiated', 'To: KMoten4@humana.com  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Tricare)  Hello, Hope you are doing well, I want to enroll a provider with tricare please confirm if the panels are open. Also send the required documents to me so i can start the enrollment process. Details of the provider are mentioned below: Provider Name: Jose, Julie  Provider NPI# 1447883061  Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks.', NULL, NULL, '2020-09-17 13:24:24', '2020-09-17 13:24:24'),
(1509, 2027, 233, NULL, '2020-09-24 00:00:00.000', 'In Process', 'Sent tricare certification form by fax to tricare ', NULL, NULL, '2020-09-17 15:25:52', '2020-09-17 15:25:52'),
(1510, 2027, 233, NULL, '2020-09-25 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  Hello,     This provider is not a certified provider with Tricare. Please go to the following link to get this provider certified with WPS.  https://www.humanamilitary.com/provider/access/become-a-tricare-provider/certification-applications        Thank you.  ', NULL, NULL, '2020-09-18 14:22:53', '2020-09-18 14:22:53'),
(1511, 2027, 233, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Tricare)  Hello Katherine,  May I know the current enrollment status of the below mentioned provider: Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks. ', NULL, NULL, '2020-10-21 12:19:47', '2020-10-21 12:19:47'),
(1512, 2027, 233, NULL, '2020-10-28 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  Good Afternoon,     This provider is showing Certified. Please provide me with a credentialing application and all documents.        Respectfully,  Katherine Moten  TRICARE Community Liaison II', NULL, NULL, '2020-10-21 16:39:05', '2020-10-21 16:39:05'),
(1513, 1006, 233, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Sent a follow-up email @ KMoten4@humana.com regarding enrollment status. ', NULL, NULL, '2020-10-28 17:57:12', '2020-10-28 17:57:12'),
(1514, 1006, 233, NULL, '2020-11-05 00:00:00.000', 'In Process', 'Received the following update from Katherine:  \"Good Morning,   Julie Jose – need a credentialing application  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"', NULL, NULL, '2020-10-29 09:09:43', '2020-10-29 09:09:43'),
(1515, 2027, 233, NULL, '2020-11-12 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Tricare)  Please find the credentialing application and supporting documents attached in this email for the credentialing process of the provider.   Thanks.', NULL, NULL, '2020-11-05 12:56:22', '2020-11-05 12:56:22'),
(1516, 2027, 233, NULL, '2020-11-13 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  Sub: (Jose, Julie)-(Normandy Urgent Care Center)-(Tricare)  This application has been submitted for processing, Please allow 90 days.     Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana', NULL, NULL, '2020-11-06 09:20:35', '2020-11-06 09:20:35'),
(1517, 2037, 233, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-11-13 17:21:33', '2020-11-13 17:21:33'),
(1518, 1006, 233, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Sent a follow-up @ KMoten4@humana.com', NULL, NULL, '2020-12-02 18:02:49', '2020-12-02 18:02:49'),
(1519, 2037, 233, NULL, '2020-12-15 00:00:00.000', 'Approved', 'Received confirmation email from K morten with the effective date 12/01/2020. Confirmation email uploaded.', NULL, NULL, '2020-12-08 17:39:55', '2020-12-08 17:39:55'),
(1520, 2027, 234, NULL, NULL, 'Approved', 'Received welcome letter for julie jose effective date is 06/09/2020', NULL, NULL, '2020-07-06 13:30:39', '2020-07-06 13:30:39'),
(1521, 3040, 234, NULL, '2021-06-24 00:00:00.000', 'Revalidation', 'Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067    Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-17 08:30:12', '2021-06-17 08:30:12'),
(1522, 3040, 234, NULL, '2021-07-12 00:00:00.000', 'Revalidation', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group under the below mentioned locations. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429  Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:- Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067   Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI : 1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 15:25:56', '2021-07-05 15:25:56'),
(1523, 3040, 234, NULL, '2021-07-27 00:00:00.000', 'Revalidated', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Mini Chennemkara is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 03/01/2016,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider James Piccione is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 05/29/2019,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/01/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Jeemol George is Active, effective date 06/09/2020,  Provider Julie Jose is Active, effective date 06/09/2020,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf 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', NULL, NULL, '2021-07-20 08:32:47', '2021-07-20 08:32:47'),
(1524, 2027, 238, NULL, NULL, 'In Process', 'To: txcredentialing@amerigroup.com  May i know how much time is required to complete the other plans for this provider and when i will receive the welcome letter for amerivantage and MMP  Thanks.', NULL, NULL, '2020-07-06 12:50:53', '2020-07-06 12:50:53'),
(1525, 2027, 238, NULL, NULL, 'In Process', 'From: txcredentialing@amerigroup.com  Provider won’t be loaded for the Medicaid line of business till they have a TPI #.  Until that TPI is reported to the health plan, the provider will remain out of network for that plan.', NULL, NULL, '2020-07-06 14:31:15', '2020-07-06 14:31:15'),
(1526, 2027, 238, NULL, NULL, 'In Process', 'To: txcredentialing@amerigroup.com  The TPI of the provider jeemol george is 4095978. How much time is required to complete the request.', NULL, NULL, '2020-07-06 14:32:23', '2020-07-06 14:32:23'),
(1527, 2027, 238, NULL, '2020-08-31 00:00:00.000', 'Approved', 'Provider is in network and effective date is 7/6/2020 welcome letter and screenshot from directory is attached', NULL, NULL, '2020-08-24 10:54:21', '2020-08-24 10:54:21'),
(1528, 2027, 240, NULL, '2020-09-01 00:00:00.000', 'In Process', 'To: CHC.Contracting@communityhealthchoice.org  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Community Health Choice)  May i know the current status of the provider mentioned below: Provider Name-George, Jeemol Provider NPI#1497219067 Group Name-Normandy Urgent Care Center Group Tax-ID-27-0796429 Thanks.', NULL, NULL, '2020-08-25 13:19:56', '2020-08-25 13:19:56'),
(1529, 2027, 240, NULL, '2020-09-02 00:00:00.000', 'In Process', 'From: CHC.Contracting@communityhealthchoice.org  Good Afternoon Martin,     The initial request was submitted, however it was incomplete. Please see attached letter and complete the roster in its entirety. Once completed, you may submit to our mailbox at CHC.Contracting@CommunityHealthChoice.org.     Thank you', NULL, NULL, '2020-08-26 17:46:08', '2020-08-26 17:46:08'),
(1530, 2027, 240, NULL, '2020-09-02 00:00:00.000', 'In Process', 'To: CHC.Contracting@communityhealthchoice.org  Please find the filled roster attached which you have requested.  Thanks.', NULL, NULL, '2020-08-26 17:47:23', '2020-08-26 17:47:23'),
(1531, 2027, 240, NULL, '2020-09-04 00:00:00.000', 'In Process', 'From: Vanessa.Brown@communityhealthchoice.org  Good Morning,     In order not to delay the process of adding this provider to the Group TIN, it is imperative that all fields are filled in or ‘N/A’ is entered where applicable [i.e. hospital affiliation, orig. credential date] otherwise, the add submission will be rejected     Thanks', NULL, NULL, '2020-08-28 14:16:06', '2020-08-28 14:16:06'),
(1532, 2027, 240, NULL, '2020-09-04 00:00:00.000', 'In Process', 'To: Vanessa.Brown@communityhealthchoice.org  Please find the roster attached. I have filled all the fields in the roster as per your advice and I have mentioned N/A where necessary.  Thanks.', NULL, NULL, '2020-08-28 14:16:54', '2020-08-28 14:16:54'),
(1533, 2027, 240, NULL, '2020-09-08 00:00:00.000', 'In Process', 'To: Vanessa.Brown@communityhealthchoice.org  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Community Health Choice)  May i know the current status of the provider mentioned below: Provider Name-George, Jeemol Provider NPI#1497219067 Group Name-Normandy Urgent Care Center Group Tax-ID-27-0796429  Thanks.', NULL, NULL, '2020-09-01 17:26:08', '2020-09-01 17:26:08'),
(1534, 1005, 240, NULL, '2020-10-15 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2020-09-24 13:54:28', '2020-09-24 13:54:28'),
(1535, 2027, 240, NULL, '2020-10-16 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 08/28/2020. Welcome letter is attached', NULL, NULL, '2020-10-09 09:59:43', '2020-10-09 09:59:43'),
(1536, 1005, 241, NULL, NULL, 'In Process', 'Contract has been signed via DocuSign. Downloaded copy has been attached in the App.  Current Status: In Process', NULL, NULL, '2020-07-09 14:18:51', '2020-07-09 14:18:51'),
(1537, 2027, 241, NULL, NULL, 'In Process', 'From; ONBEloquaNotice@cigna.com  Dear JEEMOL GEORGE,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.', NULL, NULL, '2020-07-13 15:00:11', '2020-07-13 15:00:11'),
(1538, 2027, 241, NULL, NULL, 'In Process', 'From: PDM Notification     Hi ,  Thank you for your submission. This is to confirm that your request has been completed.     ∙ Cigna Internal Reference WID # W202007161136759   ∙ HCP ID : 4840918  ∙ HCP Name : Jeemol George  ∙ Effective date : 07/13/2020     Please do not reply to this e-mail message. The return address is not monitored. All future request should be sent to intake_PDM@cigna.com\".     Thank You.  PDM', NULL, NULL, '2020-07-23 16:35:26', '2020-07-23 16:35:26'),
(1539, 2027, 241, NULL, '2020-09-04 00:00:00.000', 'In Process', 'To: Intake_PDM@cigna.com  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Cigna)  May i know the current status of the provider mentioned below: Provider Name-George, Jeemol Provider NPI#1497219067 Group Name-Normandy Urgent Care Center Group Tax-ID-27-0796429  Thanks.', NULL, NULL, '2020-08-28 16:59:45', '2020-08-28 16:59:45'),
(1540, 2027, 241, NULL, '2020-09-08 00:00:00.000', 'Approved', 'Provider is linked with the insurance effective date is 7/13/2020 ', NULL, NULL, '2020-09-01 12:18:58', '2020-09-01 12:18:58'),
(1541, 2027, 242, NULL, NULL, 'In Process', 'To: Laura.Bevin@aetna.com, DavisE11@aetna.com, PDSDallas@aetna.com   Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(First Health)  May I know the current status of the application for the provider which we have submitted on 6/23/2020. Provider details are mentioned below: Provider Name:  George, Jeemol  Provider NPI# 1497219067 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429   I am attaching the application for your reference. Kindly look into this and reply to me as soon as you get it.  Thanks.', NULL, NULL, '2020-07-15 17:29:49', '2020-07-15 17:29:49'),
(1542, 2027, 242, NULL, NULL, 'In Process', 'To: bharathb@aetna.com  I have a list of providers mentioned below who are under Normandy Urgent Care Center. I want to know their status of application. Also if there\'s anything missing regarding their documents for the enrollment process please let me know and i have already submitted the online application form of aetna.  Providers	NPI#	Tax ID	Insurance Brown, Brittany	1275163537	27-0796429	First Health Chennemkara, Mini Philip	1841755956	27-0796430	First Health George, Jeemol	1497219067	27-0796431	First Health Jose, Julie	1447883061	27-0796432	First Health Joseph, Vibitha	1447883061	27-0796433	First Health Kourouma , Odette Tiranke	1134525868	27-0796434	First Health Piccione JR, James M	1356321509	27-0796435	First Health Stephen, Ani	1588959118	27-0796436	First Health Thomas, Cini	1134777238	27-0796437	First Health ', NULL, NULL, '2020-07-20 12:30:54', '2020-07-20 12:30:54'),
(1543, 2027, 242, NULL, '2020-09-29 00:00:00.000', 'In Process', 'Online application has been submitted ', NULL, NULL, '2020-09-22 15:20:11', '2020-09-22 15:20:11'),
(1544, 2027, 242, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: bharathb@aetna.com  May I know the current status of the application for the provider mentioned below: Provider Name:  George, Jeemol Provider NPI# 1497219067 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429    Thanks.', NULL, NULL, '2020-10-21 15:20:40', '2020-10-21 15:20:40'),
(1545, 2037, 242, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Follow up email sent to : bharathb@aetna.com', NULL, NULL, '2020-10-29 14:11:44', '2020-10-29 14:11:44'),
(1546, 2037, 242, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  ------------ Greetings, We have submitted online applications for the below mentioned providers for enrollment with first health.May I know if they have been received and are currently being processed? ProvidersProvider NPI#Group NameGroup Tax-IDBrown, Brittany1275163537Normandy Urgent Care Center27-0796429Chennemkara, Mini Philip1841755956Normandy Urgent Care Center27-0796429George, Jeemol1497219067Normandy Urgent Care Center27-0796429Jose, Julie1447883061Normandy Urgent Care Center27-0796429Joseph, Vibitha1952931560Normandy Urgent Care Center27-0796429Kourouma , Odette Tiranke1134525868Normandy Urgent Care Center27-0796429Piccione JR, James M1356321509Normandy Urgent Care Center27-0796429Stephen, Ani1588959118Normandy Urgent Care Center27-0796429Thomas, Cini1134777238Normandy Urgent Care Center27-0796429', NULL, NULL, '2020-11-13 16:51:26', '2020-11-13 16:51:26'),
(1547, 2037, 242, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com,  ------------ Greetings, We have submitted online applications for the below mentioned providers for enrollment with first health.May I know if they have been received and are currently being processed? ProvidersProvider NPI#Group NameGroup Tax-IDBrown, Brittany1275163537Normandy Urgent Care Center27-0796429Chennemkara, Mini Philip1841755956Normandy Urgent Care Center27-0796429George, Jeemol1497219067Normandy Urgent Care Center27-0796429Jose, Julie1447883061Normandy Urgent Care Center27-0796429Joseph, Vibitha1952931560Normandy Urgent Care Center27-0796429Kourouma , Odette Tiranke1134525868Normandy Urgent Care Center27-0796429Piccione JR, James M1356321509Normandy Urgent Care Center27-0796429Stephen, Ani1588959118Normandy Urgent Care Center27-0796429Thomas, Cini1134777238Normandy Urgent Care Center27-0796429', NULL, NULL, '2020-11-13 16:51:33', '2020-11-13 16:51:33'),
(1548, 2037, 242, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Another Follow up email sent to AbhishekV@aetna.com, LakkakulaS@aetna.com, bharathb@aetna.com,  SidleyJ1@firsthealth.com, ', NULL, NULL, '2020-11-20 11:00:19', '2020-11-20 11:00:19'),
(1549, 2037, 242, NULL, '2020-12-08 00:00:00.000', 'In Process', 'Follow up email sent to bharathb@aetna.com', NULL, NULL, '2020-12-01 10:04:06', '2020-12-01 10:04:06'),
(1550, 2037, 242, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Follow up email sent to AbhishekV@aetna.com', NULL, NULL, '2020-12-08 13:45:11', '2020-12-08 13:45:11'),
(1551, 2037, 242, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Follow up email sent to LakkakulaS@aetna.com', NULL, NULL, '2020-12-11 13:18:41', '2020-12-11 13:18:41'),
(1552, 3040, 242, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: 	AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers under both the locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany  Provide NPI# 1275163537   Provider Name: Chennemkara, Mini Philip  Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  If you need any additional information please feel to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-26 13:34:16', '2021-02-26 13:34:16'),
(1553, 3040, 242, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: AbhishekV@aetna.com, bharathb@aetna.com, SidleyJ1@firsthealth.com  Subject: Re: Enrollment Status || Providers || Normandy Urgent Care Center || First Health ||  Greetings,  This is a follow up email regarding the enrollment status for the below mentioned providers under both the locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-08 15:50:07', '2021-03-08 15:50:07'),
(1554, 3040, 242, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Follow up email sent to 	pdsdallas@aetna.com  Subject: Enroll Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || First Health ||  Greetings,  Hope you are doing well. I had a word with a First Health representative and she advised me you need to credentialed the providers first with Aetna and after we can add the provider in First health.   In Aetna we already have an ancillary contract so still we need to credentialed the providers with Aetna.   Below are the practice details:   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany Provide NPI# 1275163537  Provider Name: Chennemkara, Mini Philip Provide NPI# 1841755956  Provider Name: George, Jeemol Provide NPI# 1497219067  Provider Name: Jose, Julie Provide NPI# 1447883061  Provider Name: Joseph, Vibitha Provide NPI# 1952931560  Provider Name: Kourouma , Odette Tiranke Provide NPI# 1134525868  Provider Name: Piccione JR, James M Provide NPI# 1356321509  Provider Name: Stephen, Ani Provide NPI# 1588959118  Provider Name: Thomas, Cini Provide NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-03-19 13:45:17', '2021-03-19 13:45:17'),
(1555, 3040, 242, NULL, '2021-06-02 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our provider is enrolled with First Health because First Health is the part of Aetna.   For Effective date please see group task. ', NULL, NULL, '2021-05-26 17:03:31', '2021-05-26 17:03:31'),
(1556, 2027, 247, NULL, NULL, 'Approved', 'Call to insurance talk to the representative she said this provider is in network. Effective date is 01/01/2020 and Re credentialing date is 08/18/2020', NULL, NULL, '2020-07-01 10:11:59', '2020-07-01 10:11:59'),
(1557, 2027, 250, NULL, NULL, 'In Process', 'To: Jamie.Llefi@molinahealthcare.com  Sub: Need status Update For Provider  Hello, Hope you are doing well, May i Know the status update of the provider. Following are the details: Provider Name:  George, Jeemol  Provider NPI# 1497219067 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429 In the last follow up you have requested for the \"Contract Request Form\" which we have already sent to you. So kindly look into this and reply to me as soon as you get this email.  Thanks.', NULL, NULL, '2020-06-30 14:36:51', '2020-06-30 14:36:51'),
(1558, 2027, 250, NULL, NULL, 'In Process', 'From: Jamie.Llefi@molinahealthcare.com  To: mk@claimsmedinc.com  Good Afternoon Martin,     I am routing this to the appropriate department for assistance. MHTX Provider Services MHTXProviderServices@MolinaHealthCare.Com     Thank you,', NULL, NULL, '2020-06-30 14:55:25', '2020-06-30 14:55:25'),
(1559, 2027, 250, NULL, NULL, 'In Process', 'From: MHTXProviderServices@molinahealthcare.com  To: mk@claimsmedinc.com  Good Afternoon Martin,     I see that Luis perez forwarded this over to us in 5/29/2020. The turn around time for these request can take between 45-90 days.     Please know that we have reached out to Texas Expansion Contracting to obtain status update.     Thank you,', NULL, NULL, '2020-07-01 13:51:18', '2020-07-01 13:51:18'),
(1560, 2027, 250, NULL, '2020-09-09 00:00:00.000', 'In Process', 'To: MHTXProviderServices@molinahealthcare.com  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Molina Health)  May I know the current status of the provider mentioned below: Provider Name- George, Jeemol Provider NPI# 1497219067 Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429  Thanks.', NULL, NULL, '2020-09-02 16:55:06', '2020-09-02 16:55:06'),
(1561, 2027, 250, NULL, '2020-09-09 00:00:00.000', 'In Process', 'From: MHTXProviderServices@molinahealthcare.com  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Molina Health)  Good afternoon,     I have included your contracting coordinator Mauricio Chavez.     Record #168051        Thank you,   MHTX Provider Services – DFW & EL Paso SDA’s – Sandra S', NULL, NULL, '2020-09-02 17:25:16', '2020-09-02 17:25:16'),
(1562, 2027, 250, NULL, '2020-09-09 00:00:00.000', 'In Process', 'To: Mauricio.Chavez@molinahealthcare.com  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Molina Health)  May I know the current status of the provider mentioned below: Provider Name- George, Jeemol Provider NPI# 1497219067 Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429  Thanks.', NULL, NULL, '2020-09-02 17:26:11', '2020-09-02 17:26:11'),
(1563, 2027, 250, NULL, '2020-09-28 00:00:00.000', 'In Process', 'To: Mauricio.Chavez@molinahealthcare.com  Sub; (George, Jeemol)-(Normandy Urgent Care Center)-(Molina Health)  May I know the current status of the provider mentioned below: Provider Name- George, Jeemol Provider NPI# 1497219067 Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429  Thanks.', NULL, NULL, '2020-09-21 13:11:32', '2020-09-21 13:11:32'),
(1564, 2027, 250, NULL, '2020-09-30 00:00:00.000', 'In Process', 'From: Mauricio.Chavez@molinahealthcare.com  Good afternoon,     There is no record for the provider mentioned below. Please complete the Contract request form (CRF) attached and submit it to mhtcontractrequest@molinahealthcare.com with a W9.     Thank you,     Mauricio Chavez', NULL, NULL, '2020-09-23 17:18:51', '2020-09-23 17:18:51'),
(1565, 2027, 250, NULL, '2020-09-30 00:00:00.000', 'In Process', 'To: mhtcontractrequest@molinahealthcare.com  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Molina Health)  Please find the requested documents attached in this email.  Thanks.', NULL, NULL, '2020-09-23 17:20:12', '2020-09-23 17:20:12'),
(1566, 2027, 250, NULL, '2020-10-12 00:00:00.000', 'In Process', 'From; MHTContractrequest@molinahealthcare.com  Goo afternoon,  Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for (Jeemol George) to contract under TAX ID number (27-0796429).     I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.     Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.     Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com     Please see your designated Coordinators information below:  HARRIS  Michele Thomas Martin  Michele.Thomas-Martin@MolinaHealthcare.com  888-562-5442 x200042', NULL, NULL, '2020-10-05 09:15:09', '2020-10-05 09:15:09'),
(1567, 2027, 250, NULL, '2020-10-22 00:00:00.000', 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  Record # 171061     Good Morning,     Thank you for your inquiry.  The request has been sent to credentialing for processing.  Please allow 30 days for processing.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042', NULL, NULL, '2020-10-15 15:09:18', '2020-10-15 15:09:18'),
(1568, 2037, 250, NULL, '2020-11-02 00:00:00.000', 'In Process', 'Need to allow more time', NULL, NULL, '2020-10-26 17:22:34', '2020-10-26 17:22:34'),
(1569, 2027, 250, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Molina Health)  Please confirm if this below mentioned provider is enrolled in all requested locations of (Normandy Urgent Care Center) Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: (Normandy Urgent Care Center)   Group Tax-ID: 270796429  Thanks.', NULL, NULL, '2020-11-02 12:32:25', '2020-11-02 12:32:25'),
(1570, 2027, 250, NULL, '2020-11-09 00:00:00.000', 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Molina Health)  Record # 171061     Provider: Jeemol George     Good Afternoon,     Thank you for your inquiry.  The request has been sent for loading in the billing system under Normandy Urgent Care for service location 779 Normandy St, suite 114.  This is the only location listed on the contract request form. Please allow 30 days for this request to complete.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2020-11-02 15:23:58', '2020-11-02 15:23:58'),
(1571, 2027, 250, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  May I know the current status of this request?  Thanks.', NULL, NULL, '2020-11-09 15:21:42', '2020-11-09 15:21:42'),
(1572, 2037, 250, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent to Michal Thomas. ------------ (George, Jeemol)-(Normandy Urgent Care Center)-(Molina Health)', NULL, NULL, '2020-11-16 12:28:54', '2020-11-16 12:28:54'),
(1573, 2037, 250, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Response received from Martin@molinahealthcare.com ----------- Record # 171061     Good Afternoon,     Thank you for your inquiry.  The request for the below provider has been sent for loading in the billing system eff 12/1/2020.   Please allow more time for processing.     Thank You, Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2020-11-19 14:32:20', '2020-11-19 14:32:20'),
(1574, 2037, 250, NULL, '2020-12-16 00:00:00.000', 'In Process', 'provider has been sent for loading in the billing system eff 12/1/2020.   Need to  allow more time for processing.', NULL, NULL, '2020-11-30 17:51:24', '2020-11-30 17:51:24'),
(1575, 2037, 250, NULL, '2020-12-11 00:00:00.000', 'Approved', 'Received welcome letter via email with the effective date of 12/01/2020 and confirmation email for all plans. Letter uploaded.Approval sent', NULL, NULL, '2020-12-04 16:35:49', '2020-12-04 16:35:49'),
(1576, 2027, 252, NULL, NULL, 'In Process', 'From; HPCREDENTIALINGEXPEDITE@bswhealth.org   Last Name  First Name  NPI  TIN  ORG name  George  Jeemol  1497219067  27-0796429  Normandy Urgent Care Center PA  Jose  Julie  1447883061  27-0796429  Normandy Urgent Care Center PA  Joseph  Vibitha  1952931560  27-0796429  Normandy Urgent Care Center PA        Need information in the next 10 days (July 24, 2020).  No follow up email will be sent.     Here at Scott & White Health Plan (SWHP) and First Care Health Plan (FCHP) we take pride in working expeditiously to provide you with quality service in a timely and accurate manner. We have recently received a request to add a provider(s) to your existing SWHP or FCHP group agreement. In order for this to be accomplished, we will need your assistance in providing all documentation requested by our Provider Relations Dept. and our Credentialing Verification Organization (CVO), Aperture Credentialing.     Please forward, via email to HPCREDENTIALINGEXPEDITE@BSWHealth.org, with the subject line EXPEDITED and the attached documents before the above date so we can initiate the process to start your credentialing process.     Required:  1.      Provider Information Spreadsheet – This is not your credentialing application.  This provides us information to send to Aperture to get you started with their request.  If you use CAQH please ensure your information and attestations are up to date and that you have designated SWHP and/or FCHP as an authorized provider.  If you do not use CAQH please send us your Texas Standardized Credentialing Application (TSCA) and attachments.   2.       Copy of the W-9  If applicable:  3.       Privilege Exception/Mid-Level Form - If applicable  4.       CME Acknowledgement:  For any non-boarded PHYSICIANs, who are no longer in the eligibility period for certification, SWHP and FCHP requires additional CMEs annually.  To acknowledge this requirement please sign, date, and return the attached CME form.     This will be the only request sent from SWHP and FCHP requesting these items above to initiate the credentialing process. If the information above has not been received within 10 days, you will be required to re-apply through www.swhp.org     Once we have processed the initial information the Credentialing process will begin. Once credentialing is complete, we will contact you with your effective date. If you have any questions or concerns please contact your provider relations representatives.     Thank you,', NULL, NULL, '2020-07-13 14:38:27', '2020-07-13 14:38:27'),
(1577, 2027, 252, NULL, NULL, 'In Process', 'To: HPCREDENTIALINGEXPEDITE@bswhealth.org  Sub: EXPEDITED  Please Find the attached documents which you have requested for credentialing of these providers.  Name            NP#                      Tax-ID                           Group george  -  1497219067 -   27-0796429 -   Normandy Urgent Care Center PA   Jeemol    Jose     -    1447883061 -  27-0796429 -   Normandy Urgent Care Center PA    Julie    Joseph -    1952931560 -   27-0796429 -  Normandy Urgent Care Center PA    Vibitha        Thanks.', NULL, NULL, '2020-07-13 14:40:30', '2020-07-13 14:40:30'),
(1578, 2027, 252, NULL, '2020-08-24 00:00:00.000', 'In Process', 'From: HPCREDENTIALINGEXPEDITE@bswhealth.org  Good afternoon,     Attached is the credentialing approval letter for the above named provider. Please save for your reference.           Thank you,', NULL, NULL, '2020-08-17 10:55:46', '2020-08-17 10:55:46'),
(1579, 2027, 252, NULL, '2020-08-26 00:00:00.000', 'In Process', 'From: SWHPEXPEDITES@bswhealth.org  Sub: To add Jeemol George and Vibitha Joseph to Normandy Urgent Care Center PA  The provider information for Jeemol George and Vibitha Joseph to be added to Normandy Urgent Care Center PA has been received and is in process.     He/she has an effective date of 8/31/2020.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.     Thank you and have a great day.        Provider Relations  Scott & White Health Plan', NULL, NULL, '2020-08-19 09:20:35', '2020-08-19 09:20:35'),
(1580, 2027, 252, NULL, '2020-08-26 00:00:00.000', 'In Process', 'To: SWHPEXPEDITES@bswhealth.org  Thanks for the confirmation. Can I have welcome letters or executed signed contracts for these providers?  Thanks.', NULL, NULL, '2020-08-19 09:21:34', '2020-08-19 09:21:34'),
(1581, 2027, 252, NULL, '2020-08-26 00:00:00.000', 'In Process', 'From: SWHPEXPEDITES@bswhealth.org  Good morning,     The confirmation effective date is when the provider joins the network in which you may use as the welcome letter. If you are in need of credentialing approval letters I have included our credentialing department on the email in case you have not received them. Please keep in mind the credentialing approval date is not the effective date.      Thank you,  Vanessa', NULL, NULL, '2020-08-19 09:22:23', '2020-08-19 09:22:23'),
(1582, 2027, 252, NULL, '2020-09-15 00:00:00.000', 'In Process', 'To: SWHPEXPEDITES@bswhealth.org  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Scott & White)  May I know the current status of the provider mentioned below: Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks.', NULL, NULL, '2020-09-08 17:11:54', '2020-09-08 17:11:54'),
(1583, 2027, 252, NULL, '2020-09-16 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 8/31/2020. Screenshot of the confirmation email and approval letter is attached.', NULL, NULL, '2020-09-09 09:40:37', '2020-09-09 09:40:37'),
(1584, 2027, 253, NULL, NULL, 'In Process', 'From: SHP.NetworkDevelopment@superiorhealthplan.com  To: ma@claimsmedinc.com  Hello,     We received your completed application on (6/2/20).  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.     Thank You,  Sasha Henry', NULL, NULL, '2020-06-29 09:42:33', '2020-06-29 09:42:33'),
(1585, 2027, 253, NULL, NULL, 'In Process', 'To: SHP.NetworkDevelopment@superiorhealthplan.com,Daniel.Velez@superiorhealthplan.com  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Superior Health)  Hello, Hope you are doing great, I want to know about the current status of the provider George, Jeemol   Following are the details: Group Name: Normandy Urgent Care Center   Provider NPI: 1497219067   Group Tax ID: 27-0796429      Thanks.', NULL, NULL, '2020-07-31 11:32:36', '2020-07-31 11:32:36'),
(1586, 2027, 253, NULL, '2020-09-28 00:00:00.000', 'In Process', 'To: SHP.NetworkDevelopment@superiorhealthplan.com Daniel.Velez@superiorhealthplan.com  Sub: (Providers)-(Normandy Urgent Care Center)-(Superior Health)  May I know the current status of the below mentioned providers:  Provider Name	Provider NPI#	Group Name	Group Tax ID George, Jeemol	1497219067	Normandy Urgent Care Center	27-0796429 Jose, Julie	1447883061	Normandy Urgent Care Center	27-0796429  Thanks.', NULL, NULL, '2020-09-21 12:13:35', '2020-09-21 12:13:35'),
(1587, 2027, 253, NULL, '2020-09-30 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good Afternoon Martin     I hope you are doing well. I wanted to follow-up regarding your request below, please see the updates in the Notes column.        Provider Name  Provider NPI#  Group Name  Group Tax ID  Notes  George, Jeemol  1497219067  Normandy Urgent Care Center  27-0796429  An email was sent from our credentialing team on 9/17/2020 to  nucc@claimsmedinc.com advising to return page 12 of the disclosures. Please sign back 12 of the disclosure forms attached and email them back to credentialing@superiorhealthplan.com. Please be sure to specify your TIN & NPI.  Jose, Julie  1447883061  Normandy Urgent Care Center  27-0796429  This provider is still in credentialing approaching the par(in network stage) and should be finished up soon. Please continue to allow time for processing and follow-up next month with an update.           Should you have any additional questions please let us know.     Have a great rest of the day!     Thanks', NULL, NULL, '2020-09-23 09:56:40', '2020-09-23 09:56:40'),
(1588, 2027, 253, NULL, '2020-09-30 00:00:00.000', 'In Process', 'To; credentialing@superiorhealthplan.com  Please find the application form attached in this email with page 12 signed as per your request.  Thanks.', NULL, NULL, '2020-09-23 09:59:47', '2020-09-23 09:59:47'),
(1589, 2027, 253, NULL, '2020-10-28 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and the effective date is 11/01/2020', NULL, NULL, '2020-10-21 13:17:21', '2020-10-21 13:17:21'),
(1590, 2027, 254, NULL, NULL, 'In Process', 'To: 	TCHPNetworkManagemen@texaschildrens.org  Sub: Need Status Update For Provider  Hello, Hope you are doing well, May i Know the status update of the provider. Following are the details: Provider Name:  George, Jeemol  Provider NPI# 1497219067 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429 In the last follow up you have requested for the LOI and W9 on the company\'s letterhead which we have already sent to you. So kindly look into this and reply me as soon as you get this email.  Thanks.', NULL, NULL, '2020-06-30 14:23:36', '2020-06-30 14:23:36'),
(1591, 2027, 254, NULL, '2020-09-01 00:00:00.000', 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Texas Children Health Plan)  May i know the current status of the provider mentioned below: Provider Name-George, Jeemol Provider NPI#1497219067 Group Name-Normandy Urgent Care Center Group Tax-ID-27-0796429 Thanks.', NULL, NULL, '2020-08-25 14:54:24', '2020-08-25 14:54:24'),
(1592, 2027, 254, NULL, '2020-09-01 00:00:00.000', 'In Process', 'From: tchpnetworkmanagement@texaschildrens.org  This LOI is pending', NULL, NULL, '2020-08-25 15:58:27', '2020-08-25 15:58:27'),
(1593, 2027, 254, NULL, '2020-09-01 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  Please find attached the LOI which you have asked for.', NULL, NULL, '2020-08-25 15:59:11', '2020-08-25 15:59:11'),
(1594, 2027, 254, NULL, '2020-09-01 00:00:00.000', 'In Process', 'From: tchpnetworkmanagement@texaschildrens.org  Thank you for your interest in our health plan’s network. Your LOI/PIF has been received and communication will be sent out to you once the review has been completed.     Liz J. Ramirez  Texas Children’s Health Plan', NULL, NULL, '2020-08-25 16:02:35', '2020-08-25 16:02:35'),
(1595, 2027, 254, NULL, '2020-09-16 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  May I know the current status of this provider and how much time is required for the completion of this request. Details are mentioned below:  Provider Name-George, Jeemol Provider NPI#1497219067 Group Name-Normandy Urgent Care Center Group Tax-ID-27-0796429 Thanks.', NULL, NULL, '2020-09-09 15:32:03', '2020-09-09 15:32:03');
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
(1596, 2027, 254, NULL, '2020-10-28 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Texas Children Health Plan)  May i know the current status of the provider mentioned below: Provider Name-George, Jeemol Provider NPI#1497219067 Group Name-Normandy Urgent Care Center Group Tax-ID-27-0796429 Thanks.', NULL, NULL, '2020-10-21 10:07:30', '2020-10-21 10:07:30'),
(1597, 1006, 254, NULL, '2020-11-12 00:00:00.000', 'In Process', 'Sent a follow-up email for status @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org>', NULL, NULL, '2020-10-28 18:04:22', '2020-10-28 18:04:22'),
(1598, 2037, 254, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Follow up email sent to tchpnetworkmanagement@texaschildrens.org', NULL, NULL, '2020-11-12 10:34:04', '2020-11-12 10:34:04'),
(1599, 2037, 254, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Received PIFs filled out and submitted back to \"tchpnetworkmanagement@texaschildrens.org\" with IVUC as the secondary Location.= and request.', NULL, NULL, '2020-11-13 14:41:46', '2020-11-13 14:41:46'),
(1600, 2037, 254, NULL, '2020-12-08 00:00:00.000', 'In Process', 'PIF\'s Submitted need to allow more time.', NULL, NULL, '2020-11-25 13:08:40', '2020-11-25 13:08:40'),
(1601, 2037, 254, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent for the submitted PIF', NULL, NULL, '2020-12-08 14:51:22', '2020-12-08 14:51:22'),
(1602, 1006, 254, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Sent a follow-up email to TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org for an updated status of enrollment. ', NULL, NULL, '2020-12-15 18:12:10', '2020-12-15 18:12:10'),
(1603, 2037, 254, NULL, '2021-01-07 00:00:00.000', 'In Process', 'PIF submitted on 11/03/2020 Need to allow more time ', NULL, NULL, '2020-12-29 16:46:57', '2020-12-29 16:46:57'),
(1604, 1006, 254, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Received following response from @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org: \"The LOI for Jeemol George resubmitted in October is pending. Thank you for your patience.\" ', NULL, NULL, '2021-01-11 17:51:12', '2021-01-11 17:51:12'),
(1605, 1006, 254, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Received the following update from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org: \"Provider Name: Jeemol George –in process\" ', NULL, NULL, '2021-01-29 09:41:10', '2021-01-29 09:41:10'),
(1606, 1006, 254, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Carter, Krisheena J.\" kjcarter@texaschildrens.org regarding the status of the PIF forms that were submitted on 11/13/2020 for the provider.  ', NULL, NULL, '2021-02-16 17:19:44', '2021-02-16 17:19:44'),
(1607, 1006, 254, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Carter, Krisheena J.\" kjcarter@texaschildrens.org regarding the status of the PIF forms that were submitted on 11/13/2020 for the provider.  ', NULL, NULL, '2021-02-16 17:22:02', '2021-02-16 17:22:02'),
(1608, 1006, 254, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Received the following response from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org: \"Provider Name: Jeemol George in process NPI# 1497219067 (TCHP use-20210202034552872)\"', NULL, NULL, '2021-02-19 15:19:14', '2021-02-19 15:19:14'),
(1609, 3040, 254, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: 	TXCredentialing@amerigroup.com  Subject: Provider Enrollment Status - Normandy Urgent Care Center  Greetings,  Please advise me the enrollment status for the following providers under our group as their enrollment requests have been in process since the start of last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-01 12:56:07', '2021-03-01 12:56:07'),
(1610, 3040, 254, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Provider Enrollment Status || Normandy Urgent Care Center || TCHP ||   Greetings,  Please advise me the enrollment status for the following providers under our group as their enrollment requests have been in process since last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-01 13:00:22', '2021-03-01 13:00:22'),
(1611, 3040, 254, NULL, '2021-03-23 00:00:00.000', 'Approved', 'Email rcvd from: axhartma@texaschildrens.org  Subject: TCHP Welcome Letter - Jeemol George, FNP - Normandy Urgent Care Center PA - Imperial Valley Dr. and Normandy St.  Good Morning,  Welcome to TCHP. Jeemol George, FNP is now participating with Texas Children’s Health Plan under Normandy Urgent Care Center PA. Attached you will find a welcome letter with an effective date for all contracted products as well as the contact information for your Provider Relations Representative.  Please reach out to your PR Rep or the main Contracting Department phone line at (832) 828-1063 with any questions.  Thank you,  Anna Hartmann Contract Specialist Texas Children\'s Health Plan *: axhartma@texaschildrens.org (: (832) 828-1063', NULL, NULL, '2021-03-16 14:48:24', '2021-03-16 14:48:24'),
(1612, 2027, 255, NULL, NULL, 'In Process', 'Sent provider certification application form by fax at (608) 221-7535 and attached', NULL, NULL, '2020-07-01 12:55:29', '2020-07-01 12:55:29'),
(1613, 2027, 255, NULL, '2020-09-09 00:00:00.000', 'In Process', 'To: kmoten4@humana.com  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Tricare)  May I know the current status of the provider mentioned below: Provider Name- George, Jeemol Provider NPI# 1497219067 Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429  Thanks.', NULL, NULL, '2020-09-02 17:04:28', '2020-09-02 17:04:28'),
(1614, 2027, 255, NULL, '2020-09-10 00:00:00.000', 'Approved', 'From: KMoten4@humana.com  Sub: Secured: RE: (George, Jeemol)-(Normandy Urgent Care Center)-(Tricare)  This provider is eff: 7/28/2020.  He is showing Credentialed and affiliated to this group.     Thank you.', NULL, NULL, '2020-09-03 09:40:27', '2020-09-03 09:40:27'),
(1615, 2027, 256, NULL, NULL, 'In Process', 'From: scruz@trpnppo.com  Good Morning,  Provider jeemol george is now active with effective date 06/09/2020', NULL, NULL, '2020-07-06 13:15:34', '2020-07-06 13:15:34'),
(1616, 2027, 256, NULL, NULL, 'In Process', 'To: scruz@trpnppo  I need welcome letter also.  Thanks.', NULL, NULL, '2020-07-06 13:16:31', '2020-07-06 13:16:31'),
(1617, 2027, 256, NULL, NULL, 'In Process', 'To: 	scruz@trpnppo.com  Can I have the welcome letter for this provider as the effective date has already issued 6/9/2020 Provider details are mentioned below: Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429  Thanks. ', NULL, NULL, '2020-07-16 17:51:34', '2020-07-16 17:51:34'),
(1618, 2027, 256, NULL, NULL, 'In Process', 'From: scruz@trpnppo.com  Hello,     Please see attached welcome letter.', NULL, NULL, '2020-07-20 17:45:30', '2020-07-20 17:45:30'),
(1619, 2027, 256, NULL, NULL, 'In Process', 'To: scruz@trpnppo.com  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-(Three Rivers Provider Network- TRPN)  There is no effective date and other details of the provider mentioned in the welcome letter which you have sent to me, kindly send me with all the details written on it.  Thanks.   ', NULL, NULL, '2020-07-20 17:52:59', '2020-07-20 17:52:59'),
(1620, 2027, 256, NULL, NULL, 'Approved', 'From: kfry@trpnppo.com  Sub: tin#270796429  Good Morning Martin,        I received an email in regards to the providers add this year, I show the following:  Jeemol George NPI  1497219067 effect 6/9/2020  Julie Jose  NPI 1447883061effect 6/9/2020     Thank you,', NULL, NULL, '2020-07-22 09:57:27', '2020-07-22 09:57:27'),
(1621, 3040, 256, NULL, '2021-06-24 00:00:00.000', 'Revalidation', 'Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067    Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-17 08:30:09', '2021-06-17 08:30:09'),
(1622, 3040, 256, NULL, '2021-07-12 00:00:00.000', 'Revalidation', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group under the below mentioned locations. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429  Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:- Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067   Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI : 1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 15:25:55', '2021-07-05 15:25:55'),
(1623, 3040, 256, NULL, '2021-07-27 00:00:00.000', 'Revalidated', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Mini Chennemkara is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 03/01/2016,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider James Piccione is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 05/29/2019,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/01/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Jeemol George is Active, effective date 06/09/2020,  Provider Julie Jose is Active, effective date 06/09/2020,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf 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', NULL, NULL, '2021-07-20 08:32:44', '2021-07-20 08:32:44'),
(1624, 2027, 257, NULL, NULL, 'In Process', 'TCHPNetworkManagemen@texaschildrens.org  Credentialing request-Glory Abraham-Need Status Update    Hello,  Hope you are doing great, I want to know about the current status of the provider. Following are the details: Provider Name: Glory Abraham NPI# 1194206490Group Name: Normandy Urgent Care CenterTax-ID: 27-0796429 Kindly update me how much time is required for the completion of this request. Thanks.', NULL, NULL, '2020-06-17 12:02:11', '2020-06-17 12:02:11'),
(1625, 2027, 257, NULL, NULL, 'In Process', 'Talk To the representative request is still in process she said insurance will call us back in 48 hours for further details', NULL, NULL, '2020-06-24 09:44:37', '2020-06-24 09:44:37'),
(1626, 2027, 257, NULL, NULL, 'In Process', 'To: 	ljramir1@texaschildrens.org  Sub: (Abraham, Glory)-(Normandy Urgent Care Center)-(Texas Children Health Plan - TCHP)  Please find the attached PIF form and W9 as you have requested to complete the credentialing process of the below mentioned provider. Provider Name:  Abraham, Glory  Provider NPI# 1194206490 Group Name: Normandy Urgent Care Center Tax ID: 27-0796429  Thanks.', NULL, NULL, '2020-07-10 17:45:18', '2020-07-10 17:45:18'),
(1627, 2027, 257, NULL, NULL, 'In Process', 'From: ljramir1@texaschildrens.org  Sub: (Abraham, Glory)-(Normandy Urgent Care Center)-(Texas Children Health Plan - TCHP)  You application has been received and appreciated. Communication will be sent once review is complete', NULL, NULL, '2020-07-13 10:20:32', '2020-07-13 10:20:32'),
(1628, 2027, 257, NULL, NULL, 'In Process', 'From: tchpnetworkmanagement@texaschildrens.org  RE: Credentialing request for Glory Abraham  Provider is under review.', NULL, NULL, '2020-07-14 17:39:23', '2020-07-14 17:39:23'),
(1629, 2027, 257, NULL, '2020-09-10 00:00:00.000', 'In Process', 'To: tchpnetworkmanagement@texaschildrens.org  May I know the current status of the provider mentioned below: Provider Name- Abraham, Glory Provider NPI# 1194206490 Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429  Thanks.', NULL, NULL, '2020-09-03 17:32:09', '2020-09-03 17:32:09'),
(1630, 2027, 257, NULL, '2020-09-15 00:00:00.000', 'In Process', 'Provider is linked with the insurance and the effective date is 05/07/2020 screenshot from provider directory is attached', NULL, NULL, '2020-09-08 09:52:53', '2020-09-08 09:52:53'),
(1631, 2027, 257, NULL, '2020-09-15 00:00:00.000', 'Approved', 'Provider is linked with the insurance and the effective date is 05/07/2020 screenshot from provider directory is attached', NULL, NULL, '2020-09-08 09:53:13', '2020-09-08 09:53:13'),
(1632, 2027, 260, NULL, NULL, 'In Process', 'From: Janee R Provider Service Unit   Thank you for contacting Cigna.      Your application is currently in process and was started on 05/08/2020. The credentialing/contracting process takes up to 90 business days. If you have any additional questions, please contact the Provider Services Unit at 800.882.4462.      Provider Name: Glory Abraham  Tax ID: 760612416  Application Number: 12051992     Thank you,  ConnectedCare PROVIDER OPERATIONS  Janee R  Provider Service Unit  ', NULL, NULL, '2020-06-26 14:16:25', '2020-06-26 14:16:25'),
(1633, 2027, 260, NULL, '2020-10-06 00:00:00.000', 'In Process', 'To; intake_pdm@cigna.com  Sub: (Abraham, Glory)-(Longpoint Medical Center)-(Cigna)  May I know the current status of the below mentioned provider: Provider Name: Abraham, Glory Provider NPI# 1194206490 Group Name: Longpoint Medical Center Group Tax-ID: 76-0612416  Thanks.', NULL, NULL, '2020-09-29 10:02:01', '2020-09-29 10:02:01'),
(1634, 2027, 260, NULL, '2020-10-09 00:00:00.000', 'In Process', 'Application has been resubmitted again it may take 90 days to be completed. The application tracking id is App#12348752 ', NULL, NULL, '2020-10-02 10:58:32', '2020-10-02 10:58:32'),
(1635, 2037, 260, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent: ------------- Greetings, May I know the current status of the below mentioned provider: Provider Name: Abraham, Glory Provider NPI# 1194206490 Group Name: Longpoint Medical Center Group Tax-ID: 76-0612416  Thanks.', NULL, NULL, '2020-10-26 15:24:37', '2020-10-26 15:24:37'),
(1636, 2037, 260, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Follow up email sent  (Abraham, Glory)-(Longpoint Medical Center)-(Cigna)', NULL, NULL, '2020-11-25 17:11:12', '2020-11-25 17:11:12'),
(1637, 2037, 260, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Another follow up email sent', NULL, NULL, '2020-12-07 12:35:03', '2020-12-07 12:35:03'),
(1638, 2037, 260, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Group contracting initiated for LPMC TIN', NULL, NULL, '2020-12-14 15:03:50', '2020-12-14 15:03:50'),
(1639, 2037, 260, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Group contracting in process', NULL, NULL, '2020-12-21 18:00:00', '2020-12-21 18:00:00'),
(1640, 2037, 260, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Group contracting in process', NULL, NULL, '2020-12-29 16:54:22', '2020-12-29 16:54:22'),
(1641, 1006, 260, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Received the following reply from 9psscent@cigna.com: \"Re:	Reference number 12348752 Application complete: Credentialing process to begin Dear GLORY ABRAHAM,  We have confirmed that your application is complete, and have forwarded it for credentialing review  What happens next?  During this stage of the application process, Credentialing will perform primary source verification, and your application will be reviewed by the Credentialing committee. We will contact you if we need any additional information, and will let you know when this step is complete.  Sincerely, Cigna\"', NULL, NULL, '2021-01-22 13:28:18', '2021-01-22 13:28:18'),
(1642, 1006, 260, NULL, '2021-03-04 00:00:00.000', 'Approved', 'Dear GLORY ABRAHAM MD,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 02/01/2021. Your provider identification number is‍ ‌4048834. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  ', NULL, NULL, '2021-02-25 10:30:25', '2021-02-25 10:30:25'),
(1643, 2027, 261, NULL, NULL, 'In Process', 'To: intake_pdm@cigna.com  Subject: Need Update of Credentialing status for Glory Abraham    Hello,  Hope you are doing great, I want to know about the current status of the provider. Following are the details: Provider Name: Glory AbrahamNPI# 1194206490Group Name: Normandy Urgent Care CenterTax-ID: 27-0796429 Kindly update me how much time is required for the completion of this request. Thanks.', NULL, NULL, '2020-06-17 12:44:24', '2020-06-17 12:44:24'),
(1644, 2027, 261, NULL, NULL, 'In Process', 'From: PDMNotification@cigna.com  To: mk@claimsmedinc.com  Hi,     Please find the below status for your reference.     • Cigna Internal Reference #  W20190523419956  ∙ Provider Name: Glory Abraham.  ∙ Provider Cigna PID: 4048834.     Status: Provider is in process of completion you will be notified once completed under Cigna Internal reference ID # 12051992.     \"Thank you for your submission. The below status request has been completed.\" ***Please do not reply to this email.***  Thank You.  Intake PDM.', NULL, NULL, '2020-06-18 13:41:18', '2020-06-18 13:41:18'),
(1645, 2027, 261, NULL, NULL, 'In Process', 'talk to the representative of cigna she said application is still in process it will take 60 to 90 days for completion from the day we initiated this request.', NULL, NULL, '2020-06-24 10:25:57', '2020-06-24 10:25:57'),
(1646, 2027, 261, NULL, NULL, 'In Process', 'To: 	intake_pdm@cigna.com  Sub: (Abraham, Glory)-(Normandy Urgent Care Center)-(Cigna)  May I know the current status of the application following are the details of the provider:   Provider Name: Abraham, Glory  NPI#  1194206490    Group Name:Normandy Urgent Care Center  Tax ID: 27-0796429     Thanks.', NULL, NULL, '2020-07-14 17:11:20', '2020-07-14 17:11:20'),
(1647, 2027, 261, NULL, NULL, 'In Process', 'From: PDMCOGZ@cigna.com  Hi,     Thank you for your submission.     The attached request has been reviewed.     See below the current status of the requested provider with Name, PID #, TIN # and Eff. Date.     HCP NAME  PID  TIN  STATUS  GLORY ABRAHAM  4048834  270796429  NON-CONTRACTED        Cigna Internal Ref. ID : W202007141133144           Enclosure: A copy of your original request           Please do not reply to this email message. The return address is not monitored. All future request should be sent to Intake_PDM@cigna.com        Sincerely,  Cigna PDM', NULL, NULL, '2020-07-15 13:28:03', '2020-07-15 13:28:03'),
(1648, 2027, 261, NULL, NULL, 'In Process', 'To: 	intake_pdm@cigna.com  I have received your secure email in which you have said that this provider is not contracted yet but you mention the \"Provider ID-4048834\" so may i know the reason why this provider is not contracted  Thanks.  Below is the copy of your original email for reference.     See below the current status of the requested provider with Name, PID #, TIN # and Eff. Date.     HCP NAME  PID  TIN  STATUS  GLORY ABRAHAM  4048834  270796429  NON-CONTRACTED        Cigna Internal Ref. ID : W202007141133144', NULL, NULL, '2020-07-15 13:29:07', '2020-07-15 13:29:07'),
(1649, 2027, 261, NULL, NULL, 'In Process', 'From: PDMCOGZ@cigna.com     Hi,     Thank you for your submission.     The attached request has been reviewed.     See below the current status of the requested provider with Name, PID #, TIN # and Eff. Date.     HCP NAME  PID  TIN  STATUS  GLORY ABRAHAM  4048834  270796429  NON-CONTRACTED     Cigna Internal Ref. ID : W202007151135367         Note : TIN’s was not contracted for the providers “GLORY ABRAHAM” If we need to have your provider loaded under your group TIN, kindly submit the below requested information to Intake_PDM@Cigna.com.        New Add Request  1. Provider ID or Provider Name  2. Effective Date  3. Office and Billing address and phone numbers  4. Group Name  5. Payee Name  6. Hospital ( IL see GMI. No hospital loaded  in provider\'s record, LA & TX for HBP providers)  7. Network IDs  8. Fee Schedule (if no GSI attached)  9. TIN  10. Degree  11. Specialty  12. Role  13. Place of Service (Hospital Based or not)  14. License #  15. A W-9 is required for TIN owner name and address for non-delegated TINS that do not exist in CPF.  16. Market Suppression  17. On Call required for PCP  18. NPI (National Provider Identifier) Individual HCP\'s  Note:  This is required for all new Adds for non-atypical HCPs  19. Internet Information - If given in source document and California HCP.        Please do not reply to this email message. The return address is not monitored. All future request should be sent to Intake_PDM@cigna.com        Sincerely,  Cigna PDM', NULL, NULL, '2020-07-16 13:18:36', '2020-07-16 13:18:36'),
(1650, 2027, 261, NULL, NULL, 'Approved', 'Call to insurance: Talk to the representative his name is Torrey and ref number is Torrey 7/16/2020 he said this provider don\'t need to be enrolled individually as the group has an ancillary contract. Signed and executed contract has been attached.    ', NULL, NULL, '2020-07-16 13:57:50', '2020-07-16 13:57:50'),
(1651, 2027, 262, NULL, NULL, 'In Process', 'To: pr.south@healthsmart.com  Sub: Need Status Update For The Provider  Hello, Hope you are doing great, May i know the current enrollment status of the provider Jeemol George. Following are his details: Provider NPI# 1497219067 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429  Last time when i did follow up for this provider i got this Inventory Log ID : 56507 from your side.  Thanks. ', NULL, NULL, '2020-06-30 13:41:16', '2020-06-30 13:41:16'),
(1652, 2027, 262, NULL, NULL, 'In Process', 'From: mdiprsupport@healthsmart.com  To: mk@claimsmedinc.com  Hi,  \" George, Jeemol NP \" is effective date \" 03/11/2020 \".  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Inventory Log ID : 56507)  Thanks HealthSmart Provider Relations', NULL, NULL, '2020-07-01 17:47:06', '2020-07-01 17:47:06'),
(1653, 2027, 262, NULL, NULL, 'In Process', 'To: mdiprsupport@healthsmart.com, pr.south@healthsmart.com  Hello, May i have the welcome letter for \"George, Jeemol NP\" as you have already issued the effective date.  Thanks.', NULL, NULL, '2020-07-01 17:52:49', '2020-07-01 17:52:49'),
(1654, 2027, 262, NULL, NULL, 'In Process', 'To: pr.south@healthsmart.com  Sub: (George, Jeemol)-(Normandy Urgent Care Center)-Health Smart  Can I have the welcome letter for this provider as the effective date has already issued 03/11/2020 Provider details are mentioned below: Provider Name: George, Jeemol Provider NPI# 1497219067 Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429  Thanks.  ', NULL, NULL, '2020-07-16 17:33:05', '2020-07-16 17:33:05'),
(1655, 2027, 262, NULL, NULL, 'In Process', 'Provider is now showing in this location with these plans Health smart accel Health Smart Preferred Health smart Payors Organization (HPO) Health Smart Workers Compensation Health Smart Auto Medical C-8(PFOA) Medical Monitoring Program Health Smart Physician/Ancillary Only and effective date is 3/11/2020', NULL, NULL, '2020-07-24 17:14:51', '2020-07-24 17:14:51'),
(1656, 2027, 262, NULL, '2020-09-23 00:00:00.000', 'Approved', 'Provider is showing linked with the insurance and the effective date is 3/11/2020. ', NULL, NULL, '2020-09-16 09:20:55', '2020-09-16 09:20:55'),
(1657, 2027, 266, NULL, NULL, 'In Process', 'To: hpdemo@uhc.com  Hello, May i know the Current status of the provider Abraham, Glory . On May 05/07/2020 I talked to a representative for the status. She said it will take 30-45 days to complete this request. She also gave me a reference# 01582965.  Following are the provider details: Provider Name: Abraham, Glory  Provider NPI# 1194206490 Group Name:Columbus Urgent Care PA  Thanks.', NULL, NULL, '2020-07-01 16:51:25', '2020-07-01 16:51:25'),
(1658, 2027, 266, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: billing@claimsmedinc.com  (Providers)-(Columbus Urgent Care)-(United HealthCare)  This is to inform the billing department that (United HealthCare) has refused to change this contract into urgent care with (Columbus Urgent Care). What else we should try please advise?  Thanks.', NULL, NULL, '2020-10-12 17:57:02', '2020-10-12 17:57:02'),
(1659, 1006, 266, NULL, '2020-11-05 00:00:00.000', 'On Hold', 'Sent another email @ Billing - Claims Med billing@claimsmedinc.com>: \"We have discussed this issue verbally also, So please advise how we should proceed on this.  Thanks.\"', NULL, NULL, '2020-10-26 13:48:42', '2020-10-26 13:48:42'),
(1660, 2027, 266, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: uhc_provider_contracting_cen@uhc.com, networkhelp@uhc.com  Sub: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-06 10:13:07', '2020-11-06 10:13:07'),
(1661, 2027, 266, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: corey_j_ford@uhc.com  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-13 16:51:07', '2020-11-13 16:51:07'),
(1662, 2027, 266, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: networkhelp@uhc.com  Thank you for  contacting Network Management Resource Team. We will be happy to see if we can assist regarding your inquiry. We are needing additional information in order to accurately review your request. Please provide the provider’s NPI number along with the group TIN/NPI. Please note for future emails many times our confidential/secured emails go directly to spam/junk folders.     If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.     For questions related to credentialing, benefits or claim status, please utilize www.UHCprovider.com or call the United Voice Portal at  877-842-3210.  For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.       For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.   Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation', NULL, NULL, '2020-11-20 12:30:03', '2020-11-20 12:30:03'),
(1663, 2027, 266, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com  Please find the requested information below to start the process.  Providers	Provider-NPI#	Group-TIN# Joseph, Vibitha	1952931560	471914151 Brown, Brittany	1275163537	471914151 Stephen, Ani	1588959118	471914151 Jose, Julie	1447883061	471914151 George, Jeemol	1497219067	471914151 Abraham, Glory	1194206490	471914151 Kourouma , Odette Tiranke	1134525868	471914151 Chennemkara, Mini Philip	1841755956	471914151    Thanks.', NULL, NULL, '2020-11-20 12:30:12', '2020-11-20 12:30:12'),
(1664, 2027, 266, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com   I have provided the requested information in my last email. Please assist me how can I enroll these providers under this contract.   Thanks.', NULL, NULL, '2020-11-30 15:52:03', '2020-11-30 15:52:03'),
(1665, 2037, 266, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Email sent to corey_j_ford@uhc.com & networkhelp@uhc.com --------- Subject: (Providers)-(Columbus Urgent Care)-(United HealthCare)  Greetings, May I know if we can proceed further with the credentialing process of the group and the below mentioned providers.Also note that we are unable to access the sent group contract for signatures.Kindly send us the consent to release information form in order to get it signed by the authorized person.   Providers           Provider-NPI# Group-TIN# Joseph, Vibitha        1952931560 471914151 Brown, Brittany       1275163537 471914151 Stephen, Ani           1588959118 471914151 Jose, Julie            1447883061 471914151 George, Jeemol         1497219067 471914151 Abraham, Glory         1194206490 471914151 Kourouma , Odette Tiranke              1134525868 471914151 Chennemkara, Mini Philip               1841755956 471914151 ', NULL, NULL, '2020-12-08 17:17:46', '2020-12-08 17:17:46'),
(1666, 1006, 266, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ NMRT networkhelp@uhc.com, \"Ford, Corey J\" corey_j_ford@uhc.com, UHC Provider Contracting CEN uhc_provider_contracting_cen@uhc.com:  \"Hello,   I hope you\'re doing well, we keep receiving the group contract for   CUCC but as previously mentioned we are unable to access it. Please   let me know what is required to get this sorted as this has been going   for quite a while and we are unable to move forward with this request.   Please get back to me as soon as possible.  Thanks. \"', NULL, NULL, '2020-12-15 17:39:22', '2020-12-15 17:39:22'),
(1667, 2037, 266, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email Sent to networkhelp@uhc.com ------------------------------ Hi Nathan,  Yes the TIN that you highlighted is the one in question which is 471914151.   We have an Urgent Care Contract for the facility however we did request an amendment and would want to be contract as a group with all billable CPT\'s included rather then only the S Codes for Urgent Care services and also that we may go ahead and add all our providers to the group contract.  As per my correspondence with Cortney I did mention that an amended secured contract is being forwarded to us with the Subject: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA @ cucc@claimsmedinc.com last received 12/15/2020, however I requested the contract to be sent out to the office manager Selena directly @ selenalara504@gmail.com for her to review and sign.  If you could kindly double check the current status of our request and what exactly got closed as you mentioned in your response. Looking forward hearing back from you soon.  Regards, Sherry Deen.', NULL, NULL, '2020-12-22 17:51:57', '2020-12-22 17:51:57'),
(1668, 1006, 266, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Sent email @ NMRT networkhelp@uhc.com: Sub: Contract Linkage Request - Columbus Urgent Care  \"Hello,  I hope you\'re doing well, we wish to add/link the following providers as in-network to our group contract, the info for the group and providers is as follows: Group Name: Columbus Urgent Care PATIN# 47-1914151 Provider Name: Vibitha JosephNPI# 1952931560Provider Name: Brittany Brown NPI# 1275163537Provider Name: Ani StephenNPI# 1588959118Provider Name: Julie JoseNPI# 1447883061Provider Name: Jeemol GeorgeNPI# 1497219067Provider Name: Glory AbrahamNPI# 1194206490Provider Name: James PiccioneNPI# 1356321509Provider Name: Odette KouroumaNPI# 1134525868Provider Name: Ramegowda BelakereNPI# 1235166687 I\'ve also attached an LOI for your reference with W9.  Thanks. \"', NULL, NULL, '2021-01-05 18:12:11', '2021-01-05 18:12:11'),
(1669, 1006, 266, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Request currently pending at Latresha\'s end sent the following email to her @ \"Coles, Latresha M\" latresha_m_coles@uhc.com: \"Hello,   I definitely appreciate the help, Corey.   @Latresha - I\'d appreciate it if you could please get back to us regarding what our options are for the group contract and how fast we would be able to set it up since we would also need to enroll our providers under it and that could take quite a while, so if there\'s any way to expedite both procedures I\'d definitely be thankful.   Thank you!\"', NULL, NULL, '2021-02-02 17:54:51', '2021-02-02 17:54:51'),
(1670, 1006, 266, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Received the following reply from Coles, Latresha M latresha_m_coles@uhc.com: \"Greetings Brad,  As previously discussed, it is not our policy to contract urgent care centers, physicians, and medical groups, under the same TIN, under separate agreements.  This is something that cannot be administered  and you will need to make a business decision regarding how you would like to be contracted.  In our previous discussion you indicated that you would make a decision and get back to me.  Based on your request to reinstate the urgent care agreement, it appears that the decision was to be contracted as an urgent care center.   This prevents the contracting of a medical group agreement under this TIN.  As previously discussed, this will impact the current agreement for Dr. Rauf under this same TIN.  We will have to terminate his agreement, as we cannot not administer different types of agreements under the same TIN as there will be a negative impact on claims.  Please let me know if you have any additional questions.  Regards, Latresha Coles  Sr. Network Account Manager |UnitedHealthcare South Texas - Physician 2000 West Loop South, Suite 900, Houston, TX 77027 | (763)283-3194| 888-845-9481 (fax) | latresha_m_coles@uhc.com\"  Sent following reply:  \"Good morning Latresha,   I appreciate you finally getting back to me. We already made that business decision a few months ago when we asked Corey to remove the urgent care contract and initiated a request for the group contract. It wasn\'t our decision to reinstate the urgent care contract, Corey did that on his end as he did not see any other contracts and wanted our claims to be paid. As per my discussion with Corey, there was a group contract that was loaded under our group but wasn\'t set-up correctly and didn\'t have any physician lines on it, and my suggestion was to correct that group contract instead of reinstating the urgent care contract.   Do let me know how we can set up our group contract as it\'s been quite a few months already and we are still no further along than we were back then, so we need the request to be expedited as well.   Looking forward to hearing from you!  Thanks.\"', NULL, NULL, '2021-02-11 10:24:18', '2021-02-11 10:24:18'),
(1671, 3040, 266, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-05-20 14:43:58', '2021-05-20 14:43:58'),
(1672, 2027, 267, NULL, NULL, 'In Process', 'To: Rajika.Reid@communityhealthchoice.org  Sub: Need Status update of provider Glory Abraham  Hello,    Hope you are doing great, I want to know about the current status of the provider.  Following are the details:  Provider Name: Glory Abraham  NPI# 1194206490  Group Name:Normandy Urgent Care Center  Tax ID: 27-0796429    We have already sent the LOI which you have asked in the last follow up. May I know the completion time for this request.       Thanks.', NULL, NULL, '2020-06-18 12:09:17', '2020-06-18 12:09:17'),
(1673, 2027, 267, NULL, NULL, 'Approved', 'Welcome letter received from insurnce effective date is 04/29/2020 ', NULL, NULL, '2020-06-19 10:48:37', '2020-06-19 10:48:37'),
(1674, 2028, 268, NULL, NULL, 'In Process', 'To: hdocredentialing2@aetna.com Sub: Re-credentialing application required  Hello, I am looking for a re-credentialing application form for Aetna (Including Coventry & first Health) as we received a fax for the re-credentialing of the facility.  The details are as follows. Group Name: Bay Area Quick care PLLC TIN# 27-1702009 NPI# 1437481421  Please get back to me as soon as you\'re able. Thank you  ', NULL, NULL, '2020-06-25 18:11:25', '2020-06-25 18:11:25'),
(1675, 2028, 268, NULL, NULL, 'In Process', 'From: HDOCredentialing2@aetna.com Sub: Re-credentialing application required  Good morning   -facility credentialing is processed by physical address, we find in our data base under 27-1702009 address:                     9929 S.P.I.D.                 Suite 109                     Corpus Christi        TX 78418    Urgent Care facilities in TX do not require credentialing, therefore, the credentialing dept would not have sent a faxed recredentialing request  If you can provide a copy of the faxed request we can review the address       We will not be providing a credentialing application for this address, please contact whomever sent the fax   Thank you', NULL, NULL, '2020-06-26 10:29:24', '2020-06-26 10:29:24'),
(1676, 2028, 268, NULL, NULL, 'In Process', 'TO: HDOCredentialing2@aetna.com SUB: Re-credentialing application required  Good morning,  I\'ve attached the fax that we received, please let me know what department we will need to contact regarding this request.  Thank you ', NULL, NULL, '2020-06-26 10:31:35', '2020-06-26 10:31:35'),
(1677, 2028, 268, NULL, NULL, 'Approved', 'Rep: mike Contacted Customer Service Center and asked for the re-credentialing  as Mike said that all 3 provider CAQH is updated so Re- credentialing is not required  and also approval is attached.', NULL, NULL, '2020-06-26 14:01:33', '2020-06-26 14:01:33'),
(1678, 2028, 269, NULL, NULL, 'In Process', 'TO: Juliana.Mata@molinahealthcare.com SUB:  Updates for credentialing Hello,  Are there any updates for credentialing of the following group?  The details are as follows. Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI#  1437481421  Please get back to me as soon as you\'re able. Thank you -- ', NULL, NULL, '2020-06-29 12:11:50', '2020-06-29 12:11:50'),
(1679, 2028, 269, NULL, NULL, 'In Process', 'From: Juliana.Mata@molinahealthcare.com Sub: Updates for credentialing  Good morning,  Facility is in process of credentialing.  Please note, credentialing process might take from 30-45 days.     Thank you  ', NULL, NULL, '2020-07-01 16:38:01', '2020-07-01 16:38:01'),
(1680, 2028, 269, NULL, NULL, 'In Process', 'TO: Juliana.Mata@molinahealthcare.com Sub: Updates for credentialing  Hello,  Hope you are doing great, I want to know about the current status of the Group.  The details are as follows: Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421    Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-08 17:49:02', '2020-07-08 17:49:02'),
(1681, 2028, 269, NULL, NULL, 'In Process', 'From: Juliana.Mata@molinahealthcare.com  Sub: Updates for credentialing  Good afternoon,  Per information on our system, contract was forwarded to plan’s president for execution.  Once contract is executed, we will go ahead and forward information to networks billing system to have contract loaded.  Process might take from 30-45 days.     Thank you for your patience', NULL, NULL, '2020-07-13 15:55:14', '2020-07-13 15:55:14'),
(1682, 2028, 269, NULL, NULL, 'In Process', 'TO: Juliana.Mata@molinahealthcare.com   Sub: Updates for credentialing  Hello,  Are there any updates for the credentialing of the following group?  The details are as follows. Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI#  1437481421   Please get back to me as soon as you\'re able. Thank you', NULL, NULL, '2020-07-31 04:15:15', '2020-07-31 04:15:15'),
(1683, 2037, 269, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Follow up email sent to Juliana Mata @ Juliana.Mata@molinahealthcare.com ----------- Hi Juliana, As per the last update provided to us on 07/13/2020. The contract was forwarded to the plan\'s president for execution and that the process for loading might take from 30-45 days. If you could kindly check on the current status for me.The details are as follows.  Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI#  1437481421   Looking forward to hearing from you soon.Thank you! ', NULL, NULL, '2020-10-07 17:27:36', '2020-10-07 17:27:36'),
(1684, 2037, 269, NULL, '2020-10-22 00:00:00.000', 'Approved', 'Approval Email Received :\" ----------------- Good afternoon Sherry,  Per information on our system Bay Area Quick Care is loaded into network billing system with effective date 9/1/2020.  Please see attached for welcome letter', NULL, NULL, '2020-10-15 16:48:50', '2020-10-15 16:48:50'),
(1685, 2028, 271, NULL, NULL, 'In Process', 'Hello,   I need to confirm as it has been 3 months since we received your Email about the closing of the network for our specialty/location. Just need to confirm  if it is still closed?  The details are as follows:  Address: 9929 South padre                 Island Drive                 Suite 109                 Corp Christi. TX Group Name:  Bay Area Quick Care PLLC  TIN# 27-1702009  NPI# 1437481421  Thank you', NULL, NULL, '2020-06-26 14:09:37', '2020-06-26 14:09:37'),
(1686, 2028, 271, NULL, NULL, 'On Hold', 'From: Donna.Penberthy@superiorhealthplan.com SUB: Confirming extending contracts for Medicaid or Medicare  Good morning Samuel,     No, not for Medicaid or Medicare.  We are only extending Commercial Exchange (Ambetter) contracts, if the facility provides Level III care.      Thank you,  Donna', NULL, NULL, '2020-06-29 09:38:31', '2020-06-29 09:38:31'),
(1687, 2028, 271, NULL, NULL, 'In Process', 'From: txcredentialing@amerigroup.com SUB: RE- opening of your network for our specialty/location  Thank you for your interest with Amerigroup Real Solutions - An Anthem Company.    All Credentialing and Contracting related items for Provider Enrollment will be responded to in the order received.    All enrollment inquiries will be responded to via email.    Please note:  Due to COVID-19, Amerigroup has closed down a number of offices until further notice.    We thank you greatly for your patience and understanding.     For other non-credentialing related items, see below:   *Rejected claims – please contact EDI at 1-800-590-5745   *Claims inquiries – please contact the Provider Services Unit at 1-800-454-3730   *Amerivantage Provider Services 1-866-805-4589  *MMP Provider Services 1-855-878-1785   For demographic updates, please contact your assigned Network Relations Consultant.', NULL, NULL, '2020-06-29 10:23:05', '2020-06-29 10:23:05'),
(1688, 2028, 271, NULL, NULL, 'In Process', 'TO: txcredentialing@amerigroup.com SUB: Group - Amerigroup - BAQC  Hello,  Hope you are doing great, I want to know about the current status of the Group.  The details are as follows: Group Name: Bay Area Quick Care PLLC Provider Name: Group TIN# 27-1702009 NPI# 1437481421  Please get back to me as soon as you\'re able.  Thank you ', NULL, NULL, '2020-07-06 10:52:56', '2020-07-06 10:52:56'),
(1689, 2028, 271, NULL, NULL, 'In Process', 'TO: Re- txcredentialing@amerigroup.com SUB: Group - Amerigroup - BAQC  Hello, I was just confirming the closing of the network for our specialty/location and wanted to know if you\'re accepting it now. Thank you', NULL, NULL, '2020-07-06 14:30:48', '2020-07-06 14:30:48'),
(1690, 2028, 271, NULL, NULL, 'In Process', 'TO: txcredentialing@amerigroup.com Sub: (Reminder) Group - Amerigroup - BAQC  Hello,  I was just confirming the closing of the network for our specialty/location and wanted to know if you\'re accepting it now. Please get back to me as you\'re able.  Thank you', NULL, NULL, '2020-07-20 14:24:09', '2020-07-20 14:24:09'),
(1691, 1006, 271, NULL, '2020-08-11 00:00:00.000', 'In Process', 'Received following email from TX Credentialing txcredentialing@amerigroup.com>:   \"Attach a w9 and a demographic form.     List the service address, billing address, phone, fax, office hours and age limits.  Thanks\"  Gave them the requested info. ', NULL, NULL, '2020-08-04 17:53:34', '2020-08-04 17:53:34'),
(1692, 1006, 271, NULL, '2020-08-13 00:00:00.000', 'Rejected', 'Received following update from Amerigroup:  \"Ok, so I see that the location is in Corpus. Amerigroup is currently not in Corpus as far as membership is concerned\"', NULL, NULL, '2020-08-06 17:23:40', '2020-08-06 17:23:40'),
(1693, 2028, 272, NULL, NULL, 'In Process', 'TO: Donna.Penberthy@superiorhealthplan.com Sub: Confirming extending contracts for Medicaid or Medicare  Hello,  We wanted to confirm you\'re still not extending contracts for Superior for UrgentCare providers. As it has been 3 months since we received you\'re last email regarding it. The details are as follows.Group name: Bay Area Quick Care PLLCTax ID:  27-1702009NPI:  1437481421 Please get back to me as soon as you\'re able. Thank you', NULL, NULL, '2020-06-26 14:33:09', '2020-06-26 14:33:09');
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
(1694, 2028, 272, NULL, NULL, 'In Process', 'From: Donna.Penberthy@superiorhealthplan.com SUB: Confirming extending contracts for Medicaid or Medicare  Good morning Samuel,     No, not for Medicaid or Medicare.  We are only extending Commercial Exchange (Ambetter) contracts, if the facility provides Level III care.      Thank you,  Donna', NULL, NULL, '2020-06-29 10:17:01', '2020-06-29 10:17:01'),
(1695, 2028, 272, NULL, NULL, 'On Hold', 'From: Donna.Penberthy@superiorhealthplan.com SUB: Confirming extending contracts for Medicaid or Medicare  Good morning Samuel,     No, not for Medicaid or Medicare.  We are only extending Commercial Exchange (Ambetter) contracts, if the facility provides Level III care.      Thank you,  Donna', NULL, NULL, '2020-06-29 10:26:16', '2020-06-29 10:26:16'),
(1696, 2028, 272, NULL, NULL, 'Rejected', 'cannot provide Medicaid or Medicare services contracts and also cannot provide level III for commercial insurances', NULL, NULL, '2020-07-01 15:45:15', '2020-07-01 15:45:15'),
(1697, 1006, 272, NULL, NULL, 'Revalidation', 'We received the following email from Superior Healthplan @ SHP Network Development NPR Contracting SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com:  Sub: Important request from Superior HealthPlan  \"Hello Provider,  We received a request for TIN 27-1702009 to receive a new contract from Superior Health Plan.   In order to process your request:  Ø  Can you provide me the name of the group/ facility or if (provider) practices alone? Ø  Please respond with a copy of your W9. Ø  Does the provider want to participate with all of our products (Medicaid, Chip, Medicare, and Ambetter)? Ø  Please provide a good call back number.  Without a response, we are unable to move forward.   Jeannie Lopez Superior Health Plan | Network Operations\"  Replied to them with requested information. ', NULL, NULL, '2021-05-10 12:16:57', '2021-05-10 12:16:57'),
(1698, 1006, 272, NULL, '2021-06-17 00:00:00.000', 'Revalidation', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Important request from Superior HealthPlan Hello,   Please find the requested information below:  Group Name: Bay Area Quick Care PLLC Yes, we wish to participate in all products. Call back# 713-893-6214 W9 is attached for your reference, please let me know if anything else is required and what the expected timeframe is for this to be completed?  Thank you. ', NULL, NULL, '2021-06-10 12:33:02', '2021-06-10 12:33:02'),
(1699, 1006, 272, NULL, '2021-06-18 00:00:00.000', 'Revalidation', 'Sent f/u email @ SHP Network Development NPR Contracting SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com:  Sub: Enrollment Status - BAQC - Superior Health  \"Hello,  I wanted to get an update regarding the enrollment status for the following group and providers:   Group Name: Bay Area Quick Care PLLC NPI# 1437481421 TIN# 27-1702009  Provider Name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: Francis William NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  Please get back to me as soon as possible. Thank you.\"', NULL, NULL, '2021-06-11 11:48:31', '2021-06-11 11:48:31'),
(1700, 1006, 272, NULL, '2021-06-22 00:00:00.000', 'Revalidation', 'Left voicemail @ (877) 687-1196 asking for enrollment updates as we\'re not getting any updates through the email.  ', NULL, NULL, '2021-06-15 12:04:03', '2021-06-15 12:04:03'),
(1701, 1006, 272, NULL, '2021-06-23 00:00:00.000', 'Revalidation', 'We received the following reply from Credentialing Credentialing@superiorhealthplan.com:  Sub: 1437481421  \"Good Morning,  We received a voice message from you and I am happy to assist you. I understand that you would like to check the status for NPI: 1437481421.  I do not currently show information for this provider. The process to inquire about a new contract/adding provider or service to your existing contract begins by completing a Network Participation Inquiry through our website.   http://www.superiorhealthplan.com/for-providers/join-our-network/  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com\"  Submitted ancillary enrollment request, attached in main group task for reference. ', NULL, NULL, '2021-06-16 16:38:32', '2021-06-16 16:38:32'),
(1702, 1006, 272, NULL, '2021-07-09 00:00:00.000', 'Revalidation', 'We rcvd the following reply from SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"We received your signed contract. However, we have not received your Credentialing Application packet. Attached is the email that was sent. Please complete the forms & return along with a copy of your current W9 so that we can start the process.  Thank you, Leslie Gilchrist Intake Coordinator Contract Management\"  Replied with:  \"Hello Leslie,  Please find the requested documents attached, do let me know if anything else is required.  Thank you. \"  The ancillary contracting request is attached in the main group task for reference. ', NULL, NULL, '2021-07-02 11:00:24', '2021-07-02 11:00:24'),
(1703, 1006, 272, NULL, '2021-07-30 00:00:00.000', 'Revalidation', 'Sent f/u email @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,   I wanted to get an update regarding the enrollment status for our provider. Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-23 14:30:27', '2021-07-23 14:30:27'),
(1704, 1006, 272, NULL, '2021-08-17 00:00:00.000', 'Revalidation', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,  We received your completed application on July 2, 2021 Your projected effective date is August 1, 2021. Currently, it is in the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Sincerely,  Lucy Escobar Lead Contracts Coordinatoor, Contract Management\"  Need to allow more time for it to process and complete. ', NULL, NULL, '2021-08-10 12:59:14', '2021-08-10 12:59:14'),
(1705, 11056, 272, NULL, '2021-08-27 00:00:00.000', 'Revalidation', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Hello,   I appreciate the update, I just wanted to confirm what the status for the ancillary contract is as well?  Thank you. ', NULL, NULL, '2021-08-20 10:21:53', '2021-08-20 10:21:53'),
(1706, 11056, 272, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope this email finds you well. Whenever the application is uploaded and the provider\'s enrollment is completed, please inform us. Please keep us updated with the process. Please let us know the latest status for the ancillary contract too.  If you need any document or information feel free to reach out to me. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-30 10:20:55', '2021-08-30 10:20:55'),
(1707, 11056, 272, NULL, '2021-10-01 00:00:00.000', 'Revalidation', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope you are doing well. We are still waiting to get the latest updates regarding the enrollment status of the below mentioned providers and practice as soon as possible. We haven\'t received the welcome packet yet.   Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148  Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	  1336173244 Melissa Ramsden	1194376228    If you have any questions or concerns please let me know. Eagerly,waiting to get the response from you.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-24 09:12:45', '2021-09-24 09:12:45'),
(1708, 11056, 272, NULL, '2021-10-05 00:00:00.000', 'Revalidation', 'Email received from : Jeannie.Lopez@superiorhealthplan.com  Sub : Superior HealthPlan Participating Provider Agreement - BAY AREA QUICK CARE (534990) has been Signed and Filed    Attached is the final agreement for your reference. You can also open it online to review its activity history.', NULL, NULL, '2021-09-28 13:32:58', '2021-09-28 13:32:58'),
(1709, 11056, 272, NULL, '2021-10-18 00:00:00.000', 'Revalidation', 'Email received from : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Hello  We received your completed application for Melissa Ramsden on 7/2/21. Your effective date is 8/1/21  and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-10-11 09:53:33', '2021-10-11 09:53:33'),
(1710, 11056, 272, NULL, '2021-10-25 00:00:00.000', 'Revalidation', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Please assist me with the query at your earliest convenience. Does the Superior Health plan come under Medicare or Medicaid?', NULL, NULL, '2021-10-18 09:05:00', '2021-10-18 09:05:00'),
(1711, 11056, 272, NULL, '2021-11-02 00:00:00.000', 'Revalidation', 'Email received from: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Good morning!  Hope all is well. Please find the attached forms for the remaining providers mentioned below. If further information or documents are needed please let me know.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148 Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	1336173244   In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-10-26 09:59:17', '2021-10-26 09:59:17'),
(1712, 11056, 272, NULL, '2021-11-11 00:00:00.000', 'Revalidation', 'Email received from :SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Hello     Thank you for your email. However, your Account Manager can best assist you with your questions.        Find my Account Manager:  https://www.superiorhealthplan.com/providers/resources/find-my-provider-rep.html', NULL, NULL, '2021-11-04 14:41:23', '2021-11-04 14:41:23'),
(1713, 11056, 272, NULL, '2021-11-25 00:00:00.000', 'Revalidation', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Good morning!  Hope all is well with you. Please respond to my query at your earliest convenience.  Also, provide us with the contact no. and the Account Manager\'s email for our further assistance.  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, '2021-11-18 16:53:15', '2021-11-18 16:53:15'),
(1714, 11056, 272, NULL, '2021-12-08 00:00:00.000', 'Revalidation', 'Email received from:  AM.Houston@superiorhealthplan.com  Sub:  [secure]RE: MELISSA RAMSDEN  Hi, All of the requested information for Kynda Orsak NPI: 1528553724 & Cynthia Malowitz NPI: 1336173244 been received and they are still in the credentialing phase. Please reference ticket # 69145 if you have any questions.   Sincerely,  Barbara McDonald  Account Manager, Provider Relations Region 7 (Harris & Jefferson)   ', NULL, NULL, '2021-12-01 12:05:33', '2021-12-01 12:05:33'),
(1715, 11056, 272, NULL, '2021-12-15 00:00:00.000', 'Revalidation', 'Email received from:  AM.Houston@superiorhealthplan.com  Sub:  [secure]Credentialing Updates   Hi, Both providers Kynda Orsak NPI: 1528553724 & Cynthia Malowitz NPI: 1336173244 are still being credentialed. It can take anywhere from 3 to 6 months to complete the process. The applications were received on 10/13/2021 and are still within the 3 month time frame. Please reference ticket #70273 if you have any questions.   Sincerely,       Barbara McDonald Account Manager, Provider Relations Region 7 (Harris & Jefferson)   711 N. Carancahua Street, Ste. 600 Corpus Christi, TX 78401 Direct Line: 1 (800)656-4817 Press 1 for English or 2 for Spanish, then option #3 for Provider Relations Fax: 1-866-683-5630 AM.houston@superiorhealthplan.com | SuperiorHealthPlan.com', NULL, NULL, '2021-12-08 14:23:34', '2021-12-08 14:23:34'),
(1716, 11056, 272, NULL, '2021-12-23 00:00:00.000', 'Revalidation', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Case 70277 RE: MELISSA RAMSDEN   & RE: MELISSA RAMSDEN  [secure]Credentialing Updates   Good morning!  Hope all is well with you. Kindly, update us regarding reference ticket # 69145, and with a credentialing phase of the providers, Kynda Orsak NPI: 1528553724 & Cynthia Malowitz NPI: 1336173244  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-12-16 17:56:20', '2021-12-16 17:56:20'),
(1717, 11056, 272, NULL, '2021-12-29 00:00:00.000', 'Revalidation', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Sub: [secure] RE: [secure]Credentialing Updates   Hello Talha,     I hope this email finds you well. I reviewed both providers and am reflecting them to be in the credentialing process. Please take note credentialing review can take up to 90 days for completion.     Cynthia Malowitz- 1336173244 shows to be under review for 64 days  Kynda Orsak – 1528553724 shows to be under review for 64 days     Thank you,     Patricia Torres  Provider Account Manager II 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', NULL, NULL, '2021-12-22 17:13:23', '2021-12-22 17:13:23'),
(1718, 22077, 272, NULL, '2022-04-29 00:00:00.000', 'Revalidation', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Query || BAQC || Group || Superior Health || - REF # 79267  Hi,  I would like to know the status of our group and if it\'s expired I want to revalidate it.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary & Billing Address	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 07:47:31', '2022-04-22 07:47:31'),
(1719, 22077, 272, NULL, '2022-04-29 00:00:00.000', 'Revalidation', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Query || BAQC || Group || Superior Health || - REF # 79267  Good morning,     Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #91178     If you are in need of immediate assistance, you can call to speak to an Account Manager by phone at 1-800-656-4817 (English 1, Spanish 2), and Option 3  Provider Relations Team', NULL, NULL, '2022-04-22 09:53:14', '2022-04-22 09:53:14'),
(1720, 2028, 274, NULL, NULL, 'Rejected', NULL, NULL, NULL, '2020-07-01 15:12:42', '2020-07-01 15:12:42'),
(1721, 2028, 278, NULL, NULL, 'In Process', ' To: wwtxcontracts@texasmutual.com Sub: Group - Texas Mutual Workers Comp - CBUC Hello,  Hope you are doing great, I would like to know when can we expect this request to be complete? There was supposed to be a site visit but it was cancelled due to the non-essential travel ban.   The details are as follows: Group Name: Coastal Bend Urgent Care TIN# 81-1890349 NPI# 1427509264  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-09 15:38:44', '2020-07-09 15:38:44'),
(1722, 2028, 278, NULL, NULL, 'On Hold', 'From: wwtxcontracts@texasmutual.com Sub: Group - Texas Mutual Workers Comp - CBUC  I sincerely apologize for the delay in finalizing your addition to our network due to the travel ban.  Unfortunately, we cannot bypass the requirement of an on-site visit and physical inspection, and I am still not allowed to travel to a clinic to do the visit.     Since we are in the final stages of the credentialing process, please use our out-of-network request form to request approval to treat network patients.  You can download the form here.  This does not guarantee acceptance into the network, but it gives you the ability to start treating network patients until we can complete the credentialing process.  This form will need to be completed on a claim-by-claim basis.     Thank you, and please let me know if you run into any issues.', NULL, NULL, '2020-07-14 14:18:22', '2020-07-14 14:18:22'),
(1723, 2037, 278, NULL, '2020-11-07 00:00:00.000', 'In Process', 'Follow up email sent to wwtxcontracts@texasmutual.com ---------- Greetings,  As per the last update provided to us on 07/14/2020.Finalizing our addition to our network was delayed due to the travel ban and requirement of an on-site visit is mandatory. Just wanted to double check if travelling to the clinic for a visit is a possibility for you now or at any point in the near future? The details are as follows:  Group Name: Coastal Bend Urgent Care TIN# 81-1890349 NPI# 1427509264 ', NULL, NULL, '2020-10-07 17:40:00', '2020-10-07 17:40:00'),
(1724, 2037, 278, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Follow up email sent to Ryan for scheduling the onsite visit with the insurance.', NULL, NULL, '2020-11-09 10:23:35', '2020-11-09 10:23:35'),
(1725, 2037, 278, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Virtual Site Survey Scheduled for 11/20/2020 With Matt', NULL, NULL, '2020-11-09 12:10:09', '2020-11-09 12:10:09'),
(1726, 2037, 278, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Virtual site visit in process', NULL, NULL, '2020-11-20 14:30:34', '2020-11-20 14:30:34'),
(1727, 2037, 278, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Waiting for the response from Matt', NULL, NULL, '2020-11-30 17:52:58', '2020-11-30 17:52:58'),
(1728, 2037, 278, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Email sent to Ryan regarding the virtual site visits', NULL, NULL, '2020-12-08 14:54:48', '2020-12-08 14:54:48'),
(1729, 2037, 278, NULL, '2020-12-23 00:00:00.000', 'In Process', ' Matt Gorman Fri, Dec 11, 11:28 AM (5 days ago) to me  Hi Sherry!  Sorry for the delay.     Ryan did GREAT on both clinics, and everything came out very well.  Both clinics passed with flying colors.     I just verified with our Credentialing team that both clinics will be presented to the Committee next week for approval.  This should allow them to go live on January 1st should they be approved (I see no reason why they shouldn’t be approved, but we’ll let the process play out).     Thanks, and have a wonderful Christmas season!  ____________________________________________________  Matt Gorman, CPCU, AINS, ARC, AIM, API, AIC, AIS, SPPA  Provider Relations Consultant  Texas Mutual Policyholder Services (512) 224-2747 Office   |   (512) 224-8826 Fax  mgorman@texasmutual.com', NULL, NULL, '2020-12-16 17:58:22', '2020-12-16 17:58:22'),
(1730, 2037, 278, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Need to allow more time.', NULL, NULL, '2020-12-23 10:51:23', '2020-12-23 10:51:23'),
(1731, 1006, 278, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Sent a follow-up email @ Matt Gorman MGorman@texasmutual.com for updated status.  ', NULL, NULL, '2021-01-04 18:00:26', '2021-01-04 18:00:26'),
(1732, 1006, 278, NULL, '2021-01-12 00:00:00.000', 'Approved', 'Good morning Brad.     Coastal Bend was presented to our Credentialing Committee last month and approved for network participation.  Official start date was January 1st, 2021.      Welcome to the team, and please never hesitate to reach out to me should you encounter any problems.     Have a safe and happy 2021!!  ____________________________________________________  Matt Gorman, CPCU, AINS, ARC, AIM, API, AIC, AIS, SPPA  Provider Relations Consultant  Texas Mutual Policyholder Services (512) 224-2747 Office   |   (512) 224-8826 Fax  mgorman@texasmutual.com  ', NULL, NULL, '2021-01-05 10:25:18', '2021-01-05 10:25:18'),
(1733, 2028, 280, NULL, NULL, 'In Process', 'TO: michal.simms@christushealth.org SUB: Flynn, Mercedita N - Christus Spohn - CBUC  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Coastal Bend Urgent Care Provider Name: Flynn, Mercedita N TIN# 81-1890349NPI# 1619166188  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-06 13:52:34', '2020-07-06 13:52:34'),
(1734, 2028, 280, NULL, NULL, 'In Process', 'FROM: michal.simms@christushealth.org Sub: Flynn, Mercedita N - Christus Spohn - CBUC  Hello Samuel,     Beeville Medical Center is contracted as an Ancillary provider effective 4/1/2018, and claims are submitted under Beeville Medical Center, not the practitioner.     We do have Mercedita Flynn attached to that ancillary record and she is in the process of being recredentialed.     Please contact CHRISTUS.HP.Credentialing@christushealth.org if you need additional credentialing status information.     Best regards, Michal     Ms. Michal Simms  Network Contractor  CHRISTUS Health Plan  (c) 972-896-5417     www.christushealthplan.org     Dignity. Integrity. Excellence. Compassion. Stewardship.     ** Credentialing status and updates can be obtained by emailing CHRISTUS.HP.Credentialing@christushealth.org**   ', NULL, NULL, '2020-07-07 09:54:03', '2020-07-07 09:54:03'),
(1735, 2028, 280, NULL, NULL, 'In Process', 'TO: 	CHRISTUS.HP.Credentialing@christushealth.org SUB:  Flynn, Mercedita N - Christus Spohn - CBUC  Hello,  Hope you are doing great, I need additional credentialing status information of the provider.  The details are as follows: Group Name: Coastal Bend Urgent Care Provider Name: Flynn, Mercedita N TIN# 81-1890349 NPI# 1619166188  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-07 10:16:41', '2020-07-07 10:16:41'),
(1736, 2028, 280, NULL, NULL, 'In Process', 'rep: Yolanda will give a call back, for the approval letter no reference number', NULL, NULL, '2020-07-15 13:04:39', '2020-07-15 13:04:39'),
(1737, 2028, 280, NULL, NULL, 'In Process', 'To: CHRISTUS.HP.Credentialing@christushealth.org Sub: Flynn, Mercedita N - Christus Spohn - CBUC  Hope you are doing great, I need a Welcome letter for the provider. The effective date is 4/1/2018.  The details are as follows: Group Name: Coastal Bend Urgent Care Provider Name: Flynn, Mercedita N TIN# 81-1890349 NPI# 1619166188  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-16 11:18:22', '2020-07-16 11:18:22'),
(1738, 2028, 280, NULL, NULL, 'In Process', 'TO: michal.simms@christushealth.org Sub: Coastal Bend Urgent Care LLC(CHP)  Good afternoon,     An executed copy of our contract for Coastal Bend Urgent Care LLC is attached for your records.     Thanks, Michal', NULL, NULL, '2020-07-16 14:05:51', '2020-07-16 14:05:51'),
(1739, 2028, 280, NULL, NULL, 'In Process', 'To: michal.simms@christushealth.org Sub: Coastal Bend Urgent Care LLC(CHP)  Hello,   We would also like to add this address for the provider, 504A Houston Street George West TX 78022 and the request for the address is from 5/8/2020.  The details are as follows: Group Name: Coastal Bend Urgent Care Provider Name: Flynn, Mercedita N TIN# 81-1890349 NPI# 1619166188  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-16 14:19:26', '2020-07-16 14:19:26'),
(1740, 2028, 280, NULL, NULL, 'In Process', 'From: michal.simms@christushealth.org Sub: Coastal Bend Urgent Care LLC(CHP)  After further review, your request was submitted internally in April, however I am checking with Provider Data as I don’t see the second address in the system.     Our quick reference guide is attached for your records.     Thanks, Michal', NULL, NULL, '2020-07-16 14:20:50', '2020-07-16 14:20:50'),
(1741, 2028, 280, NULL, NULL, 'In Process', 'To: michal.simms@christushealth.org Sub: Coastal Bend Urgent Care LLC(CHP)  Hope you are doing great. I need the second address updated which is  504A Houston Street George West Tx 78022, till when will it be possible for you to add the address for this provider?  The details are as follows: Group Name: Coastal Bend Urgent Care Provider Name: Flynn, Mercedita N TIN# 81-1890349 NPI# 1619166188  Please get back to me as soon as you\'re able.', NULL, NULL, '2020-07-20 09:14:01', '2020-07-20 09:14:01'),
(1742, 2028, 280, NULL, NULL, 'In Process', 'Rep: Brea As per rep, they are not available who can help you for the address update can call back any other time (844) 282-3025 REF: No number provided as she doesn\'t have access.', NULL, NULL, '2020-07-21 10:32:02', '2020-07-21 10:32:02'),
(1743, 2028, 280, NULL, NULL, 'In Process', 'Rep: Alisea As per rep, it will take some time. also have takin the callback number, and said will let you know when 2nd address update will be done. ref: Alisea 7-22-2020 ', NULL, NULL, '2020-07-22 16:20:14', '2020-07-22 16:20:14'),
(1744, 2037, 280, NULL, '2020-10-22 00:00:00.000', 'In Process', 'Follow up email sent for address addition request for CBUC (URGENT CARE CONTRACT) to Michal Simms. Reference email as follows: --------------------------- Hello Michal, Hope this email finds you well.If I may get a confirmation of the secondary location address addition request for the below mentioned facility. Coastal Bend Urgent Care, LLC Tax ID                       : 81-1890349 NPI                            : 1427509264 Primary Location     : 301 S HILLSIDE DR STE 4                                     County BEE                                    BEEVILLE , TX 78102-5324Secondary Location: 504A Houston Street                                     Live Oak County                                      George West , TX 78022-3663.', NULL, NULL, '2020-10-02 17:44:50', '2020-10-02 17:44:50'),
(1745, 2037, 280, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Following up for written confirmation: ----------- Greetings, We got a confirmation over the call that the secondary location has been added.If we may get a written confirmation of the same, that would be great.Reference # FL01225667  Coastal Bend Urgent Care, LLC Tax ID                       : 81-1890349 NPI                            : 1427509264 Primary Location     : 301 S HILLSIDE DR STE 4                                     County BEE                                    BEEVILLE , TX 78102-5324Secondary Location: 504A Houston Street                                     Live Oak County                                      George West , TX 78022-3663.Thank you.', NULL, NULL, '2020-10-23 16:59:43', '2020-10-23 16:59:43'),
(1746, 2037, 280, NULL, '2020-11-02 00:00:00.000', 'Approved', 'CBUC is contracted as an Urgent Care Contract effective 04/01/2018', NULL, NULL, '2020-10-26 10:29:59', '2020-10-26 10:29:59'),
(1747, 3040, 282, NULL, '2021-06-24 00:00:00.000', 'Revalidation', 'Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067    Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-17 08:30:05', '2021-06-17 08:30:05'),
(1748, 3040, 282, NULL, '2021-07-12 00:00:00.000', 'Revalidation', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group under the below mentioned locations. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429  Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:- Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067   Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI : 1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 15:25:55', '2021-07-05 15:25:55'),
(1749, 3040, 282, NULL, '2021-07-27 00:00:00.000', 'Revalidated', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Mini Chennemkara is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 03/01/2016,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider James Piccione is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 05/29/2019,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/01/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Jeemol George is Active, effective date 06/09/2020,  Provider Julie Jose is Active, effective date 06/09/2020,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf 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', NULL, NULL, '2021-07-20 08:32:35', '2021-07-20 08:32:35'),
(1750, 2028, 283, NULL, NULL, 'In Process', 'REP: Nitasha starpulus cigna .com -> provider resource -> form fill the forms and send it to the given address which is mentioned on the forms', NULL, NULL, '2020-07-07 10:05:41', '2020-07-07 10:05:41'),
(1751, 2028, 283, NULL, NULL, 'Initiated', 'TO: MedicaidProviderOperations@healthspring.com Sub: Aizon, Bernice - Cigna Healthspring - CBUC Hello, Here are the attachments for the provider Bernice Aizon. Please get back to me as soon as you\'re able.  Thank you -- ', NULL, NULL, '2020-07-07 18:28:34', '2020-07-07 18:28:34'),
(1752, 2028, 283, NULL, NULL, 'In Process', 'Rep: Nikki As per rep the information for the provide could not be pull out through both NPI numbers instead provided an email address where I sent the documentation for Cigna healthspring.', NULL, NULL, '2020-07-20 09:35:31', '2020-07-20 09:35:31'),
(1753, 2028, 283, NULL, NULL, 'In Process', 'To: MedicaidProviderOperations@healthspring.com Sub: Aizon, Bernice - Cigna Healthspring - CBUC Hello,  Hope you are doing great, I want to know about the current status of the Provider. The details are as follows:  Group Name: Coastal Bend Urgent Care, LLC Provider Name: Aizon, Bernice TIN# 81-1890349 NPI# 1083177984    Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-20 09:44:13', '2020-07-20 09:44:13'),
(1754, 2028, 283, NULL, NULL, 'Rejected', NULL, NULL, NULL, '2020-07-21 15:40:04', '2020-07-21 15:40:04'),
(1755, 2037, 285, NULL, '2020-10-16 00:00:00.000', 'Approved', 'Below Location is successfully . Added to the provider\'s profile.  301 S HILLSIDE DR STE 4 County BEE BEEVILLE , TX 78102-5324  ', NULL, NULL, '2020-10-09 17:05:55', '2020-10-09 17:05:55'),
(1756, 2028, 286, NULL, NULL, 'Initiated', 'Online application Faxed Fax #  6082217535', NULL, NULL, '2020-06-29 17:13:19', '2020-06-29 17:13:19'),
(1757, 2028, 286, NULL, NULL, 'In Process', 'TO: KMoten4@humana.com SUB: Aizon, Bernice - Tricare - (CBUC)  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Coastal Bend Urgent Care Provider Name: Aizon, Bernice TIN# 81-1890349 NPI# 1427509264   Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-09 16:49:28', '2020-07-09 16:49:28'),
(1758, 2028, 286, NULL, NULL, 'In Process', 'From: KMoten4@humana.com SUB: RE: Aizon, Bernice - Tricare - (CBUC)  Good Afternoon,     This provider is not showing certified in the system. It can take up to 120 days from when application was submitted to WPS.     Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana  T 502-318-5250  F 210-239-0401  kmoten4@humana.com  HumanaMilitary.com   ', NULL, NULL, '2020-07-10 09:19:44', '2020-07-10 09:19:44'),
(1759, 2028, 286, NULL, NULL, 'In Process', 'TO: KMoten4@humana.com Sub: Re: Secured: RE: Aizon, Bernice - Tricare - (CBUC)  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: Coastal Bend Urgent Care Provider Name: Aizon, Bernice TIN# 81-1890349 NPI# 1083177984   Please get back to me as soon as you\'re able.  Thank you ', NULL, NULL, '2020-07-23 12:48:58', '2020-07-23 12:48:58'),
(1760, 2028, 286, NULL, NULL, 'In Process', 'To: KMoten4@humana.com Sub: RE: Secured: RE: Aizon, Bernice - Tricare - (CBUC)  This provider is showing credentialed with your group as of 11/17/19.  Thank you.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com  ', NULL, NULL, '2020-07-24 09:14:24', '2020-07-24 09:14:24'),
(1761, 2028, 286, NULL, NULL, 'In Process', 'To: Katherine Moten KMoten4@humana.com Sub: Re: Secured: RE: Secured: RE: Aizon, Bernice - Tricare - (CBUC)  Hello,  Hope you\'re doing great, as in your last email you provided me the effective date for the provider, I would like to make a request for the welcome letter for Aizon, Bernice and also please confirm me with the address that shows on your records. It should be as below.  The details are as follows: Group Name: Coastal Bend Urgent Care, LLC Provider Name: Aizon, Bernice TIN# 81-1890349 NPI# 1083177984 Primary address: 301 S HILLSIDE DR STE 4 County BEE BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street George West TX 78022-3663    Please get back to me as soon as you\'re able.  Thank you ', NULL, NULL, '2020-07-28 13:13:01', '2020-07-28 13:13:01'),
(1762, 2028, 286, NULL, NULL, 'In Process', 'From: KMoten4@humana.com Sub: Secured: RE: Secured: RE: Secured: RE: Secured: RE: Aizon, Bernice - Tricare - (CBUC)  When a provider is certified with Humana Military, you receive a Welcome Letter from WPS ( our claims processing company). I do not have access to those letters since WPS is a third party company and will not be able to provide those. (no. for WPS is 1-800-444-5445)', NULL, NULL, '2020-07-28 16:58:05', '2020-07-28 16:58:05'),
(1763, 2028, 286, NULL, NULL, 'In Process', 'Name: Grg ( 1-800-444-5445) Took the Fax number and have sent the Welcome letter. ref: 9803476', NULL, NULL, '2020-07-28 16:59:48', '2020-07-28 16:59:48'),
(1764, 2028, 286, NULL, NULL, 'Approved', 'Welcome letter received also attached', NULL, NULL, '2020-07-29 13:17:50', '2020-07-29 13:17:50'),
(1765, 3040, 295, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Email sent to: ywyatt@humana.com  Subject: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,   Hope you are doing well. I wanted to add the location under the below mentioned providers in Tricare in our group under the below mentioned locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Jose, Julie Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:   Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-09 14:33:10', '2021-07-09 14:33:10'),
(1766, 11056, 295, NULL, '2021-08-18 00:00:00.000', 'Revalidation', 'Email received from :    ywyatt@humana.com  Sub : Fwd: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Morning Adil,     To add a provider to a network location you need to complete the attached spreadsheet and email it to the HGB Roster team to process.     Send the completed spreadsheet to the following email address     HGBProviderRosters@Humana.com              Thanks,  Yvonne', NULL, NULL, '2021-08-11 11:31:58', '2021-08-11 11:31:58'),
(1767, 3040, 295, NULL, '2021-08-25 00:00:00.000', 'Revalidation', 'Email sent to: HGBProviderRosters@humana.com, ywyatt@humana.com  Subject: Re: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Received Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in an additional location in Tricare in our group under the below highlighted locations. We already submitted the roster for an additional location on 07/19/2021.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:     Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:    Provider Name: Rauf, Abdur   Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:    Provider Name: Thomas, Cini   Provider NPI# 1134777238  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:    Provider Name: Abraham, Jeena   Provider NPI# 1467901587  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!! ', NULL, NULL, '2021-08-18 16:51:50', '2021-08-18 16:51:50'),
(1768, 10057, 295, NULL, '2021-11-08 00:00:00.000', 'Revalidation', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks, Yvonne W. Wyatt, Humana Military  TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax  ywyatt@humana.com', NULL, NULL, '2021-11-01 11:50:26', '2021-11-01 11:50:26'),
(1769, 10057, 295, NULL, '2021-11-18 00:00:00.000', 'Revalidation', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:24:20', '2021-11-11 17:24:20'),
(1770, 10057, 295, NULL, '2021-12-16 00:00:00.000', 'Revalidation', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning,  Hope this email finds you well. Could you please let me know the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 09:49:08', '2021-12-02 09:49:08'),
(1771, 10057, 295, NULL, '2021-12-22 00:00:00.000', 'Revalidation', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Steve,  The status is listed below. You can check status by using the self-service Provider Portal.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt, TRICARE Community Liaison II Humana Military', NULL, NULL, '2021-12-15 13:31:28', '2021-12-15 13:31:28'),
(1772, 10057, 295, NULL, '2021-12-29 00:00:00.000', 'Revalidation', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Thank you for reaching out. Unfortunately, we do not have access to the provider self service portal. Is there any way that we can get the status for below mentioned providers enrollment status?  Your earliest response will be highly appreciated.  Kind Regards, Steve Albert ', NULL, NULL, '2021-12-21 15:14:49', '2021-12-21 15:14:49'),
(1773, 10057, 295, NULL, '2022-01-05 00:00:00.000', 'Revalidation', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  We are requesting Providers to create a log in on the Provider Portal highlighted below is the link', NULL, NULL, '2021-12-29 13:10:25', '2021-12-29 13:10:25'),
(1774, 20067, 295, NULL, '2022-01-25 00:00:00.000', 'Revalidation', 'Email sent to: ywyatt@humana.com   Sub: Enrollment Status Query -  Longpoint Medical Center - Tricare   Good Morning! Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned providers.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Mini Chennemkara	1841755956 James Piccione JR	1356321509 Ani Stephen	1588959118 Molly Joseph	1396380077  Thanks & Regards Syed Ahad', NULL, NULL, '2022-01-18 10:13:40', '2022-01-18 10:13:40'),
(1775, 20067, 295, NULL, '2022-01-26 00:00:00.000', 'Revalidation', 'Email received from: ywyatt@humana.com  Sub: Enrollment Status Query - Longpoint Medical Center - Tricare  Good Morning  Syed,  We show all four Providers has been added.  You can check status on a provider by using our self  service Provider Portal see the link highlighted below.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt,  TRICARE Community Liaison II  Humana Military', NULL, NULL, '2022-01-19 09:44:12', '2022-01-19 09:44:12'),
(1776, 20067, 295, NULL, '2022-02-28 00:00:00.000', 'Revalidation', 'Email sent to: ywyatt@humana.com  Sub: Revalidation Query - James Piccione - Longpoint Medical Center - Tricare  Good Afternoon!  Hope you had a great weekend. I would like to begin the revalidation process for the below-mentioned provider.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI James Piccione	1356321509  Kindly let me know what is the next step.  Regards,', NULL, NULL, '2022-02-21 14:20:14', '2022-02-21 14:20:14');
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
(1777, 20067, 295, NULL, '2022-03-04 00:00:00.000', 'Revalidated', 'Email received from: ywyatt@humana.com  Sub: Revalidation Query - James Piccione - Longpoint Medical Center - Tricare  Good Afternoon Syed,  I am not sure what you are asking. We show this Tax id and individual Provider as non-network and is TRICARE certified.  We show these individual providers as non-network and Tricare certified to see the Tricare Beneficiaries with the following Tricare Plans.  Tricare Select Tricare for Life Tricare Reserve Select Tricare Retired Reserve Tricare Retired Reserved Tricare Young Adult  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.', NULL, NULL, '2022-02-25 16:55:15', '2022-02-25 16:55:15'),
(1778, 2037, 300, NULL, '2021-03-19 00:00:00.000', 'On Hold', 'Panels are closed.', NULL, NULL, '2020-10-12 14:10:08', '2020-10-12 14:10:08'),
(1779, 1006, 300, NULL, '2021-06-25 00:00:00.000', 'Initiated', 'Sent following enrollment query @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Tricare  \"Hello Yvonne,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Tricare and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \" ', NULL, NULL, '2021-06-18 14:59:28', '2021-06-18 14:59:28'),
(1780, 1006, 300, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Tricare  \"Hello Yvonne,  I wanted to get an update regarding the status of enrollment for the mentioned group. Please get back to me as soon as you\'re able to.   Thank you!\"', NULL, NULL, '2021-06-28 09:31:23', '2021-06-28 09:31:23'),
(1781, 11056, 300, NULL, '2021-07-24 00:00:00.000', 'In Process', 'Email received from : ywyatt@humana.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - Tricare  Good Afternoon Brad,  We show this group tax id as non-network and TRICARE certified who can see Tricare Beneficiaries with the following Tricare Plans.  Tricare Select Tricare for Life Tricare Reserve Select Tricare Retired Reserve Tricare Retired Reserved Tricare Young Adult  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston', NULL, NULL, '2021-07-16 15:39:18', '2021-07-16 15:39:18'),
(1782, 11056, 300, NULL, '2021-07-27 00:00:00.000', 'Not Eligible', 'Email received from : ywyatt@humana.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - Tricare  Good Morning Ahmed,        Humana Military thanks you for your interest in joining the TRICARE East Region network to provide care for our beneficiaries.  At this time, we are not currently expanding our network based on your specialty and location within the East Region.  Please understand that every market is different based on the beneficiary population, and the types of services needed in a particular location.  We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future. Thank you again for your inquiry     As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary     •            Tricare Select   •            Tricare for Life  •            Tricare Reserve Select  •            Tricare Retired Reserve  •            Tricare Retired Reserved  •            Tricare Young Adult        Thanks,  Yvonne W. Wyatt,  Humana Military  TRICARE Community Liaison II  Houston/Galveston  502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com', NULL, NULL, '2021-07-20 13:45:11', '2021-07-20 13:45:11'),
(1783, 2028, 307, NULL, NULL, 'In Process', 'TO: txcredentialing@amerigroup.com SUB: Adeoye, Segun P - Amerigroup - NASAHC  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: NASA Health Clinic  Provider Name: Adeoye, Segun P TIN# 47-2682655 NPI# 1629418025  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-01 17:59:50', '2020-07-01 17:59:50'),
(1784, 2028, 307, NULL, NULL, 'In Process', 'TO: txcredentialing@amerigroup.com SUB: (Reminder) Adeoye, Segun P - Amerigroup - NASAHC  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows: Group Name: NASA Health Clinic Provider Name: Adeoye, Segun P TIN# 47-2682655  NPI# 1629418025  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-09 11:29:29', '2020-07-09 11:29:29'),
(1785, 2028, 307, NULL, NULL, 'In Process', 'As per rep the address is 21214 n w fair ws Sybaris TX which is wrong have to call for address update', NULL, NULL, '2020-07-17 16:57:39', '2020-07-17 16:57:39'),
(1786, 2028, 307, NULL, NULL, 'In Process', 'Rep: Caela As per rep, the provider address for Adeoye Segun they have is 21214 n w fair w s  Sybaris TX and for the group, they have the only primary address which is 985 NASA Parkway Houston, TX 77058-3039 for both the groups Nasa Urgent Care and Nasa health clinic for address update email txcredentialing@amerigroup.com Ref: i-114725607', NULL, NULL, '2020-07-27 17:10:59', '2020-07-27 17:10:59'),
(1787, 2028, 307, NULL, NULL, 'In Process', 'To: txcredentialing@amerigroup.com Sub: Adeoye, Segun P - Amerigroup - NASAHC  Hello, Hope you\'re doing great, I have spoken with the customer service regarding an issue with the address of the provider Segun P Adeoye as it showed in you records 21214 n w fair w s Sybaris TX, which is wrong and also I have confirmed that the address for the group that show on your end is the primary address only as they cannot see the secondary and tertiary addresses for the group, please update it The details are as follows: Group Name: NASA Health Clinic Provider Name: Adeoye, Segun P TIN# 47-2682655 Individual NPI# 1629418025Group NPI#  1740661453Primary address: 985 NASA Parkway, Houston, TX 77058-3039Secondary address: 3623 S. Main St. Suite 109, Stafford TX 77477-5406Tertiary address: 2101 Raspberry Lane Pasadena TX 77502-4014    Please get back to me as soon as you\'re able.  Thank you ', NULL, NULL, '2020-07-27 17:42:11', '2020-07-27 17:42:11'),
(1788, 2028, 307, NULL, NULL, 'In Process', 'TO: txcredentialing@amerigroup.com Sub: Re: (Reminder) Adeoye, Segun P - Amerigroup - NASAHC  Hello, As we have made the request for the address change on Amerigroup customer service and on the provided email please see my previous email as I have mentioned that the address for the provider is not correct and also notified the group secondary and tertiary address that it has not been updated please let us know the procedure how could we change or update the address for this group and provider. The details are as follows: Group Name: NASA Health Clinic Provider Name: Adeoye, Segun P TIN# 47-2682655 Individual NPI# 1629418025 Group NPI#  1740661453 Primary address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary address: 3623 S. Main St. Suite 109, Stafford TX 77477-5406 Tertiary address: 2101 Raspberry Lane Pasadena TX 77502-4014  Please get back to me as soon as you\'re able.  Thank you ', NULL, NULL, '2020-07-31 03:45:54', '2020-07-31 03:45:54'),
(1789, 2028, 307, NULL, NULL, 'In Process', 'REp:  As per rep, she provided me an email address for address correction (eric.preston@amerigroup.com) Ref: 114936441', NULL, NULL, '2020-07-31 10:37:48', '2020-07-31 10:37:48'),
(1790, 2028, 307, NULL, NULL, 'In Process', 'TO: eric.preston@amerigroup.com Sub: Adeoye, Segun P - Amerigroup - NASAHC Sub:  Hello,  Hope you\'re doing great, I would like to make a request for the address correction as I contacted The customer service and I got to know that as per your records we see a wrong address for the provider which is 21214 n w fair w s  Sybaris TX and also for the group only the primary address is been updated we would like to make corrections as the address for the group should be updated for all three locations and as well for the provider. The details are as follows: Group Name: NASA Health Clinic Provider Name: Adeoye, Segun P TIN# 47-2682655 Individual NPI# 1629418025 Group NPI#  1740661453 Primary address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary address: 3623 S. Main St. Suite 109, Stafford TX 77477-5406 Tertiary address: 2101 Raspberry Lane Pasadena TX 77502-4014  Please get back to me as soon as you\'re able.  Thank you   ', NULL, NULL, '2020-07-31 10:57:23', '2020-07-31 10:57:23'),
(1791, 2028, 307, NULL, NULL, 'In Process', 'Name: Courtney harris 7135766586 courtney.harris@amerigroup.com (New details provided as previous is wrong)', NULL, NULL, '2020-07-31 11:21:54', '2020-07-31 11:21:54'),
(1792, 2028, 307, NULL, NULL, 'In Process', 'From: courtney.harris@amerigroup.com  Sub: Adeoye, Segun P - Amerigroup - NASAHC Hello,     You have reached Courtney Harris-Behavioral Health Network Relations Consultant Sr. Amerigroup Texas.     I\'m out of the office today 7/31/2020. I’ll respond to your email or call at my earliest convenience on Monday 8/3/2020. Thank you for contacting Amerigroup!', NULL, NULL, '2020-07-31 11:24:13', '2020-07-31 11:24:13'),
(1793, 2037, 307, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Follow up email sent to courtney.harris@amerigroup.com --------------------------- Hello Courtney,  If I may know the current status of the request to add additional locations.Details are as follows and W-9 forms attached. Group Name: NASA Health Clinic Provider Name: Adeoye, Segun P TIN# 47-2682655 Individual NPI# 1629418025 Group NPI#  1740661453 Primary address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary address: 3623 S. Main St. Suite 109, Stafford TX 77477-5406 Tertiary address: 2101 Raspberry Lane Pasadena TX 77502-4014 Looking forward to hearing from you soon.  Thank you!', NULL, NULL, '2020-10-06 17:32:26', '2020-10-06 17:32:26'),
(1794, 2037, 307, NULL, '2020-10-20 00:00:00.000', 'In Process', 'The rep has sent a follow up to the network manager for location addition and they will be contacting me back within 5 to 7 business days.Reference#Ref#I118343667 ', NULL, NULL, '2020-10-07 13:34:56', '2020-10-07 13:34:56'),
(1795, 2037, 307, NULL, '2020-10-29 00:00:00.000', 'In Process', 'As per the Rep we will have to get in touch with the network manager in order to proceed further with this request as we might have to get the additional locations credentialed separately .Obtained Contact details and sent email .Left Voice mail aswell. --------------------- latonya Henry 214-983-6310 latoyna.henry@amerigroup.com ---------- Hello, We have submitted a request to add group secondary and tertiary service location address @ txcredentialing@amerigroup.com back in July. However we haven\'t heard anything back yet. Kindly let us know how to proceed further with this. The details are as follows: Group Name: NASA Health Clinic Provider Name: Adeoye, Segun P TIN# 47-2682655 Individual NPI# 1629418025 Group NPI#  1740661453  Primary address: 985 NASA Parkway, Houston, TX 77058-3039                               Contact:281-821-8200 Secondary address: 3623 S. Main St. Suite 109, Stafford TX 77477-5406                                 Contact: (281) 969-7643 Tertiary address: 2101 Raspberry Lane Pasadena TX 77502-4014                                   Please get back to me as soon as you\'re able.', NULL, NULL, '2020-10-20 10:23:38', '2020-10-20 10:23:38'),
(1796, 2037, 307, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Demographic Updation forms filled out and submitted to add secondary and tertiary addresses to : TXProviderRelations@amerigroup.com', NULL, NULL, '2020-10-28 12:33:16', '2020-10-28 12:33:16'),
(1797, 2037, 307, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Follow up email sent to TXProviderRelations@amerigroup.com', NULL, NULL, '2020-11-30 14:33:18', '2020-11-30 14:33:18'),
(1798, 2037, 307, NULL, '2020-12-29 00:00:00.000', 'In Process', '	 Follow up email sent to TXProviderRelations@amerigroup.com', NULL, NULL, '2020-12-11 13:03:13', '2020-12-11 13:03:13'),
(1799, 2037, 307, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-29 10:31:00', '2020-12-29 10:31:00'),
(1800, 3046, 307, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email Sent to: TXProviderRelations@amerigroup.com Subject: Demographic Update Request || Nasa Health Clinic || Adeoye, Segun P  ||  Hello, I would like to request an update on the status of demographic updates. Also, please note that the forms were submitted on 10/28/2020 to add the secondary and tertiary addresses.  The details are as follows: Group Name: Nasa Health Clinic Tax ID: 47-2682655 Provider Name: Adeoye, Segun P Provider NPI: 1629418025 Kindly feel free to reply back if you need any further information. I hope to hear from you soon. Thank you.', NULL, NULL, '2021-02-25 14:32:15', '2021-02-25 14:32:15'),
(1801, 3046, 307, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email Sent to: TXProviderRelations@amerigroup.com Subject: Demographic Update Request || Nasa Health Clinic || Adeoye, Segun P  ||   Good Morning,  I would like to inform you that this is a polite reminder from my end for the update on the status of demographic location.  As I\'ve mentioned in my previous email that forms were submitted on 10/28/2020 which is more than 4 months now to add the secondary and tertiary addresses, but unfortunately we haven\'t received any reply as yet. The details are as follows:  Group Name: Nasa Health Clinic Tax ID: 47-2682655 Provider Name: Adeoye, Segun P Provider NPI: 1629418025  Kindly feel free to reply back if you need any further information. Your quick response in this regard would be highly appreciated.  Thank you. ', NULL, NULL, '2021-03-04 10:34:26', '2021-03-04 10:34:26'),
(1802, 3046, 307, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email Sent to: TXProviderRelations@amerigroup.com Subject: Demographic Update Request || Nasa Health Clinic || Adeoye, Segun P  ||   Hello, Hope you are doing well. I would like to know the status of the demographic location. As I\'ve mentioned in my previous email that forms were submitted on 10/28/2020 which is more than 4 months now to add the secondary and tertiary addresses, but unfortunately we haven\'t received any reply as yet.The details are as follows:  Group Name: Nasa Health Clinic Tax ID: 47-2682655 Provider Name: Adeoye, Segun P Provider NPI: 1629418025  Kindly feel free to contact me if you need any further information. Your quick response in this regard would be highly appreciated.  Thank you.', NULL, NULL, '2021-03-18 12:17:26', '2021-03-18 12:17:26'),
(1803, 3040, 307, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: TXProviderRelations@amerigroup.com  Subject: Enrollment Status - Nasa Health Clinic - Adeoye, Segun P - AMERIGROUP -  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group under the below location.  Group Name: Nasa Health Clinic Tax ID: 47-2682655 Provider Name: Adeoye, Segun P Provider NPI: 1629418025  Please get back to me as soon as you can get a chance. Waiting to hear from you soon. \\  Thank you ', NULL, NULL, '2021-06-10 09:40:43', '2021-06-10 09:40:43'),
(1804, 1006, 307, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing txcredentialing@amerigroup.com:  Sub; Enrollment & Location Status Query - NASA HealthClinic - Amerigroup  \"Hello,   We are still waiting on an update regarding the enrollment status of the group and provider mentioned, please get back to us as soon as possible.  Thank you. \"', NULL, NULL, '2021-06-28 10:41:04', '2021-06-28 10:41:04'),
(1805, 11056, 307, NULL, '2021-07-24 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!', NULL, NULL, '2021-07-16 14:55:54', '2021-07-16 14:55:54'),
(1806, 11056, 307, NULL, '2021-08-10 00:00:00.000', 'In Process', '	 Email sent to : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!', NULL, NULL, '2021-08-03 08:52:17', '2021-08-03 08:52:17'),
(1807, 11056, 307, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!', NULL, NULL, '2021-08-18 09:41:33', '2021-08-18 09:41:33'),
(1808, 11056, 307, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com &  keth.jackson@amerigroup.com  Sub : Enrollment & Location Status Query - NASA Health Clinic - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!   Contacted thrice on different phone numbers but no one received . Voice mails have been left out for the updates', NULL, NULL, '2021-08-27 09:36:00', '2021-08-27 09:36:00'),
(1809, 11056, 307, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Email received from : mpswebinquiries@amerigroup.com  Sub  : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good Afternoon,   Thank you for contacting us. I will be happy to assist you.  After review, the provider Segun Adeoye is non-participating in the network. The group practice Nasa Health Clinic is also non participating. To get the status of your application you will need to email your request to txcredentialing@amerigroup.com. Please note many providers apply, once we have a panel opening the credentialing team will contact you.    This mailbox is for general questions. We are encouraging all of our providers, to please log-on and/or register on our website (website per market)/Availity, and submit your questions and/or concerns via our secure portal. Using our secure portal helps maintain  the Provider’s and Member’s privacy and assists us in responding to you in a thorough and timely manner.  Please use this link to access our website.  https://availity.com/healthplans  If the provider is requiring assistance please contact Availity technical support at 800-973-3957.   Please advise if there is any other way we can assist.  Thank you,  Nordra D. MPS Inquiries', NULL, NULL, '2021-09-23 16:42:37', '2021-09-23 16:42:37'),
(1810, 11056, 307, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good morning!  Hope all is well with you. We are still waiting to get updates regarding our credentialing process of our below mentioned provider & facility. We have been waiting for this since May and we are losing our patience, please respond to our emails soon.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a blessed day!', NULL, NULL, '2021-10-08 10:06:29', '2021-10-08 10:06:29'),
(1811, 11056, 307, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : May D & Maya & Cristel M  Status :  Try to contact 3 or 4 contact no.s to get updates but every one transferred my call to the provider relations depart but haven\'t get a response.  The voice mail has been left out on every contact no.s  Contacted no.s :  9405312496 8004543730 (800) 454-3730  Also sent an email too.', NULL, NULL, '2021-10-18 15:36:16', '2021-10-18 15:36:16'),
(1812, 11056, 307, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup   Good morning!  Hope all is well with you. Could you let me know the exact time period for the credentialing process?  Because we have been waiting for this since May and we are losing our patience.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a great day!   Also left out voice mails. Contacting no.s are on recording process', NULL, NULL, '2021-10-25 16:53:00', '2021-10-25 16:53:00'),
(1813, 11056, 307, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Greetings,     Amerigroup has received your request to contract directly with our Healthplan.     We will be glad to assist.     To ensure that we have your credentialing updated, please complete the attached Letter of Intent to begin that process.        When finished completing the LOI, please email it back to me along with a copy of your W9 and group application release form.     We ask that the Letter of Interest be completed in its entirety.     **For Nurse Practitioners completing the Letter of Interest:    Your Specialty type would be considered “Family Nurse Practitioner, Geriatric Nurse Practitioner, Psychiatric Nurse Practitioner” or whichever applies to your training.     Thank you', NULL, NULL, '2021-11-10 17:16:40', '2021-11-10 17:16:40'),
(1814, 11056, 307, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good afternoon!  Hope this email finds you well. Pardon us. Please accept our apology for the delay. Please find the attached Letter of Intent for credentialing.  Furthermore, any documents or information is required don\'t hesitate to contact us.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-18 18:04:21', '2021-11-18 18:04:21'),
(1815, 11056, 307, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  TXCredentialing@amerigroup.com  Sub:  RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Good afternoon!  Hope this email finds you well. Please provide me with the latest updates on the credentialing process of the provider, Segun Adeoye under the facility, Nasa Health Clinic.  Eagerly, waiting for your reply.  Thank you!', NULL, NULL, '2021-12-03 17:58:10', '2021-12-03 17:58:10'),
(1816, 11056, 307, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope you are doing great. Please provide me with the welcome letter & effective dates for the provider & practice. Please expedite my request for processing.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a wonderful weekend!  Voice msgs have been left out.', NULL, NULL, '2021-12-14 17:47:24', '2021-12-14 17:47:24'),
(1817, 11056, 307, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Madonna h & Jennifer P  Status:  1st one rep didn\'t find the provider in her system. Second one found the provider with only the secondary location and with only Nasa Health Clinic Tax ID. File is in the credentaling.  Ref code: 12202021', NULL, NULL, '2021-12-20 10:25:48', '2021-12-20 10:25:48'),
(1818, 11056, 307, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope all is well with you. I am still waiting to get the latest updates on the applications as well as on the facilities Nasa Health Clinic and Nasa Urgent care Inc.s\' Credentialing accomplishments yet. Please try to cope up with us through emails as your contact no.s aren\'t responded to us by anyone except the voice recorders. And we have left out so many Voice mails for the updates of the enrollment process, But haven\'t got the response yet.  Kindly respond to us as soon as possible. Please don\'t test our patience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-23 09:39:07', '2021-12-23 09:39:07'),
(1819, 11056, 307, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope all is well with you. I am still waiting to get the latest updates on the applications as well as on the facilities Nasa Health Clinic and Nasa Urgent care Inc.s\' Credentialing accomplishments yet. Please try to cope up with us through emails as your contact no.s aren\'t responded to us by anyone except the voice recorders. And we have left out so many Voice mails for the updates of the enrollment process, But haven\'t got the response yet.  Kindly respond to us as soon as possible. Please don\'t test our patience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-23 09:39:07', '2021-12-23 09:39:07'),
(1820, 19067, 307, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Ameri Group ||  Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group as well with Ameri Group.   Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:00:16', '2021-12-30 14:00:16'),
(1821, 19067, 307, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enrollment Query || NASA Health Clinic || Segun Adeoye & Groups || Ameri Group ||   Hello!  Any update on below mentioned Providers.  Eagerly waiting for your response.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-06 17:51:07', '2022-01-06 17:51:07'),
(1822, 1006, 310, NULL, '2021-07-05 00:00:00.000', 'Revalidation', 'We received the following reply from SWHP PROVIDER SERVICES SWHPPROVSERVICES@bswhealth.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Scott & White  \"Good morning Brad,  I do not show TIN 472682655 as contracted with SWHP/FC.  In order to join the network, you would need to click on the link below and submit a request to join our network.  Someone from our contracting department will then reach out to you once your information has been reviewed.  https://swhp.org/en-us/prov/provider-account-management#prov-join  Thank you so much,  Lacey B\"  Form filled out and attached in main group task for reference.   \"Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: b0c9167f-ad67-48fa-be7a-d1d59db6a17f\"', NULL, NULL, '2021-06-28 09:06:10', '2021-06-28 09:06:10'),
(1823, 11056, 310, NULL, '2021-07-27 00:00:00.000', 'Revalidation', 'Email sent to  : SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - Scott & White  Greetings,  Hope you are doing well. Could you Please let me know the current status of our Credentialing request and inform us as soon as possible.I have mentioned the details below of our group and providers :  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:04:17', '2021-07-19 16:04:17'),
(1824, 11056, 310, NULL, '2021-08-10 00:00:00.000', 'Revalidation', 'Email received from : SWHPPROVSERVICES@bswhealth.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - Scott & White  Good afternoon,     I do not show that TIN 472682655 is currently contracted in our system.  If you have submitted a request to join our network, you will need to reach out to your contact for the new contract for a status request.  Unfortunately, this department only handles requests after the group/provider has been contracted and credentialed, and don’t have access to the systems that our contracting and credentialing teams use.   Thank you so much,     Lacey B', NULL, NULL, '2021-08-03 09:33:31', '2021-08-03 09:33:31'),
(1825, 1006, 310, NULL, '2021-08-10 00:00:00.000', 'Revalidation', 'We received the following denial notification from SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org:  Sub: New Contract Request  \"Tax ID#: 47-2682655  RE: Network Denial Letter  Dear Nasa Health Clinic  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.  After reviewing your online application to contract submitted on 06/28/2021,  SWHP and FirstCare regretfully declines to contract with Nasa Health Clinic at this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.  For commercial providers, we welcome you to review 28 TAC 3.3706 for more detail on denial review.  Thank you again for your interest in SWHP and FirstCare Health Plans.  Best Regards,  Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans Network Development Department 1206 West Campus Dr. Temple, Texas 76502\"', NULL, NULL, '2021-08-03 14:30:25', '2021-08-03 14:30:25'),
(1826, 1006, 310, NULL, '2021-08-10 00:00:00.000', 'Revalidated', '', NULL, NULL, '2021-08-03 14:30:33', '2021-08-03 14:30:33'),
(1827, 2028, 312, NULL, NULL, 'In Process', 'To:  jason_trieu@uhc.com Sub: Reminder ( Need status update) Hello,  Hope you are doing great,  I want to know about the current status of the group.   Following are the details: Group Name: Nasa Health Clinic   Provider NPI: 1740661453 Group Tax ID: 47-2682655  Please get back to me as soon as you\'re able.  Thank you  ', NULL, NULL, '2020-06-30 14:52:16', '2020-06-30 14:52:16'),
(1828, 2028, 312, NULL, NULL, 'In Process', 'Rep: Tanie Asked for the update for star kids plan she provided an effective date (6-1-2020) and took the email address for sending a report also told her to submit the request for the welcome letter or roaster ref:1723881', NULL, NULL, '2020-07-09 13:20:13', '2020-07-09 13:20:13'),
(1829, 2028, 312, NULL, NULL, 'Approved', 'Welcome letter received', NULL, NULL, '2020-07-09 13:31:23', '2020-07-09 13:31:23'),
(1830, 2028, 315, NULL, NULL, 'Rejected', 'Limy Fernandus  is no more working with Nasa Health Clinic.', NULL, NULL, '2020-06-25 17:29:53', '2020-06-25 17:29:53'),
(1831, 2037, 317, NULL, '2021-01-15 00:00:00.000', 'On Hold', 'Panels closed', NULL, NULL, '2020-10-08 10:32:59', '2020-10-08 10:32:59'),
(1832, 1006, 317, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Enrollment request submitted via wellcare website, enrollment form is attached in main group task for reference.', NULL, NULL, '2021-06-08 11:31:18', '2021-06-08 11:31:18'),
(1833, 11056, 317, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Update - NASA HEALTH CLINIC - WELLCARE  Hello,   I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Thank you!', NULL, NULL, '2021-06-25 10:36:31', '2021-06-25 10:36:31'),
(1834, 1006, 317, NULL, '2021-07-22 00:00:00.000', 'In Process', 'We received the following update from .ProspectiveProviderTX ProspectiveProviderTX@wellcare.com:  Sub; RE: Become A Provider - Unsecured - General Practice - Texas  \"Hello,  This provider is already PAR with NASA HEALTH CLINIC effective 5/1/2021.\"  Sent query:  \"Hello,   I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Thank you!\"', NULL, NULL, '2021-07-15 16:10:14', '2021-07-15 16:10:14'),
(1835, 11056, 317, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : RE: Become A Provider - Unsecured - General Practice - Texas  Hello,   I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Thank you', NULL, NULL, '2021-08-03 08:36:54', '2021-08-03 08:36:54'),
(1836, 11056, 317, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Hello,  I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Practice: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Thank you! Have a great day!', NULL, NULL, '2021-08-17 08:49:02', '2021-08-17 08:49:02'),
(1837, 11056, 317, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Good morning!  Hope all is well. I appreciate the update. I just wanted to verify if the secondary address is also listed for the group and provider? Please inform me soon.  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you have any questions or queries let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-26 16:11:44', '2021-08-26 16:11:44'),
(1838, 11056, 317, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.   Online Application has been submitted.', NULL, NULL, '2021-09-15 09:35:43', '2021-09-15 09:35:43'),
(1839, 11056, 317, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : webuser@wellcare.com & ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Provider First Name Segun  Provider Last Name Adeoye  Degree Type MD  Check to add provider to existing agreement: False  Check to join as a group: True  Check if you service more than one state: False  Group Name Nasa Health Clinic  Tax Identification Number 47-2682655  Specialty Internal Medicine  Line of Business All  Street Address 985 NASA Parkway  City Houston  State Texas  ZIP Code 77058  County Harris  Facility Walk in clinic  NPI 1629418025  CAQH Number 12779522  Medicare Number 746150  Medicaid Number 391190102  License Number R7637  Primary Contact Name Ahmed Talha  Email nasa@claimsmedinc.com  Phone Number (713) 893-6214  Please provide any additional information Secondary Location : 3623 S. Main St. Suite 109 Stafford , TX 77477-5406 Please list the secondary location too under same Tax I.D and NPI  Confirmation email of our application submission', NULL, NULL, '2021-09-28 15:31:30', '2021-09-28 15:31:30'),
(1840, 11056, 317, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope all is well with you. Please let us know who is our provider Relations representative and provide us with his contact no. and email address as soon as possible.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 15:51:34', '2021-10-08 15:51:34'),
(1841, 11056, 317, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-10-15 16:48:26', '2021-10-15 16:48:26'),
(1842, 11056, 317, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Hello-   I have responded before… Dr. Adeoye is loaded properly and so are both addresses.   You will be able to see that using our directory as well. His Provider ID is 2504675.    Kindest Regards, Macy Mertens, LL.M. Network Performance Advisor', NULL, NULL, '2021-10-22 15:48:28', '2021-10-22 15:48:28'),
(1843, 11056, 317, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope this email finds you well. My question is simply that the effective date mentioned in the agreement is for both locations and the provider or not? Kindly, also do assist me in finding the provider in the Wellcare provider directory.  Take Care of Yourself!  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 12:35:06', '2021-11-11 12:35:06'),
(1844, 11056, 317, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email received from: Macy.Mertens@wellcare.com  Sub:  Re: Become A Provider - Unsecured - Internal Medicine - Texas   Dr. Adeoye is effective 5/1/21 for UXR, which is the WellCare LOB.  I understand. NASA Health is loaded and so is the provider.  His Provider ID is 2504675.  Hi-     Locations are added. Update is completed.', NULL, NULL, '2021-11-15 16:35:21', '2021-11-15 16:35:21'),
(1845, 2028, 319, NULL, NULL, 'On Hold', 'Rep: ella t They will contact us when the process can be started. ref:344846763', NULL, NULL, '2020-07-22 09:31:35', '2020-07-22 09:31:35'),
(1846, 2037, 319, NULL, '2021-01-15 00:00:00.000', 'On Hold', 'Panels closed', NULL, NULL, '2020-10-08 10:34:55', '2020-10-08 10:34:55'),
(1847, 1006, 319, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Group enrollment request submitted via wellcare website, attachment of form is attached in main group task for reference. ', NULL, NULL, '2021-06-08 11:26:53', '2021-06-08 11:26:53'),
(1848, 11056, 319, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub :  Enrollment Request Status - NASA Urgent Care - Wellcare  Good Morning !  Hope you are doing well. I want to know the enrollment status of the provider and group mentioned below. We have already filled out the form starting this month. Waiting for your reply.  Practice: Practice name : Nasa Urgent Care Inc. Practice NPI :1821542432 Practice TIN : 81-3237149 Main Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109,, Stafford , TX 77477-5406  Provider: Provider name : Adeoye, Segun P Provider NPI # : 1629418025  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 10:15:26', '2021-06-25 10:15:26'),
(1849, 1006, 319, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ \".ProspectiveProviderTX\" ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Request Status - NASA Urgent Care - Wellcare  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status of our group and provider.  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-07-15 16:33:01', '2021-07-15 16:33:01'),
(1850, 11056, 319, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Request Status - NASA Urgent Care - Wellcare  Good Evening!  Hope you are doing well. I want to know the enrollment status of the provider and group mentioned below. We have already filled out the form starting this month. Waiting for your reply.  Practice: Practice name : Nasa Urgent Care Inc. Practice NPI :1821542432 Practice TIN : 81-3237149 Main Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109,, Stafford , TX 77477-5406  Provider: Provider name : Adeoye, Segun P Provider NPI # : 1629418025  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-28 11:12:55', '2021-07-28 11:12:55'),
(1851, 11056, 319, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Request Status - NASA Urgent Care - Wellcare   Good morning,  I have reached out to the Contract Negotiators and they said the amendment to add WellCare to their existing Superior HealthPlan agreement will be sent through Adobe for electronic signature.   Have you signed and returned it to be processed?  Thanks Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-08-17 08:35:18', '2021-08-17 08:35:18'),
(1852, 11056, 319, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Request Status - NASA Urgent Care - Wellcare  Good Evening!  Hope you are doing well. I want to know the enrollment status of the provider and group mentioned below. We have already signed and returned Superior HealthPlan agreement through Adobe .  Practice Details: Practice name : Nasa Urgent Care Inc. Practice NPI :1821542432 Practice TIN : 81-3237149 Main Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109,, Stafford , TX 77477-5406  Provider Details: Provider name : Adeoye, Segun P Provider NPI # : 1629418025  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-26 16:07:14', '2021-08-26 16:07:14'),
(1853, 11056, 319, NULL, '2021-09-22 00:00:00.000', 'In Process', '	 Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.   Online Application has been submitted.', NULL, NULL, '2021-09-15 09:41:57', '2021-09-15 09:41:57'),
(1854, 11056, 319, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Provider First Name Segun  Provider Last Name Adeoye  Degree Type MD  Check to add provider to existing agreement: False  Check to join as a group: True  Check if you service more than one state: False  Group Name Nasa Urgent Care Inc.  Tax Identification Number 81-3237149  Specialty Internal Medicine  Street Address 985 NASA Parkway  City Houston  State Texas  ZIP Code 77058  County Harris  Facility Urgent Care  NPI 1629418025  CAQH Number 12779522  Medicare Number 738034  Medicaid Number 391190101  License Number R7637  Primary Contact Name Ahmed Talha  Email nasa@claimsmedinc.com  Phone Number (713) 893-6214  Please provide any additional information Secondary Location : 3623 S. Main St. Suite 109 Stafford , TX 77477-5406 Please list the secondary location too under same Tax I.D and NPI.  Confirmation email of our application submission.', NULL, NULL, '2021-09-28 15:35:41', '2021-09-28 15:35:41'),
(1855, 11056, 319, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope all is well with you. Please provide the latest updates regarding the credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day! ', NULL, NULL, '2021-10-08 15:44:50', '2021-10-08 15:44:50'),
(1856, 11056, 319, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email received from : Macy.Mertens@wellcare.com  Sub  : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Hello Macy,  The provider below would like to add an additional location for the provider below.    Talha,   The Prospective Provider box does not need to be included on further emails.  Thank you, Network Development', NULL, NULL, '2021-10-15 16:43:23', '2021-10-15 16:43:23'),
(1857, 11056, 319, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: Macy.Mertens@wellcare.com  Sub  : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Hello-     Please see the email attached which I never got a response to…so I do apologize but I have not added the second location.     I will submit a request for the 2nd location and process it as STAT. I’m very sorry for the delay.', NULL, NULL, '2021-10-22 15:55:49', '2021-10-22 15:55:49');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(1858, 11056, 319, NULL, '2021-11-18 00:00:00.000', 'In Process', '	 Email sent to: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good evening Macy!  Hope this email finds you well.  No problem, thank you for the update. There is no need for any apology. Please do add the locations properly as  Practice Name: Primary/ billing Address : 985 NASA Parkway, Houston , TX 77058-3039    I thought so this one is missing.& it is the main location. Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406 .  Please also confirm the effective dates.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 12:13:05', '2021-11-11 12:13:05'),
(1859, 11056, 319, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email received from: Macy.Mertens@wellcare.com  Sub: Re: Become A Provider - Unsecured - Internal Medicine - Texas   Hi-   Location is added. The update is completed.    Kindest Regards,  Macy Mertens, LL.M. Network Performance Advisor cid:image002.png@01D79E5C.9D608FD0  4888 Loop Central Drive, Suite 300 Houston, Texas 77081 Direct Mobile 281-217-0142', NULL, NULL, '2021-11-19 11:16:31', '2021-11-19 11:16:31'),
(1860, 11056, 319, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  Macy.Mertens@wellcare.com  Sub:  Re: Become A Provider - Unsecured - Internal Medicine - Texas   Good afternoon Macy!  I am very grateful to you. Great, thank you so much!  Please provide me with a welcome letter. Can we send claims on that address?  Take Care!  Have a wonderful day!', NULL, NULL, '2021-12-03 16:55:52', '2021-12-03 16:55:52'),
(1861, 11056, 319, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from: Sara.Sanchez@wellcare.com  Sub: Re: Become A Provider - Unsecured - Internal Medicine - Texas   Good morning,     Macy is out of the office but I have pulled a copy of our provider report.  You can see Dr. Adeoye’s effective date, along with other information.  If you scroll right you can see the addresses that are affiliated with the practice.   Please let me know if I can assist with anything else.     Hope this helps!  Have a great day,        Sara Sanchez  Provider Account Manager  1700 N. Zaragoza Ste 140     El Paso, TX 79936  Direct Line: 1.915.856.2502   Mobile: 1.915.801.5226    Fax: 1.915.856.2513  sara.sanchez@wellcare.com   |   https://www.wellcare.com', NULL, NULL, '2021-12-14 18:12:59', '2021-12-14 18:12:59'),
(1862, 11056, 319, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Macy.N.Roberts@wellcare.com  Sub: Re: Become A Provider - Unsecured - Internal Medicine - Texas   Good afternoon!  Hope you are staying healthy. I have already submitted the Online application for it in the past. And again on 15, September 2021. Kindly let me know what to do now, and how many times I have to submit an application for credentialing and enrolling.  Kindly, do us a favor, please figure this out soon. Let this be resolved permanently and properly.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-22 17:31:43', '2021-12-22 17:31:43'),
(1863, 19067, 319, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: Macy.N.Roberts@wellcare.com  Subject: Enrollment Query || Nasa Urgent Care || Segun Adeoye & Groups || Wellcare ||    Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Groups with Wellcare.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway, Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:39:14', '2021-12-30 14:39:14'),
(1864, 19067, 319, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Macy.N.Roberts@wellcare.com  Subject: Enrollment Query || Nasa Urgent Care || Segun Adeoye & Groups || Wellcare ||    Hello!  Hope you are doing well.  This is my Second reminder on the previous mentioned request.  Kindly get in touch as soon as you have time.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 19:09:45', '2022-01-09 19:09:45'),
(1865, 3040, 320, NULL, '2021-06-21 00:00:00.000', 'Revalidation', 'Email sent to: pr.south@healthsmart.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || Health Smart ||  Greetings,   Hope you are doing well. Please find the attached Demographic information form for the below mentioned providers as per previous email requested.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215   Provider 1:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-14 09:19:06', '2021-06-14 09:19:06'),
(1866, 11056, 320, NULL, '2021-07-08 00:00:00.000', 'Revalidated', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Providers: Provider 1:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 09:16:45', '2021-07-01 09:16:45'),
(1867, 11056, 320, NULL, '2021-07-08 00:00:00.000', 'Revalidation', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Providers: Provider 1:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 09:19:42', '2021-07-01 09:19:42'),
(1868, 11056, 320, NULL, '2021-07-12 00:00:00.000', 'Revalidation', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  01- Following Providers are currently in the credentialing process.  Provider Name   Stephen, Ani   PICCIONE JR, JAMES M   Chennemkara, Mini Philip   Abraham, Glory   Abraham, Jeena   Paul, Sigi   Jacob, Jaya   All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 81523)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-07-05 08:52:34', '2021-07-05 08:52:34'),
(1869, 3040, 320, NULL, '2021-07-30 00:00:00.000', 'Revalidation', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart in our group under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-23 13:43:31', '2021-07-23 13:43:31'),
(1870, 3040, 320, NULL, '2021-08-04 00:00:00.000', 'Revalidated', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  Please see the following Providers with effective dates.  Provider Name                                 Effective Date   STEPHEN, ANI                                      06/01/2021   CHENNEMKARA, MINI P                     06/01/2021   PICCIONE JR, JAMES M                        06/01/2021   ABRAHAM, GLORY                               06/01/2021   ABRAHAM, JEENA                                 06/01/2021   Joseph Molly, NP                                   09/01/2021   All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Inventory Log ID : 81523)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-07-28 09:11:24', '2021-07-28 09:11:24'),
(1871, 1006, 323, NULL, '2020-08-11 00:00:00.000', 'In Process', 'Received email from Molina saying that Segun isn\'t par with NUC TIN, notified them that we are only trying to update address as we have an ancillary contract: \"Hello,  Appreciate the update, regarding the update from PIM. Nasa Urgent Care is enrolled as an Ancillary/Urgentcare, so to my knowledge Segun Adeoye does not need to be PAR under the TIN for us to be able to bill under him. I\'ve attached a copy of our executed contract for your reference.  We only need to know if all three of the following addresses are coming up under the group: Primary: 985 NASA Parkway, Houston, TX 77058-3039Secondary: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406Tertiary: 1946 Pasadena Blvd, Pasadena, TX 77502-4014 If all three of the addresses are coming up under the group, please send us a roster showing it. Thank you.\"', NULL, NULL, '2020-08-04 17:49:05', '2020-08-04 17:49:05'),
(1872, 1006, 323, NULL, '2020-08-20 00:00:00.000', 'In Process', 'Followed up with Molina again, received following replies: \"Good Afternoon Brad,     This RITM1722358 service ticket was submitted directly by me. I was informed by PIM that the billing address was updated, but they were unable to add service location as provider is non par with TIN 813237149. I have reached out to PIM with your specifications mentioned below along with the copy of the amendment. If a new ticket is needed, I will submit once I hear back.  Nasa Urgent Care is enrolled as an Ancillary/Urgentcare, so to my knowledge Segun Adeoye does not need to be PAR under the TIN for us to be able to bill under him. I\'ve attached a copy of our executed contract for your reference.   I will follow up with you as soon as they get back to me,\"   \"Good Afternoon Brad, Outreach was made to PIM Specialist Susana Montijo August 10th. She reached out to her leadership. We are waiting on confirmation.  We greatly appreciate your patience on this matter.  Thank you!\"', NULL, NULL, '2020-08-13 10:54:33', '2020-08-13 10:54:33'),
(1873, 1006, 323, NULL, '2020-08-28 00:00:00.000', 'In Process', 'Sent followup email to MHTX Provider Services MHTXProviderServices@molinahealthcare.com> regarding status update.  ', NULL, NULL, '2020-08-21 13:09:54', '2020-08-21 13:09:54'),
(1874, 1006, 323, NULL, '2020-09-08 00:00:00.000', 'Approved', '\"Good Morning Brad,  Initial request to add Service location 3623 S Main St Stafford TX, has been completed as of 8/5/2020.   We are have also updated the following address: 1946 PASADENA BLVD, PASADENA, TX, 77502  Please let us know if additional assistance is needed,\"', NULL, NULL, '2020-09-01 15:21:02', '2020-09-01 15:21:02'),
(1875, 2028, 328, NULL, NULL, 'In Process', 'TO: txcredentialing@amerigroup.com Sub: Adeoye, Segun P - Amerigroup - NASAUC  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows. Group Name: NASA Urgent Care Provider Name: Adeoye, Segun P TIN# 81-3237149 NPI#  1629418025    Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-01 17:38:29', '2020-07-01 17:38:29'),
(1876, 2028, 328, NULL, NULL, 'In Process', '(800) 325-0011 Rep: janise W : Agent looked for the provider detail but could not find anything also provided a number (18557436161) to contact for Network management for Adeoye, Segun P', NULL, NULL, '2020-07-09 09:55:18', '2020-07-09 09:55:18'),
(1877, 2028, 328, NULL, NULL, 'In Process', 'Rep: Michyl Department: Aperture credentialing agent pull out the account but could not help, was saying you called the wrong department also provided a number for amerigroup wit ext. 7132185100 Ext (1067342069) Reference ID: Michyl S 7-9-2020', NULL, NULL, '2020-07-09 10:20:29', '2020-07-09 10:20:29'),
(1878, 2028, 328, NULL, NULL, 'In Process', 'TO: txcredentialing@amerigroup.com SUB: (Reminder) Adeoye, Segun P - Amerigroup - NASAUC  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows. Group Name: NASA Urgent Care Provider Name: Adeoye, Segun P TIN# 81-3237149 NPI#  1629418025    Please get back to me as soon as you\'re able.  Thank you  -- ', NULL, NULL, '2020-07-09 10:24:28', '2020-07-09 10:24:28'),
(1879, 2028, 328, NULL, NULL, 'In Process', 'As per rep the address is not,  985 NASA Parkway Houston , TX 77058-3039 it is  21214 n w fair w s  Sybaris TX,  to update the address transferred me to there Address update department where I left voicemail for call back', NULL, NULL, '2020-07-17 14:02:01', '2020-07-17 14:02:01'),
(1880, 2028, 328, NULL, NULL, 'In Process', 'Rep: kadeejih A as per rep, she summited the request for address update will get back to us through email within 3- 5 days email given. ref:i114374865', NULL, NULL, '2020-07-20 15:11:10', '2020-07-20 15:11:10'),
(1881, 2028, 328, NULL, NULL, 'In Process', 'Rep: Caela As per rep, the provider address for Adeoye Segun they have is 21214 n w fair w s  Sybaris TX and for the group, they have the only primary address which is 985 NASA Parkway Houston, TX 77058-3039 for both the groups Nasa Urgent Care and Nasa health clinic for address update email txcredentialing@amerigroup.com Ref: i-114725607', NULL, NULL, '2020-07-27 17:11:07', '2020-07-27 17:11:07'),
(1882, 2028, 328, NULL, NULL, 'In Process', 'TO: txcredentialing@amerigroup.com Sub: Adeoye, Segun P - Amerigroup - NASAUC Hello, Please also confirm with the address that is on your records for this group and provider. The details are as follows: Group Name: NASA Urgent Care Provider Name: Adeoye, Segun P TIN# 81-3237149  Individual NPI# 1629418025Group NPI# 1821542432Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109 Stafford TX 77477-5406 Tertiary Address: 1946 Pasadena Blvd Pasadena TX 77502-4014 Please get back to me as soon as you\'re able Thank you.', NULL, NULL, '2020-07-27 17:56:21', '2020-07-27 17:56:21'),
(1883, 2028, 328, NULL, NULL, 'In Process', '(The previous comment was disposed wrong due to wrong NPI on EMRBS) Rep: jasmine As per rep, only the primary address is been updated for the group and for the provider it shows 5419 n Lovington Highway Hobbs which is wrong also she transfers me to provider relations for the address correction where I left voice mail for a call back Ref: i-114755232', NULL, NULL, '2020-07-28 12:11:27', '2020-07-28 12:11:27'),
(1884, 2028, 328, NULL, NULL, 'In Process', 'TO: txcredentialing@amerigroup.com Sub: Re: (Reminder) Adeoye, Segun P - Amerigroup - NASAUC  Hello,  I have also made the same request for Nasa urgent care as both the secondary and tertiary addresses are not been updated for the provider, it also shows a wrong address Please respond back with the solution. The details are as follows: Group Name: NASA Urgent Care Provider Name: Adeoye, Segun P TIN# 81-3237149  Individual NPI# 1629418025 Group NPI# 1821542432 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109 Stafford TX 77477-5406  Tertiary Address: 1946 Pasadena Blvd Pasadena TX 77502-4014 Please get back to me as soon as you\'re able Thank you.', NULL, NULL, '2020-07-31 03:55:54', '2020-07-31 03:55:54'),
(1885, 2028, 328, NULL, NULL, 'In Process', 'REp: Stephany As per rep, she provided me an email address for address correction (eric.preston@amerigroup.com) Ref: 114936441', NULL, NULL, '2020-07-31 10:38:43', '2020-07-31 10:38:43'),
(1886, 2028, 328, NULL, NULL, 'In Process', 'TO: eric.preston@amerigroup.com Sub: Adeoye, Segun P - Amerigroup - NASAUC  Hello,  Hope you\'re doing great, I would like to make a request for the address correction as I contacted The customer service and I got to know that as per your records we see a wrong address for the provider which is 5419 n Lovington Highway Hobbs and also for the group only the primary address is been updated we would like to make corrections as the address for the group should be updated for all three locations and as well for the provider. The details are as follows: Group Name: NASA Urgent Care Provider Name: Adeoye, Segun P TIN# 81-3237149  Individual NPI# 1629418025 Group NPI# 1821542432 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109 Stafford TX 77477-5406  Tertiary Address: 1946 Pasadena Blvd Pasadena TX 77502-4014  Please get back to me as soon as you\'re able Thank you.  ', NULL, NULL, '2020-07-31 10:57:26', '2020-07-31 10:57:26'),
(1887, 2028, 328, NULL, NULL, 'In Process', 'Name: Courtney harris 7135766586 courtney.harris@amerigroup.com (New details provided as previous is wrong)', NULL, NULL, '2020-07-31 11:21:55', '2020-07-31 11:21:55'),
(1888, 2028, 328, NULL, NULL, 'In Process', 'From: courtney.harris@amerigroup.com  Sub: Adeoye, Segun P - Amerigroup - NASAUC Hello,     You have reached Courtney Harris-Behavioral Health Network Relations Consultant Sr. Amerigroup Texas.     I\'m out of the office today 7/31/2020. I’ll respond to your email or call at my earliest convenience on Monday 8/3/2020. Thank you for contacting Amerigroup!', NULL, NULL, '2020-07-31 11:24:12', '2020-07-31 11:24:12'),
(1889, 1006, 328, NULL, '2020-08-11 00:00:00.000', 'In Process', 'Amerigroup notified us that the group has an ancillary/facility agreement, sent them the following email:  \"Hello,  Appreciate the reply, we know that the group is enrolled under an ancillary/facility agreement. We\'re trying to update the address, the group should have all the following addresses listed under it: Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109 Stafford TX 77477-5406 Tertiary Address: 1946 Pasadena Blvd Pasadena TX 77502-4014 Do let me know what is required to get this done ASAP. Thanks. \"', NULL, NULL, '2020-08-04 17:16:22', '2020-08-04 17:16:22'),
(1890, 1006, 328, NULL, '2020-08-24 00:00:00.000', 'In Process', 'Sent another followup email to TX Credentialing txcredentialing@amerigroup.com> ', NULL, NULL, '2020-08-17 09:22:58', '2020-08-17 09:22:58'),
(1891, 1005, 328, NULL, '2020-10-01 00:00:00.000', 'In Process', 'Sent a reminder. Awaiting response.', NULL, NULL, '2020-09-24 13:24:36', '2020-09-24 13:24:36'),
(1892, 2037, 328, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Follow up email sent to eric.preston@amerigroup.com ------------- Hello Eric, If I may know the current status of the request to add additional locations.Details are as follows and W-9 form attached. Group Name: NASA Health Clinic Provider Name: Adeoye, Segun P TIN# 81-3237149 Individual NPI# 1629418025 Group NPI#  1821542432  Primary Address: 985 NASA Parkway Houston , TX 77058-3039.Secondary Address: 3623 S. Main St. Suite 109 Stafford TX 77477-5406. Tertiary Address: 1946 Pasadena Blvd Pasadena TX 77502-4014.  Please do let me know what is required to get this done ASAP.', NULL, NULL, '2020-10-06 17:51:17', '2020-10-06 17:51:17'),
(1893, 2037, 328, NULL, '2020-10-20 00:00:00.000', 'In Process', 'Eric\'s address is in-accurate . Inquiry resubmitted to courtney @ courtney.harris@amerigroup.com', NULL, NULL, '2020-10-06 17:56:27', '2020-10-06 17:56:27'),
(1894, 2037, 328, NULL, '2020-10-20 00:00:00.000', 'In Process', 'The rep has sent a follow up to the network manager for location addition and they will be contacting me back within 5 to 7 business days.Reference#Ref#I118343667', NULL, NULL, '2020-10-07 13:30:02', '2020-10-07 13:30:02'),
(1895, 2037, 328, NULL, '2020-10-28 00:00:00.000', 'In Process', 'As per the Rep we will have to get in touch with the network manager in order to proceed further with this request as we might have to get the additional locations credentialed separately .Obtained Contact details and sent email .Left Voice mail aswell. --------------------- latonya Henry 214-983-6310 latoyna.henry@amerigroup.com -------------- Hello,  We have submitted a request to add a group secondary and tertiary service location address @ txcredentialing @ txcredentialing@amerigroup.com back in July. However we haven\'t heard anything back yet.  Kindly let us know how to proceed further with this.  The details are as follows:  Group Name: NASA URGENT CARE TIN# 81-3237149 Group NPI# 1821542432  Primary address: 985 NASA Parkway, Houston, TX 77058-3039                               Secondary address: 3623 S. Main St. Suite 109, Stafford TX 77477-5406                      Tertiary address: 2101 Raspberry Lane Pasadena TX 77502-4014                                   Please get back to me as soon as you\'re able.', NULL, NULL, '2020-10-20 10:39:02', '2020-10-20 10:39:02'),
(1896, 2037, 328, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Demographic Updation forms filled out and submitted to add secondary and tertiary addresses to : TXProviderRelations@amerigroup.com', NULL, NULL, '2020-10-28 12:33:09', '2020-10-28 12:33:09'),
(1897, 2037, 328, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Follow up email sent to TXProviderRelations@amerigroup.com', NULL, NULL, '2020-11-30 14:33:26', '2020-11-30 14:33:26'),
(1898, 2037, 328, NULL, '2020-12-29 00:00:00.000', 'In Process', '	 Follow up email sent to TXProviderRelations@amerigroup.com', NULL, NULL, '2020-12-11 13:03:23', '2020-12-11 13:03:23'),
(1899, 2037, 328, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-29 10:31:05', '2020-12-29 10:31:05'),
(1900, 3046, 328, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email Sent to: TXProviderRelations@amerigroup.com Subject: Demographic Update Request || Nasa Health Clinic || Adeoye, Segun P ||  Hello, I would like to request an update on the status of demographic updates. Also, please note that the forms were submitted on 10/28/2020 to add the secondary and tertiary addresses.  The details are as follows: Group Name: Nasa Health Clinic Tax ID: 47-2682655 Provider Name: Adeoye, Segun P Provider NPI: 1629418025 Kindly feel free to reply back if you need any further information. I hope to hear from you soon. Thank you.', NULL, NULL, '2021-02-25 14:33:48', '2021-02-25 14:33:48'),
(1901, 3046, 328, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email Sent to: TXProviderRelations@amerigroup.com Subject: Demographic Update Request || Nasa Health Clinic || Adeoye, Segun P  ||   Good Morning,  I would like to inform you that this is a polite reminder from my end for the update on the status of demographic location.  As I\'ve mentioned in my previous email that forms were submitted on 10/28/2020 which is more than 4 months now to add the secondary and tertiary addresses, but unfortunately we haven\'t received any reply as yet. The details are as follows:  Group Name: Nasa Health Clinic Tax ID: 47-2682655 Provider Name: Adeoye, Segun P Provider NPI: 1629418025  Kindly feel free to reply back if you need any further information. Your quick response in this regard would be highly appreciated.  Thank you.', NULL, NULL, '2021-03-04 10:39:48', '2021-03-04 10:39:48'),
(1902, 3046, 328, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email Sent to: TXProviderRelations@amerigroup.com Subject: Demographic Update Request || Nasa Health Clinic || Adeoye, Segun P  ||   Hello, Hope you are doing well. I would like to know the status of the demographic location. As I\'ve mentioned in my previous email that forms were submitted on 10/28/2020 which is more than 4 months now to add the secondary and tertiary addresses, but unfortunately we haven\'t received any reply as yet.The details are as follows:  Group Name: Nasa Health Clinic Tax ID: 47-2682655 Provider Name: Adeoye, Segun P Provider NPI: 1629418025  Kindly feel free to contact me if you need any further information. Your quick response in this regard would be highly appreciated.  Thank you.', NULL, NULL, '2021-03-18 12:18:01', '2021-03-18 12:18:01'),
(1903, 3040, 328, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: TXProviderRelations@amerigroup.com  Subject: Enrollment Status - Nasa Health Clinic - Adeoye, Segun P - AMERIGROUP -  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group under the below location.  Group Name: Nasa Health Clinic Tax ID: 47-2682655 Provider Name: Adeoye, Segun P Provider NPI: 1629418025  Please get back to me as soon as you can get a chance. Waiting to hear from you soon. \\  Thank you ', NULL, NULL, '2021-06-10 09:40:49', '2021-06-10 09:40:49'),
(1904, 11056, 328, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : TXProviderRelations@amerigroup.com  Sub : Enrollment Status - Nasa Health Clinic  - AMERIGROUP   Good evening!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group under the below location.  Practice:  Practice Name: Nasa Urgent Care Inc. Practice Tax ID: 81-3237149 Practice NPI # : 1821542432  Provider: Provider Name: Adeoye, Segun P Provider NPI: 1629418025  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-06-28 16:54:07', '2021-06-28 16:54:07'),
(1905, 11056, 328, NULL, '2021-07-24 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  The secondary location is still pending, no other information is needed.', NULL, NULL, '2021-07-16 14:15:20', '2021-07-16 14:15:20'),
(1906, 11056, 328, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Good morning!  Hope all is well. This is just a follow-up email regarding the secondary location. Has the secondary location been added to the Group or not yet?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.   Thank you! Have a great week ahead!', NULL, NULL, '2021-08-03 08:40:32', '2021-08-03 08:40:32'),
(1907, 11056, 328, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Good morning!  Hope all is well. This is just a follow-up email regarding the secondary location. Has the secondary location been added to the Group or not yet?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.   Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 09:39:33', '2021-08-18 09:39:33'),
(1908, 11056, 328, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com &  keth.jackson@amerigroup.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!   Contacted thrice on different phone numbers but no one received . Voice mails have been left out for the updates', NULL, NULL, '2021-08-27 09:37:17', '2021-08-27 09:37:17'),
(1909, 11056, 328, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Good evening!  Hope all is well. We are still waiting to get an update regarding the secondary location. Has the secondary location been added to the Group or not yet? It has been a long time since our emails were being ignored.  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great week ahead!   Try to contact through call no one had received. Voice mail has been left out  for the updates.', NULL, NULL, '2021-09-23 17:08:19', '2021-09-23 17:08:19'),
(1910, 11056, 328, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Still pending, I know this is taking a while, there is currently high volume.  I will see if I can get this moved along', NULL, NULL, '2021-10-08 09:59:21', '2021-10-08 09:59:21'),
(1911, 11056, 328, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : May D & Maya & Cristel M  Status :  Try to contact 3 or 4 contact no.s to get updates but every one transferred my call to the provider relations depart but haven\'t get a response.  The voice mail has been left out on every contact no.s  Contacted no.s :  9405312496 8004543730 (800) 454-3730  Also sent an email too.', NULL, NULL, '2021-10-18 15:36:11', '2021-10-18 15:36:11'),
(1912, 11056, 328, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup   Good morning!  Hope all is well with you. Could you let me know the exact time period for the credentialing process?  Because we have been waiting for this since May and we are losing our patience.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a great day!   Also left out voice mails. Contacting no.s are on recording process', NULL, NULL, '2021-10-25 16:52:55', '2021-10-25 16:52:55'),
(1913, 11056, 328, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup   Good morning!  Hope all is well with you. Could you let me know the exact time period for the credentialing process?  Because we have been waiting for this since May and we are losing our patience.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 13:14:16', '2021-11-11 13:14:16'),
(1914, 11056, 328, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Greetings,     Amerigroup has received your request to contract directly with our Healthplan.     We will be glad to assist.     To ensure that we have your credentialing updated, please complete the attached Letter of Intent to begin that process.        When finished completing the LOI, please email it back to me along with a copy of your W9 and group application release form.     We ask that the Letter of Interest be completed in its entirety.     **For Nurse Practitioners completing the Letter of Interest:    Your Specialty type would be considered “Family Nurse Practitioner, Geriatric Nurse Practitioner, Psychiatric Nurse Practitioner” or whichever applies to your training.     Thank you', NULL, NULL, '2021-11-19 10:22:51', '2021-11-19 10:22:51'),
(1915, 11056, 328, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  TXCredentialing@amerigroup.com  Sub:  RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope this email finds you well. Please provide me with the latest updates on the credentialing process of the provider, Segun Adeoye under the facility, Nasa Health Clinic.  Eagerly, waiting for your reply.  Thank you!', NULL, NULL, '2021-12-03 18:00:57', '2021-12-03 18:00:57'),
(1916, 11056, 328, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope you are doing great. Please provide me with the welcome letter & effective dates for the provider & practice. Please expedite my request for processing.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a wonderful weekend!  Voice msgs have been left out.', NULL, NULL, '2021-12-14 17:47:20', '2021-12-14 17:47:20'),
(1917, 11056, 328, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Madonna h & Jennifer P  Status:  1st one rep didn\'t find the provider in her system. Second one found the provider with only the secondary location and with only Nasa Health Clinic Tax ID. File is in the credentaling.  Ref code: 12202021', NULL, NULL, '2021-12-20 10:25:36', '2021-12-20 10:25:36'),
(1918, 11056, 328, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope all is well with you. I am still waiting to get the latest updates on the applications as well as on the facilities Nasa Health Clinic and Nasa Urgent care Inc.s\' Credentialing accomplishments yet. Please try to cope up with us through emails as your contact no.s aren\'t responded to us by anyone except the voice recorders. And we have left out so many Voice mails for the updates of the enrollment process, But haven\'t got the response yet.  Kindly respond to us as soon as possible. Please don\'t test our patience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-23 09:39:01', '2021-12-23 09:39:01'),
(1919, 19067, 328, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Ameri Group ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group as well with Ameri Group.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:05:27', '2021-12-30 14:05:27'),
(1920, 19067, 328, NULL, '2022-01-15 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Re: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Ameri Group ||   Hello!  This is my second reminder on the previously mentioned request.  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-07 23:41:26', '2022-01-07 23:41:26'),
(1921, 2028, 329, NULL, NULL, 'In Process', ' TO: jason_trieu@uhc.com SUB: (Reminder) Need Status Update Of Provider Adeoye, Segun P  Hello,  Hope you are doing great,  I want to know about the current status of the provider   Following are the details: Group Name: Nasa Urgent Care  Provider NPI: 1740661453 Group Tax ID: 81-3237149   Please get back to me as soon as you\'re able.  Thank you ', NULL, NULL, '2020-06-30 14:33:28', '2020-06-30 14:33:28'),
(1922, 2028, 329, NULL, NULL, 'In Process', 'Rep: Britney  (866) 574-6088 Agent said that the provider is in network, also the group email is given for the Roster and welcome letter... Ref: 01723322', NULL, NULL, '2020-07-09 11:06:03', '2020-07-09 11:06:03'),
(1923, 2028, 329, NULL, NULL, 'Approved', 'Welcome letter received attached by the name roaster', NULL, NULL, '2020-07-09 13:32:19', '2020-07-09 13:32:19'),
(1924, 2028, 330, NULL, NULL, 'In Process', 'To: Irene.Sanchez@bswhealth.org  Sub: Statcare Minor Emergency Clinic - Follow up  Hi,I would like to know what\'s the current status of enrollment for our group.The details are as follow: Group Name : Statcare Minor Emergency ClinicTax ID: 46-0575924NPI: 1689924904  Please get back to me as soon as you\'re able.  Thank you. ', NULL, NULL, '2020-06-23 14:58:04', '2020-06-23 14:58:04'),
(1925, 2028, 330, NULL, NULL, 'Approved', 'From: SWHPRECRED@bswhealth.org   Sub: Statcare Minor Emergency Clinic - Follow up   Good Afternoon,    Credentialing was completed on 5/15/20.     Thank you  Irene', NULL, NULL, '2020-06-24 09:40:18', '2020-06-24 09:40:18'),
(1926, 2028, 330, NULL, NULL, 'Approved', 'Approval letter Received ', NULL, NULL, '2020-06-29 10:44:44', '2020-06-29 10:44:44'),
(1927, 1006, 335, NULL, '2021-07-22 00:00:00.000', 'Revalidation', '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 11:03:50', '2021-07-15 11:03:50'),
(1928, 1006, 335, NULL, '2021-08-31 00:00:00.000', 'Revalidation', 'Sent f/u email @ ZASHBAUGH@centene.com & ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 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, '2021-08-24 13:15:16', '2021-08-24 13:15:16'),
(1929, 1006, 335, NULL, '2021-09-08 00:00:00.000', 'Revalidation', '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 15:41:26', '2021-09-01 15:41:26'),
(1930, 11056, 335, NULL, '2021-09-29 00:00:00.000', 'Revalidation', '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, '2021-09-22 10:46:09', '2021-09-22 10:46:09'),
(1931, 11056, 335, NULL, '2021-10-07 00:00:00.000', 'Revalidation', '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.  Phone: 866-615-9399  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2021-09-30 17:01:56', '2021-09-30 17:01:56'),
(1932, 11056, 335, NULL, '2021-10-19 00:00:00.000', 'Revalidation', '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! Have a wonderful day!', NULL, NULL, '2021-10-12 16:09:22', '2021-10-12 16:09:22'),
(1933, 11056, 335, NULL, '2021-10-27 00:00:00.000', 'Revalidation', '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.   Thank you,', NULL, NULL, '2021-10-20 14:13:38', '2021-10-20 14:13:38'),
(1934, 11056, 335, NULL, '2021-11-17 00:00:00.000', 'Revalidation', 'Email sent to: 	SHP Network Development NPR Contracting  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, '2021-11-10 17:45:09', '2021-11-10 17:45:09'),
(1935, 11056, 335, NULL, '2021-11-26 00:00:00.000', 'Revalidation', 'Email sent to: SHP Network Development NPR Contracting  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, '2021-11-19 17:49:44', '2021-11-19 17:49:44'),
(1936, 11056, 335, NULL, '2021-12-08 00:00:00.000', 'Revalidation', '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.     Thank you,', NULL, NULL, '2021-12-01 13:14:30', '2021-12-01 13:14:30'),
(1937, 11056, 335, NULL, '2021-12-23 00:00:00.000', 'Revalidation', '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 16:43:47', '2021-12-16 16:43:47'),
(1938, 11056, 335, NULL, '2021-12-30 00:00:00.000', 'Revalidation', '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 15:39:01', '2021-12-23 15:39:01'),
(1939, 2028, 337, NULL, NULL, 'In Process', 'request is in process Email given.', NULL, NULL, '2020-07-01 13:01:01', '2020-07-01 13:01:01'),
(1940, 2028, 337, NULL, NULL, 'In Process', 'Incoming call: Rep (lakeisha) Provider ID: 8LH078 Effective date july-12 2018 advised to contact customer service and speak to Network Management Representative for further queries ', NULL, NULL, '2020-07-06 17:07:50', '2020-07-06 17:07:50'),
(1941, 2028, 337, NULL, NULL, 'In Process', 'To: Bel_Villarreal@bcbstx.com Sub: Ayarzagoitia, Patrick A - Blue Cross Blue Shield - BCBS - RHC  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows. Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1649568239  Please get back to me as soon as you\'re able. Thank you', NULL, NULL, '2020-07-13 14:22:06', '2020-07-13 14:22:06'),
(1942, 2028, 337, NULL, NULL, 'In Process', 'To: Bel_Villarreal@bcbstx.com Sub: (Reminder) Ayarzagoitia, Patrick A - Blue Cross Blue Shield - BCBS - RHC  Hello,  Hope you are doing great, I want to know about the current status of the Provider.  The details are as follows. Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1649568239  Please get back to me as soon as you\'re able. Thank you ', NULL, NULL, '2020-07-21 10:51:15', '2020-07-21 10:51:15');
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
(1943, 2028, 337, NULL, NULL, 'In Process', 'From: Bel_Villarreal@bcbstx.com Sub: (Reminder) Ayarzagoitia, Patrick A - Blue Cross Blue Shield - BCBS - RHC  I am out of the office on, Monday 7/20, and returning on Monday, 7/27. Email access will be limited. If you have an urgent issue, please contact Provider Relations at (361) 878-1623.', NULL, NULL, '2020-07-21 10:53:54', '2020-07-21 10:53:54'),
(1944, 2028, 337, NULL, NULL, 'In Process', 'TO: Lluvia_Munguia@bcbstx.com Sub: (Reminder) Cyriaque, Stephane - Blue Cross Blue Shield - BHCC  Hello,  I will also request the status update for Ayarzagoitia, Patrick A. Because when I last time spoke with the customer service they provided me the effective date for this provider as I am trying to reach them since then they come up with the voicemail recorder. and I hear no response from them, Kindly update me with this. The details are as follows. Group Name: Statcare Minor Emergency Clinic Provider Name: Ayarzagoitia, Patrick A. TIN# 46-0575924 NPI# 1649568239  Please get back to me as soon as you\'re able. Thank you', NULL, NULL, '2020-07-22 12:22:22', '2020-07-22 12:22:22'),
(1945, 2028, 337, NULL, NULL, 'In Process', 'To: Lluvia_Munguia@bcbstx.com Sub: (Reminder) Ayarzagoitia, Patrick A. - Blue Cross Blue Shield - RHC  Hello,  I will also request the status update for Ayarzagoitia, Patrick A. Because when I last time spoke with the customer service they provided me the effective date for this provider as I am trying to reach them since then they come up with the voicemail recorder and I hear no response from them, kindly update me with this.  The details are as follows. Group Name: Statcare Minor Emergency Clinic Provider Name: Ayarzagoitia, Patrick A.Effective date: July-12 2018 TIN# 46-0575924 NPI# 1649568239  Please get back to me as soon as you\'re able. Thank you', NULL, NULL, '2020-07-23 10:45:49', '2020-07-23 10:45:49'),
(1946, 2028, 337, NULL, NULL, 'In Process', 'Rep: Sharon As per rep, the effective date is 4-27-2020 and for Roster, we have to email provider_relations_south_texas@bcbstx.com Ref: Sharon', NULL, NULL, '2020-07-23 13:35:41', '2020-07-23 13:35:41'),
(1947, 2028, 337, NULL, NULL, 'In Process', 'TO: provider_relations_south_texas@bcbstx.com Sub: Ayarzagoitia, Patrick A. - Blue Cross Blue Shield - RHC  Hello, Hope you\'re doing great I would like to make a request for the roster of provider Ayarzagoitia, Patrick A   The details are as follows. Hello, Hope you\'re doing great I would like to make a request for the roster of provider Ayarzagoitia, Patrick A  The details are as follows. Group Name: Statcare Minor Emergency Clinic Provider Name: Ayarzagoitia, Patrick A. Effective date: 4-27-2020 TIN# 46-0575924 NPI# 1649568239 Please get back to me as soon as you\'re able. Thank you', NULL, NULL, '2020-07-23 13:44:07', '2020-07-23 13:44:07'),
(1948, 2028, 337, NULL, NULL, 'In Process', 'From: txintaketeampiermailbox@bcbstx.com Sub: BCBS of Texas Inquiry Received: Ayarzagoitia, Patrick A. - Blue Cross Blue Shield - RHC : Case Number - 01638313  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638313.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-23 13:52:17', '2020-07-23 13:52:17'),
(1949, 2028, 337, NULL, NULL, 'In Process', 'To: provider_relations_south_texas@bcbstx.com Sub: Ayarzagoitia, Patrick A. - Blue Cross Blue Shield - RHC  I would like to make a request for the roster of provider Ayarzagoitia, Patrick A, Please let me know what would be the time frame for you to send us the roster for the provider   The details are as follows. Group Name: Statcare Minor Emergency Clinic Provider Name: Ayarzagoitia, Patrick A.Effective date: 4-27-2020 TIN# 46-0575924 NPI# 1649568239 Please get back to me as soon as you\'re able. Thank you', NULL, NULL, '2020-07-27 12:55:30', '2020-07-27 12:55:30'),
(1950, 1006, 337, NULL, '2020-08-19 00:00:00.000', 'Approved', 'Received following update:  \"PATRICK AYARZAGOITIA, APN 8LH078 issued 07/12/2019 and linked to STATCARE MINOR EMERGENCY CLINIC tax 460575924  In networks as of 04/27/2020 with BLUE ADVANTAGE HMO, BLUE ESSENTIALS HMO, BLUE CHOICE PPO, CHIP, HEALTHSELECT, MEDICARE ADVANTAGE PPO, TEXAS STARKIDS and TEXAS STAR PROGRAM.   He will be due for recredentialing in three years.   Thank you. \"', NULL, NULL, '2020-08-12 16:56:03', '2020-08-12 16:56:03'),
(1951, 2028, 339, NULL, NULL, 'In Process', 'TO: patti.davidson@healthsmart.com SUB:  Statcare Minor Emergency Clinic - Follow up  Hello, Hope you are doing great, I want to know about the current status of the provider  Following are the details: Group Name: Statcare Minor Emergency Clinic (Kingsville)   Provider NPI: 1689924904   Group Tax ID: 46-0575924   Please get back to me as soon as you\'re able. Thank you', NULL, NULL, '2020-06-29 14:36:20', '2020-06-29 14:36:20'),
(1952, 2028, 339, NULL, NULL, 'In Process', 'From: Patti.Davidson@healthsmart.com Sub: Need Status Update  Hi.     The documents have been processed.  We are waiting for the next credentialing approval meeting which is 7/23.  Once approved you will receive a welcome packet from Jennifer Maligaya – Sr. PR Rep.     Thank you,', NULL, NULL, '2020-06-29 17:42:17', '2020-06-29 17:42:17'),
(1953, 2028, 339, NULL, NULL, 'In Process', 'To: Patti.Davidson@healthsmart.com Sub: Need Status Update  Hello,   I need to confirm if this update is for Anci Care or is it for healthsmart?  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-06-29 17:45:05', '2020-06-29 17:45:05'),
(1954, 2028, 339, NULL, NULL, 'In Process', 'From:  Patti.Davidson@healthsmart.com Sub: Need Status Update  Hi.  This is for Ancillary Care Services.  The HealthSmart agreement is completely separate.  I handle the ACS agreements.', NULL, NULL, '2020-06-30 10:26:11', '2020-06-30 10:26:11'),
(1955, 2028, 339, NULL, NULL, 'In Process', 'TO: patti.davidson@healthsmart.com Sub: Group - Anci Care - RHC  Hello,  Hope you are doing great, is there any update for this Group.  The details are as follows: Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-14 10:16:29', '2020-07-14 10:16:29'),
(1956, 2028, 339, NULL, NULL, 'In Process', 'To: VIPproviders@anci-care.com Sub: Group - Anci Care - RHC Hello,  Hope you are doing great, is there any update for this Group.  The details are as follows: Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-15 17:35:27', '2020-07-15 17:35:27'),
(1957, 2028, 339, NULL, NULL, 'In Process', 'TO: VIPproviders@anci-care.com Sub: (Riminder) Group - Anci Care - RHC  Hello,  Hope you are doing great, is there any update for this Group.  The details are as follows: Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-20 11:04:36', '2020-07-20 11:04:36'),
(1958, 2028, 339, NULL, NULL, 'In Process', 'From: jmaligaya@anci-care.com Sub: (Reminder) Group - Anci Care - RHC  Good Morning,     Please note that our Medical Committee Advisory’s next meeting to review/approve applications is scheduled for 7/23. We will not have an update to provide you until then. Also note, once we receive the notification for MAC results, I will be providing the updates.     Best Regards', NULL, NULL, '2020-07-20 12:05:14', '2020-07-20 12:05:14'),
(1959, 2028, 339, NULL, NULL, 'In Process', 'TO: jmaligaya@anci-care.com Sub: (Reminder) Group - Anci Care - RHC  Hello,  Hope you are doing great, is there any update for this Group.  The details are as follows: Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904  Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-07-24 12:44:55', '2020-07-24 12:44:55'),
(1960, 2028, 339, NULL, NULL, 'In Process', 'To: jmaligaya@anci-care.com Sub: Re: (Reminder) Group - Anci Care - RHC  Hello,  Hope you\'re doing great, As you mentioned previously that your Medical Committee Advisory’s next meeting to review/approve applications was scheduled for 7/23 but i have not received your response since then, please update me with this.  The details are as follows: Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904  Please get back to me as soon as you\'re able.  Thank you.', NULL, NULL, '2020-07-28 12:34:38', '2020-07-28 12:34:38'),
(1961, 2037, 339, NULL, '2020-08-25 00:00:00.000', 'In Process', 'Spoke to Jennifer Maligaya @ 4052414811 .As per Jenifer the group got recently credentialed and contracted as of 07/23/2020 with the provider ID# 457864.They are waiting for one last signature on the contract by their network development manager before they can forward it to us.It is going to be sent out @ rhc@claimsmedinc.com within the next 5 to 7 days.Follow up email address ( jmaligaya@anci-care.com ). Email Sent to vipproviders@anci-care.com to add remaining two locations as primary for the practice. ---------- Hello, Kindly add the below mentioned locations to the group: Statcare Minor Emergency Clinic. TIN# 46-0575924NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363.  Secondary Location:4042 River Hill Drive Nueces County Corpus Christi TX  78410-5606.  Tertiary Location: 6646 S Staples St #122 Nueces County  Corpus Christi TX 78413-5426.  I look forward to receiving the copy of the signed contract as soon as possible.', NULL, NULL, '2020-08-18 17:24:56', '2020-08-18 17:24:56'),
(1962, 2037, 339, NULL, '2020-08-27 00:00:00.000', 'In Process', 'Got a responce from Jennifer Maligaya: Executed contract will be forwarded to us by Tuesday 08/25/2020.  Hi Sherry,  We currently have the provider agreement offsite. My Manager is scheduled to go into the office on Tuesday to scan it to me. Please anticipate the copy from me for Tuesday, 08/25/2020 via email. Thank you so much for your patience, I do apologize.', NULL, NULL, '2020-08-20 16:52:43', '2020-08-20 16:52:43'),
(1963, 1006, 339, NULL, '2020-08-28 00:00:00.000', 'In Process', 'Received following update from Jennifer MaligayaACS jmaligaya@anci-care.com> regarding Address Update request:  \"Sherry, The provided locations have been successfully added to our system. Have a great weekend\" ', NULL, NULL, '2020-08-21 13:38:59', '2020-08-21 13:38:59'),
(1964, 2037, 339, NULL, '2020-09-02 00:00:00.000', 'Approved', 'Received executed contract from ANCI Care.All three locations are added and the group is in-network with ANCI Care effective 08/01/2020.Below is the reference email:  Jennifer Maligaya Jennifer.Maligaya@healthsmart.com Attachments   Hi Sherry,  Per our discussion, please see the attachments and welcome to the Ancillary Care Services (ACS) network. Please see the attachments.  My contact information is listed below my signature. Please do not hesitate to reach out to me with any questions or concerns. Thank you!  Best Regards,  Jennifer Maligaya Sr. Provider Relations, ACS and MyDecision  ', NULL, NULL, '2020-08-26 10:37:09', '2020-08-26 10:37:09'),
(1965, 2028, 343, NULL, NULL, 'In Process', 'TO: MHTXProviderServices@MolinaHealthCare.Com  Sub: Statcare Minor Emergency Clinic - Follow up  Hi,I have sent you all the information which was required on 6/5/2020, what is the current status of enrollment?  The details are as follows. Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904  Please get back to me as soon as you\'re able. Thank you', NULL, NULL, '2020-06-23 15:40:47', '2020-06-23 15:40:47'),
(1966, 2028, 343, NULL, NULL, 'In Process', 'TO: MHTXProviderServices@MolinaHealthCare.Com Sub: Reminder (Need Status Update)  Hello,  Hope you are doing great,  I want to know about the current status of the group  The details are as follows. Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904  Please get back to me as soon as you\'re able. Thank you ', NULL, NULL, '2020-06-29 14:56:45', '2020-06-29 14:56:45'),
(1967, 2028, 343, NULL, NULL, 'In Process', 'To: mhtcontractrequest@molinahealthcare.com Sub: Re-Sending CRF and  W-9 Form  Hello, Attached are the new change of information form and the W-9 of the facility. Please let us know if you need any other information.  The details are as follows. Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904    Please get back to me as soon as you\'re able.  Thank you', NULL, NULL, '2020-06-30 12:54:06', '2020-06-30 12:54:06'),
(1968, 2028, 343, NULL, NULL, 'In Process', 'Fax:  877-900-5655   Also faxed CRF and W-9 form', NULL, NULL, '2020-06-30 13:00:44', '2020-06-30 13:00:44'),
(1969, 2028, 343, NULL, NULL, 'In Process', 'TO: mhtcontractrequest@molinahealthcare.com Sub: Group - Molina Health - RHC  Hello,  Hope you are doing great, I want to know about the current status of the Group.  The details are as follows: Group Name: Statcare Minor Emergency Clinic (Kingsville) TIN# 46-0575924 NPI# 1689924904   Please get back to me as soon as you\'re able.', NULL, NULL, '2020-07-08 09:57:15', '2020-07-08 09:57:15'),
(1970, 2028, 343, NULL, NULL, 'In Process', 'To: MHTXProviderServices@molinahealthcare.com Sub: Statcare Minor Emergency Clinic - Follow up  Hello,  Hope you are doing great, I want to know about the current status of the Group.  The details are as follows: Group Name: Statcare Minor Emergency Clinic (Kingsville) TIN# 46-0575924 NPI# 1689924904   Please get back to me as soon as you\'re able.', NULL, NULL, '2020-07-15 17:54:10', '2020-07-15 17:54:10'),
(1971, 2028, 343, NULL, NULL, 'In Process', 'From: TexasExpansionContracting@molinahealthcare.com Sub: Statcare Minor Emergency Clinic - Follow up  Good afternoon,     The application was assigned to your designated coordinator, Juliana. Please reach out to her for further assistance. Thank you in advance!     EL PASO, NUECES & TRAVIS  Juliana Mata  Juliana.Mata@molinahealthcare.com  888-562-5442 x200249        Thank you,     Jasmine Guerrero', NULL, NULL, '2020-07-16 16:36:27', '2020-07-16 16:36:27'),
(1972, 2028, 343, NULL, NULL, 'In Process', 'From: Juliana.Mata@molinahealthcare.com Sub: Group - Molina Health - RHC  Hello,  Hope you are doing great, I want to know about the current status of the Group.  The details are as follows: Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904   Please get back to me as soon as you\'re able.   ', NULL, NULL, '2020-07-16 16:38:07', '2020-07-16 16:38:07'),
(1973, 2028, 343, NULL, NULL, 'In Process', 'From: Juliana.Mata@molinahealthcare.com Sub: Molina Contract Packet - Rabagos Health Care PLLC  Dear Provider,     Please read/review and sign the attached agreement.     Thank you', NULL, NULL, '2020-07-21 18:17:50', '2020-07-21 18:17:50'),
(1974, 2028, 343, NULL, NULL, 'In Process', 'TO: Juliana.Mata@molinahealthcare.com Sub: Molina Contract Packet - Rabagos Health Care PLLC  Hello, Hope you\'re doing great, attached are the read/reviewed and signed Provider services agreement, Molina Data Collection, Health insurance claim, and Supervising physician approval forms.  Please get back to me as soon as you\'re able. Thank you', NULL, NULL, '2020-07-21 18:19:43', '2020-07-21 18:19:43'),
(1975, 2028, 343, NULL, NULL, 'In Process', 'TO: Juliana.Mata@molinahealthcare.com Sub: Molina Contract Packet - Rabagos Health Care PLLC  Hello,  Hope you are doing great, As  We have sent you all the required Forms which sent please let us know what\'s the current update for this provider  The details are as follows: Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904   Please get back to me as soon as you\'re able. Thank you.', NULL, NULL, '2020-07-30 13:56:44', '2020-07-30 13:56:44'),
(1976, 2028, 343, NULL, '2020-08-15 00:00:00.000', 'In Process', 'From: Juliana.Mata@molinahealthcare.com Sub:Molina Contract Packet - Rabagos Health Care PLLC  Good afternoon,  Provider is in process of credentialing.  Process might take 30-45 days if no additional information is required.  Credentialing department might be reaching out to you should they need any further assistance.  Once credentialing is complete, we will go ahead and send contract to get executed by our plan’s president.  Once contract is executed, we will go ahead and forward contract to be loaded into networks billing system. Process might take 60 – 90 days to complete.     Thank you for your patience', NULL, NULL, '2020-08-03 09:13:45', '2020-08-03 09:13:45'),
(1977, 2037, 343, NULL, '2020-08-26 00:00:00.000', 'In Process', 'Called Molina Health @ (855) 322-4080 and spoke to Sandra from the contracting department our contracting is still under process and everything is going smooth as of now there is nothing required from our end.Need to allow more time.The process can sometimes take 60 to 90 days maximum. Reference # : Ref#c0001568504.', NULL, NULL, '2020-08-19 09:20:10', '2020-08-19 09:20:10'),
(1978, 1005, 343, NULL, '2020-10-03 00:00:00.000', 'In Process', 'Currently in process. Allow more time to process.', NULL, NULL, '2020-09-24 14:30:21', '2020-09-24 14:30:21'),
(1979, 2037, 343, NULL, '2020-10-15 00:00:00.000', 'In Process', 'Received Credentialing Approval letter for Molina from K-Rabagos. and now moved to the contracting process.  Approval Letter uploaded on EMRBs', NULL, NULL, '2020-09-28 14:49:51', '2020-09-28 14:49:51'),
(1980, 2037, 343, NULL, '2020-11-02 00:00:00.000', 'In Process', 'Sent a follow up email @ \"Mata, Juliana\" Juliana.Mata@molinahealthcare.com -------------- Hi Juliana, Following up on the contracting process for the above approved application. The details are as follows: Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904  Thank you!', NULL, NULL, '2020-10-19 10:16:29', '2020-10-19 10:16:29'),
(1981, 2037, 343, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Katherine (Ind.) got contracted . Requested contract for the facility Urget Care .Submitted Contract Request Forms for the three locations along with the W9 form @ MHTContractrequest@molinahealthcare.com C.C Juliana.Mata@molinahealthcare.com . Junliana is working on the application. ', NULL, NULL, '2020-10-20 16:46:38', '2020-10-20 16:46:38'),
(1982, 2037, 343, NULL, '2020-11-02 00:00:00.000', 'In Process', 'Received urgent care agreement and data collection form. Completed and Submitted back to juliana. Reference email as follows: ---------------- Hi Juliana,  Hope this email finds you well. Attached is the signed agreement and the data collection form. Kindly let me know if additional information is required.  Thank you!', NULL, NULL, '2020-10-21 17:39:35', '2020-10-21 17:39:35'),
(1983, 2037, 343, NULL, '2020-11-24 00:00:00.000', 'In Process', 'Currently being processed .Need to allow more time. Jennifer Mata is working on it. --------------- Sherry Deen  Attachments Thu, Oct 22, 4:36 PM (11 days ago) to Juliana  You are welcome Juliana. Please find the copy of professional liability insurance attached.  Thank you!', NULL, NULL, '2020-11-02 16:59:49', '2020-11-02 16:59:49'),
(1984, 2037, 343, NULL, '2021-02-28 00:00:00.000', 'In Process', 'On Hold due to the absence of general liability coverage. Double checking with Katherine if she will be obtaining the coverage or not. ', NULL, NULL, '2020-11-24 15:05:24', '2020-11-24 15:05:24'),
(1985, 1006, 343, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Sent following email to \"Mata, Juliana\" Juliana.Mata@molinahealthcare.com as we received approval confirmation: \"Hello Juliana,   Happy Monday! I just wanted to confirm, is this a group contract or an ancillary/facility contract? I just want to know if we need to add all our providers under the group or not.   Did you receive a response back from credentialing regarding the third address?  Thanks a lot!\"', NULL, NULL, '2021-01-18 18:03:24', '2021-01-18 18:03:24'),
(1986, 3046, 343, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Good morning Mr. Peterson,  Happy Tuesday!!  Thank you for your assistance filling out form.  Credentialing department is asking for general liability insurance and CMS survey could you please assist?', NULL, NULL, '2021-02-25 15:44:56', '2021-02-25 15:44:56'),
(1987, 3046, 343, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Hello Juliana,  I apologize but we do not have general liability for the group and there hasn\'t been a CMS survey of the group to our knowledge. Is there anything else that we could use instead? Thank you.', NULL, NULL, '2021-02-25 15:45:45', '2021-02-25 15:45:45'),
(1988, 3046, 343, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Still in Process. ', NULL, NULL, '2021-03-04 12:37:03', '2021-03-04 12:37:03'),
(1989, 3046, 343, NULL, '2021-03-12 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-05 17:37:29', '2021-03-05 17:37:29'),
(1990, 3040, 343, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract.  Please see attachment.', NULL, NULL, '2021-03-30 14:31:11', '2021-03-30 14:31:11'),
(1991, 2028, 345, NULL, NULL, 'On Hold', NULL, NULL, NULL, '2020-07-22 09:35:29', '2020-07-22 09:35:29'),
(1992, 2037, 345, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Received an email from Karla requesting to  sign the group contract.Below is the reference: ------------- Good afternoon,  Please find the attached DHP agreement.  Katherine Rabagos is currently in process of credentialing and we are needing the contract in place to complete the process.  Please email the signature pages back to me promptly to avoid any delays.  I look forward to hearing back from you soon.  Karla Claunch, C.M.A.', NULL, NULL, '2020-09-23 13:20:13', '2020-09-23 13:20:13'),
(1993, 2037, 345, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Sent below email to Karla for fee schedule comparison between group & urgent care contracts.Below is the reference: ------------------ Hello Karla,  Thank you for your patience.I tried to reach you over the phone but was unable to get a hold of you. As \"Stat Care Minor Emergency Clinic\" is an urgent care.Is it possible to obtain an urgent care contract rather than a group. I also wanted a comparison of fee schedules between a group contract and an urgent care to make sure that the rates are lucrative before proceeding further.  Looking forward to hearing from you soon. Thank You! Hello Karla,  Thank you for your patience.I tried to reach you over the phone but was unable to get a hold of you. As \"Stat Care Minor Emergency Clinic\" is an urgent care.Is it possible to obtain an urgent care contract rather than a group. I also wanted a comparison of fee schedules between a group contract and an urgent care to make sure that the rates are lucrative before proceeding further.  Looking forward to hearing from you soon. Thank You! ', NULL, NULL, '2020-09-23 13:21:57', '2020-09-23 13:21:57'),
(1994, 2037, 345, NULL, '2020-09-30 00:00:00.000', 'In Process', 'Contract Signed and submitted back to Karla.Below is the reference email regarding the contract type inquiry & rates. ----------------- Good afternoon,  Thank you for asking such a good question.  We don’t have a contract specifically for Urgent Care.  Per the taxonomy 193200000X, it is classified as a group.  It will have no bearing on the reimbursements as you will paid per Medicaid fee schedule by the codes billed.  Please see Attachment A(page 28) Reimbursement Schedule on the agreement.  I hope this helps.  If you have any more questions, please let me know.  I hope you have a great afternoon.  Karla Claunch    ', NULL, NULL, '2020-09-23 16:54:25', '2020-09-23 16:54:25'),
(1995, 2037, 345, NULL, '2020-10-02 00:00:00.000', 'In Process', 'Received Email from Karla: ----------- Not an inconvenience at all.  Thank you for the quick response back.  You should be hearing back from me soon with Welcome packet and executed agreement.  Have a great weekend and stay safe!', NULL, NULL, '2020-09-25 10:21:15', '2020-09-25 10:21:15'),
(1996, 2037, 345, NULL, '2020-10-26 00:00:00.000', 'In Process', 'Still in process. follow up email sent to Karla .', NULL, NULL, '2020-10-08 14:48:11', '2020-10-08 14:48:11'),
(1997, 2037, 345, NULL, '2020-11-23 00:00:00.000', 'In Process', ' Sherry Deen  1:57 PM (5 minutes ago) to Rabagos, Karla  Hi Karla,  Hope you had a great weekend.  Just wanted to follow up for the Welcome packet and executed agreement for:  Rabagos Health Care LLC dba Statcare Minor Emergency Clinic. Tax ID: 46-0575924.  Thank you! Regards:', NULL, NULL, '2020-10-26 14:07:07', '2020-10-26 14:07:07'),
(1998, 2037, 345, NULL, '2021-03-31 00:00:00.000', 'On Hold', 'Katherine will not be credentialed because of the absence of an In-network supervising physician with Driscoll. And without a Katherine the group/Facility wont be credentialed as well.Reference email is as follows. ------------------------  Karla Claunch Attachments Mon, Oct 26, 2:43 PM to me  Hi Sherry,  Looks like Katherine was withdrawn (see attached letter which should have been sent from credentialing department 10/21/2020.  Until a provider is credentialed, the practice will not be contracted and will be considered out of network.  Karla Claunch, C.M.A.  Driscoll Health Plan  Provider Contracting and Credentialing Intake Specialist  615 N Upper Broadway Ste 1621  Corpus Christi TX 78401-0764  Phone: 361-694-6554  Fax: 361-881-1349  Email: karla.claunch@dchstx.org', NULL, NULL, '2020-11-23 12:51:16', '2020-11-23 12:51:16'),
(1999, 1006, 345, NULL, '2021-04-13 00:00:00.000', 'Rejected', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:53:37', '2021-04-06 14:53:37'),
(2000, 2028, 346, NULL, NULL, 'Rejected', 'They are not accepting medicare and medicaid services and are only allowing level III for commercial insurances...', NULL, NULL, '2020-07-01 09:52:49', '2020-07-01 09:52:49'),
(2001, 3040, 346, NULL, NULL, 'Revalidation', '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 13:48:19', '2021-04-07 13:48:19'),
(2002, 3040, 346, NULL, '2021-06-17 00:00:00.000', 'Revalidation', 'Email rcvd from: AM.CorpusChristi@superiorhealthplan.com  Subject: RE: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health || ref#34556  Good afternoon Adil  Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #34556  If you are in need of immediate assistance, you can call to speak to an Account Manager by phone at 1-800-656-4817 (English 1, Spanish 2), and Option 3 Provider Relations Team   Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs', NULL, NULL, '2021-06-10 09:44:59', '2021-06-10 09:44:59'),
(2003, 3040, 346, NULL, '2021-06-17 00:00:00.000', 'Revalidation', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-06-10 09:49:54', '2021-06-10 09:49:54'),
(2004, 1006, 346, NULL, '2021-06-22 00:00:00.000', 'Revalidation', '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 17:03:37', '2021-06-15 17:03:37'),
(2005, 1006, 346, NULL, '2021-07-12 00:00:00.000', 'Revalidation', '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 16:33:35', '2021-07-05 16:33:35'),
(2006, 1006, 346, NULL, '2021-07-22 00:00:00.000', 'Revalidation', '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 11:02:25', '2021-07-15 11:02:25'),
(2007, 1006, 346, NULL, '2021-08-24 00:00:00.000', 'Revalidation', '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 16:59:46', '2021-08-17 16:59:46'),
(2008, 1006, 346, NULL, '2021-09-08 00:00:00.000', 'Revalidation', '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 15:30:35', '2021-09-01 15:30:35'),
(2009, 11056, 346, NULL, '2021-09-29 00:00:00.000', 'Revalidation', '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 12:08:19', '2021-09-22 12:08:19'),
(2010, 11056, 346, NULL, '2021-10-06 00:00:00.000', 'Revalidation', '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 17:08:37', '2021-09-29 17:08:37'),
(2011, 11056, 346, NULL, '2021-10-19 00:00:00.000', 'Revalidation', '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 14:14:26', '2021-10-12 14:14:26'),
(2012, 11056, 346, NULL, '2021-10-27 00:00:00.000', 'Revalidation', '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 12:49:05', '2021-10-20 12:49:05'),
(2013, 11056, 346, NULL, '2021-11-17 00:00:00.000', 'Revalidation', '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 17:22:44', '2021-11-10 17:22:44'),
(2014, 11056, 346, NULL, '2021-11-26 00:00:00.000', 'Revalidation', '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 17:31:40', '2021-11-19 17:31:40'),
(2015, 11056, 346, NULL, '2021-12-08 00:00:00.000', 'Revalidation', '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 12:51:01', '2021-12-01 12:51:01'),
(2016, 11056, 346, NULL, '2021-12-23 00:00:00.000', 'Revalidation', '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 16:36:11', '2021-12-16 16:36:11'),
(2017, 11056, 346, NULL, '2021-12-27 00:00:00.000', 'Revalidation', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high-quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve. Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.    Your effective date is: 10/1/2021        Please see the attachment.', NULL, NULL, '2021-12-20 14:58:20', '2021-12-20 14:58:20'),
(2018, 11056, 346, NULL, '2021-12-27 00:00:00.000', 'Revalidated', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high-quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve. Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.    Your effective date is: 10/1/2021        Please see the attachment.', NULL, NULL, '2021-12-20 14:58:26', '2021-12-20 14:58:26'),
(2019, 2027, 351, NULL, NULL, 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub: (Group-Providers)-(Valley Med Urgent Care PLLC)-(BCBS)  I have checked through the BCBS online provider directory that some of the providers are linked with insurance on three different locations of (Valley Med Urgent Care). I am mentioning those three locations below here: Location (1)2534 Boca Chica BlvdBrownsville , TX 78521-3496  Location (2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166 Location (3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 But some of the providers are not showing in all locations and some are showing in one or two locations. I\'m attaching a list of providers showing in different locations.  Providers	Location(1)2534 Boca Chica BlvdBrownsville , TX 78521-3496 	Location(2)101 E. Expressway 83, Suite #170McAllen , TX 78501-1166	Location(3)800 E Alton Gloor BlvdBrownsville , TX 78526-4248 Angiollet Escobar (NP)-NPI# 1962917997	Available	Available	Available Homero Garcia (PA)-NPI# 1730564857	Not-Available	Available	Not-Available Eder Hernandez (PA)-NPI# 1386956852	Available	Available	Not-Available Mayra Lopez (PA)-NPI# 1265945125	Not-Available	Available	Not-Available Diego Noranjo (FNP)-NPI# 1568929800	Not-Available	Not-Available	Available Cynthia Rodriguez (PA)-NPI# 1124282553	Not-Available	Available	Not-Available Mayleen Soto (PA)-NPI# 1053818054	Available	Not-Available	Not-Available Stanley Sy (MD)-NPI# 1740231893	Available	Not-Available	Not-Available TERESA SAAVEDRA(DO)-NPI#  1255676151	Available	Available	Available  As it is showing that the three locations are already updated in (Valley Med Urgent Care) with BCBS so now we need to add all these providers in the missing locations. Feel free to contact me if you need any missing documentation from the providers.  ', NULL, NULL, '2020-07-23 14:32:46', '2020-07-23 14:32:46'),
(2020, 2027, 351, NULL, NULL, 'In Process', 'From: txintaketeampiermailbox@bcbstx.com  Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your inquiry, case number is 01638252.  We will respond to your inquiry in the order it was received.To check the status of your case, please click on status checker.    Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2020-07-23 14:33:19', '2020-07-23 14:33:19'),
(2021, 2027, 351, NULL, '2020-09-28 00:00:00.000', 'In Process', 'To: ProfessionalProviderNetworkDept@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care PLLC (Brownsville)-(Blue Cross Blue Shield)  May I know the current status of the below mentioned provider and the case# of this provider is 01638252:  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care PLLC Group Tax-ID: 1265945125  Thanks. ', NULL, NULL, '2020-09-21 09:51:23', '2020-09-21 09:51:23'),
(2022, 2027, 351, NULL, '2020-10-12 00:00:00.000', 'Approved', 'From: provider_relations_houston@bcbstx.com  MAYRA A LOPEZ, PA  8LY218 issued 11/13/2019 and linked to VALLEY MED URGENT CARE PLLC tax 815123542 (00Q9Z7). In network since 12/20/2019 BLUE ADVANTAGE HMO, BLUE ESSENTIALS HMO, BLUE CHOICE PPO, CHIP, HEALTHSELECT, and MEDICARE ADVANTAGE PPO.   Thank you. ', NULL, NULL, '2020-10-05 10:18:12', '2020-10-05 10:18:12'),
(2023, 3040, 354, NULL, NULL, 'Revalidation', 'Email sent to: pr.south@healthsmart.com  Subject: Type of Contract || Valley Med Urgent Care PLLC ||Health Smart ||  Greetings,   Hope you are doing well. Can you please advise me the type of contract we have under the Tax ID# 81-5123542 and also verify me that below locations are updated in the contract. Would it be possible for you to send the provider roster if not at least send me the list of the providers coming up under the system.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please let me know. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-25 12:27:11', '2021-03-25 12:27:11'),
(2024, 3040, 354, NULL, NULL, 'Revalidated', 'Email sent to: pr.south@healthsmart.com  Subject: Additional Locations || Valley Med Urgent Care PLLC || Group & Providers || Health Smart ||  Greetings,   Hope you are doing well. I wanted to add the below mentioned group and providers in Health smart for our group Valley Med Urgent Care PLLC under the below mentioned locations.    Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Effective Date: 07/01/2019 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Effective Date: 02/01/2013 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Effective Date: 03/01/2020 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 4: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852 Effective Date: 05/01/2018 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Provider 5: Provider Name: Garcia, Homero Provider NPI# 1730564857 Effective Date: 02/01/2019 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Provider 6: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Effective Date: 08/01/2020 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-14 13:10:21', '2021-04-14 13:10:21');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(2025, 3040, 354, NULL, '2021-06-23 00:00:00.000', 'Revalidated', 'Email sent to: pr.south@healthsmart.com  Subject; Re: Additional Locations || Valley Med Urgent Care PLLC || Group & Providers || Health Smart ||  Hello,  Hope you are doing well. I wanted to add the below mentioned locations for our group and providers in Health smart for our group Valley Med Urgent Care PLLC under the below mentioned locations.    Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Effective Date: 07/01/2019 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Effective Date: 02/01/2013 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Effective Date: 03/01/2020 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 4: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852 Effective Date: 05/01/2018 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Provider 5: Provider Name: Garcia, Homero Provider NPI# 1730564857 Effective Date: 02/01/2019 Additional Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Provider 6: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Effective Date: 08/01/2020 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 7: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Effective Date: 12/01/2019 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248   Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you   ', NULL, NULL, '2021-06-16 14:03:35', '2021-06-16 14:03:35'),
(2026, 3040, 354, NULL, '2021-07-12 00:00:00.000', 'Revalidated', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Additional Locations || Valley Med Urgent Care PLLC || Group & Providers || Health Smart ||  Hello,  Hope you are doing well. I wanted to add the below locations for the below mentioned provider in Health smart in our group Valley Med Urgent Care PLLC under the below mentioned locations.    Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Effective Date: 12/01/2019 Additional Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248   Additional Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-05 11:59:59', '2021-07-05 11:59:59'),
(2027, 2027, 360, NULL, '2020-10-19 00:00:00.000', 'In Process', 'To: billing@claimsmedinc.com  (Providers)-(Columbus Urgent Care)-(United HealthCare)  This is to inform the billing department that (United HealthCare) has refused to change this contract into urgent care with (Columbus Urgent Care). What else we should try please advise?  Thanks.', NULL, NULL, '2020-10-12 17:59:33', '2020-10-12 17:59:33'),
(2028, 1006, 360, NULL, '2020-11-05 00:00:00.000', 'On Hold', 'Sent another email @ Billing - Claims Med billing@claimsmedinc.com>: \"We have discussed this issue verbally also, So please advise how we should proceed on this.  Thanks.\"', NULL, NULL, '2020-10-26 13:50:31', '2020-10-26 13:50:31'),
(2029, 2027, 360, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: 	uhc_provider_contracting_cen@uhc.com, networkhelp@uhc.com  Sub: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-06 10:17:38', '2020-11-06 10:17:38'),
(2030, 2027, 360, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: corey_j_ford@uhc.com  Hello,  We have received a contract to enroll with (UHC) for our practice (Columbus Urgent Care Center) and the DOCUSIGN email which we have received from (UHC) cannot be accessed on our end, since we\'re a third party credentialing provider, please send us a version of the application that can be easily accessed and worked on. Do let me know if u have further questions.  Thanks.', NULL, NULL, '2020-11-13 16:51:55', '2020-11-13 16:51:55'),
(2031, 2027, 360, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: networkhelp@uhc.com  Thank you for  contacting Network Management Resource Team. We will be happy to see if we can assist regarding your inquiry. We are needing additional information in order to accurately review your request. Please provide the provider’s NPI number along with the group TIN/NPI. Please note for future emails many times our confidential/secured emails go directly to spam/junk folders.     If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.     For questions related to credentialing, benefits or claim status, please utilize www.UHCprovider.com or call the United Voice Portal at  877-842-3210.  For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.       For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.   Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation', NULL, NULL, '2020-11-20 12:30:38', '2020-11-20 12:30:38'),
(2032, 2027, 360, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com  Please find the requested information below to start the process.  Providers	Provider-NPI#	Group-TIN# Joseph, Vibitha	1952931560	471914151 Brown, Brittany	1275163537	471914151 Stephen, Ani	1588959118	471914151 Jose, Julie	1447883061	471914151 George, Jeemol	1497219067	471914151 Abraham, Glory	1194206490	471914151 Kourouma , Odette Tiranke	1134525868	471914151 Chennemkara, Mini Philip	1841755956	471914151    Thanks.', NULL, NULL, '2020-11-20 12:30:48', '2020-11-20 12:30:48'),
(2033, 2027, 360, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: networkhelp@uhc.com corey_j_ford@uhc.com   I have provided the requested information in my last email. Please assist me how can I enroll these providers under this contract.   Thanks.', NULL, NULL, '2020-11-30 15:52:37', '2020-11-30 15:52:37'),
(2034, 2037, 360, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Email sent to corey_j_ford@uhc.com & networkhelp@uhc.com --------- Subject: (Providers)-(Columbus Urgent Care)-(United HealthCare)  Greetings, May I know if we can proceed further with the credentialing process of the group and the below mentioned providers.Also note that we are unable to access the sent group contract for signatures.Kindly send us the consent to release information form in order to get it signed by the authorized person.   Providers           Provider-NPI# Group-TIN# Joseph, Vibitha        1952931560 471914151 Brown, Brittany       1275163537 471914151 Stephen, Ani           1588959118 471914151 Jose, Julie            1447883061 471914151 George, Jeemol         1497219067 471914151 Abraham, Glory         1194206490 471914151 Kourouma , Odette Tiranke              1134525868 471914151 Chennemkara, Mini Philip               1841755956 471914151 ', NULL, NULL, '2020-12-08 17:17:52', '2020-12-08 17:17:52'),
(2035, 1006, 360, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent a follow-up email @ NMRT networkhelp@uhc.com, \"Ford, Corey J\" corey_j_ford@uhc.com, UHC Provider Contracting CEN uhc_provider_contracting_cen@uhc.com:  \"Hello,   I hope you\'re doing well, we keep receiving the group contract for   CUCC but as previously mentioned we are unable to access it. Please   let me know what is required to get this sorted as this has been going   for quite a while and we are unable to move forward with this request.   Please get back to me as soon as possible.  Thanks. \"', NULL, NULL, '2020-12-15 17:39:28', '2020-12-15 17:39:28'),
(2036, 2037, 360, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email Sent to networkhelp@uhc.com ------------------------------ Hi Nathan,  Yes the TIN that you highlighted is the one in question which is 471914151.   We have an Urgent Care Contract for the facility however we did request an amendment and would want to be contract as a group with all billable CPT\'s included rather then only the S Codes for Urgent Care services and also that we may go ahead and add all our providers to the group contract.  As per my correspondence with Cortney I did mention that an amended secured contract is being forwarded to us with the Subject: Reminder: UHC COMMERCIAL CONTRACT-GD-18696333-COLUMBUS URGENT CARE, PA @ cucc@claimsmedinc.com last received 12/15/2020, however I requested the contract to be sent out to the office manager Selena directly @ selenalara504@gmail.com for her to review and sign.  If you could kindly double check the current status of our request and what exactly got closed as you mentioned in your response. Looking forward hearing back from you soon.  Regards, Sherry Deen.', NULL, NULL, '2020-12-22 17:52:13', '2020-12-22 17:52:13'),
(2037, 1006, 360, NULL, '2021-01-08 00:00:00.000', 'In Process', 'Sent email @ NMRT networkhelp@uhc.com: Sub: Contract Linkage Request - Columbus Urgent Care  \"Hello,  I hope you\'re doing well, we wish to add/link the following providers as in-network to our group contract, the info for the group and providers is as follows: Group Name: Columbus Urgent Care PATIN# 47-1914151 Provider Name: Vibitha JosephNPI# 1952931560Provider Name: Brittany Brown NPI# 1275163537Provider Name: Ani StephenNPI# 1588959118Provider Name: Julie JoseNPI# 1447883061Provider Name: Jeemol GeorgeNPI# 1497219067Provider Name: Glory AbrahamNPI# 1194206490Provider Name: James PiccioneNPI# 1356321509Provider Name: Odette KouroumaNPI# 1134525868Provider Name: Ramegowda BelakereNPI# 1235166687 I\'ve also attached an LOI for your reference with W9.  Thanks. \"', NULL, NULL, '2021-01-05 18:13:08', '2021-01-05 18:13:08'),
(2038, 1006, 360, NULL, '2021-02-15 00:00:00.000', 'In Process', 'Request currently pending at Latresha\'s end sent the following email to her @ \"Coles, Latresha M\" latresha_m_coles@uhc.com: \"Hello,   I definitely appreciate the help, Corey.   @Latresha - I\'d appreciate it if you could please get back to us regarding what our options are for the group contract and how fast we would be able to set it up since we would also need to enroll our providers under it and that could take quite a while, so if there\'s any way to expedite both procedures I\'d definitely be thankful.   Thank you!\"', NULL, NULL, '2021-02-02 17:55:20', '2021-02-02 17:55:20'),
(2039, 1006, 360, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Received the following reply from Coles, Latresha M latresha_m_coles@uhc.com: \"Greetings Brad,  As previously discussed, it is not our policy to contract urgent care centers, physicians, and medical groups, under the same TIN, under separate agreements.  This is something that cannot be administered  and you will need to make a business decision regarding how you would like to be contracted.  In our previous discussion you indicated that you would make a decision and get back to me.  Based on your request to reinstate the urgent care agreement, it appears that the decision was to be contracted as an urgent care center.   This prevents the contracting of a medical group agreement under this TIN.  As previously discussed, this will impact the current agreement for Dr. Rauf under this same TIN.  We will have to terminate his agreement, as we cannot not administer different types of agreements under the same TIN as there will be a negative impact on claims.  Please let me know if you have any additional questions.  Regards, Latresha Coles  Sr. Network Account Manager |UnitedHealthcare South Texas - Physician 2000 West Loop South, Suite 900, Houston, TX 77027 | (763)283-3194| 888-845-9481 (fax) | latresha_m_coles@uhc.com\"  Sent following reply:  \"Good morning Latresha,   I appreciate you finally getting back to me. We already made that business decision a few months ago when we asked Corey to remove the urgent care contract and initiated a request for the group contract. It wasn\'t our decision to reinstate the urgent care contract, Corey did that on his end as he did not see any other contracts and wanted our claims to be paid. As per my discussion with Corey, there was a group contract that was loaded under our group but wasn\'t set-up correctly and didn\'t have any physician lines on it, and my suggestion was to correct that group contract instead of reinstating the urgent care contract.   Do let me know how we can set up our group contract as it\'s been quite a few months already and we are still no further along than we were back then, so we need the request to be expedited as well.   Looking forward to hearing from you!  Thanks.\"', NULL, NULL, '2021-02-11 10:24:24', '2021-02-11 10:24:24'),
(2040, 3040, 360, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Pending group enrollment. ', NULL, NULL, '2021-05-20 14:44:10', '2021-05-20 14:44:10'),
(2041, 2027, 361, NULL, NULL, 'In Process', 'To: mhorton1@humana.com  Sub: Need Status Update For Provider Odette Tiranke Kourouma  Hello,   Hope you are doing great, I want to know about the current status of the provider. Following are the details:  Provider Name: Odette Tiranke Kourouma  NPI# 1134525868 Group Name: Longpoint Medical Center  Tax-ID: 76-0612416  Kindly update me how much time is required for the completion of this request.  Thanks.', NULL, NULL, '2020-06-19 14:25:56', '2020-06-19 14:25:56'),
(2042, 2027, 361, NULL, '2020-08-31 00:00:00.000', 'In Process', 'To: ywyatt@humana.com	HumanaHoustonPD@humana.com	kmoten4@humana.com  Sub: (Kourouma , Odette Tiranke)-(Longpoint Medical Center)-(Tricare)  May i know the current status of the provider mentioned below: Provider Name-Kourouma , Odette Tiranke Provider NPI#1134525868 Group Name-Longpoint Medical Center Group Tax-ID-76-0612416  Thanks.', NULL, NULL, '2020-08-24 15:05:33', '2020-08-24 15:05:33'),
(2043, 2027, 361, NULL, '2020-09-02 00:00:00.000', 'In Process', 'From: kmoten4@humana.com  Good Afternoon,   This is provider is showing credentialed eff 7/28/20.', NULL, NULL, '2020-08-26 09:45:12', '2020-08-26 09:45:12'),
(2044, 2027, 361, NULL, '2020-09-02 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  Hi Martin,   I received your voicemail. I wanted to confirm with you that this provider is showing under TIN: 760612416 Longview Medical.', NULL, NULL, '2020-08-26 09:46:22', '2020-08-26 09:46:22'),
(2045, 2027, 361, NULL, '2020-09-02 00:00:00.000', 'In Process', 'To: kmoten4@humana.com  Sub: (Kourouma , Odette Tiranke)-(Longpoint Medical Center)-(Tricare)  I have checked through your provider directory this provider is not showing there. Please send me the welcome letter or executed signed contract for my record.  Provider Name:Kourouma , Odette Tiranke Provider NPI# 1134525868  Group Name:Longpoint Medical Center Group Tax-ID:76-0612416   Thanks. ', NULL, NULL, '2020-08-26 09:47:22', '2020-08-26 09:47:22'),
(2046, 2027, 361, NULL, '2020-09-10 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Kourouma , Odette Tiranke)-(Longpoint Medical Center)-(Tricare)  Hello hope you are doing great, I have received an email from you on 8/28/2020 regarding our provider Kourouma , Odette Tiranke you have confirmed that this provider is showing under the tax id-760612416 but when i tried to check through your provider directory i didn\'t find this provider there as well as i didn\'t find the group. So kindly confirm to me one last time that either this provider is in the network or not.   Thanks. ', NULL, NULL, '2020-09-03 13:44:36', '2020-09-03 13:44:36'),
(2047, 2027, 361, NULL, '2020-09-15 00:00:00.000', 'Approved', 'Provider is linked with tricare and effective date is 7/28/2020 screenshot of the email for confirmation is attached', NULL, NULL, '2020-09-08 10:17:38', '2020-09-08 10:17:38'),
(2048, 3040, 361, NULL, '2021-07-16 00:00:00.000', 'Revalidation', 'Email sent to: ywyatt@humana.com  Subject: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,   Hope you are doing well. I wanted to add the location under the below mentioned providers in Tricare in our group under the below mentioned locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Jose, Julie Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:   Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-09 14:33:06', '2021-07-09 14:33:06'),
(2049, 11056, 361, NULL, '2021-08-18 00:00:00.000', 'Revalidation', 'Email received from :    ywyatt@humana.com  Sub : Fwd: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Morning Adil,     To add a provider to a network location you need to complete the attached spreadsheet and email it to the HGB Roster team to process.     Send the completed spreadsheet to the following email address     HGBProviderRosters@Humana.com              Thanks,  Yvonne', NULL, NULL, '2021-08-11 11:31:53', '2021-08-11 11:31:53'),
(2050, 3040, 361, NULL, '2021-08-25 00:00:00.000', 'Revalidation', 'Email sent to: HGBProviderRosters@humana.com, ywyatt@humana.com  Subject: Re: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Received Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in an additional location in Tricare in our group under the below highlighted locations. We already submitted the roster for an additional location on 07/19/2021.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:     Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:    Provider Name: Rauf, Abdur   Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:    Provider Name: Thomas, Cini   Provider NPI# 1134777238  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:    Provider Name: Abraham, Jeena   Provider NPI# 1467901587  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!! ', NULL, NULL, '2021-08-18 16:51:25', '2021-08-18 16:51:25'),
(2051, 3040, 361, NULL, '2021-09-08 00:00:00.000', 'Revalidated', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Afternoon Adil,  We show the following.  This information is available on the Providers Portal or directory Highlighted is the link to check status. I have attached a copy of the spreadsheet of the Providers we show affiliated to these groups under this tax id.   https://infocenter.humana-military.com/provider/service/Account/Login  HumanaMilitary - Find care (goperspecta.com)  Provider 1:   Provider Name: Jose, Julie- Show has been added Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 – Show added Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226- Show not added yet  Provider 3:  Show Added Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:  Show added to both locations Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 5:  - Show added Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini – show added to all three locations Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 7:  - Show added. Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-09-01 13:16:52', '2021-09-01 13:16:52'),
(2052, 2027, 362, NULL, NULL, 'In Process', 'Call to the representative of Tricare she said it takes 90 days to complete the process ', NULL, NULL, '2020-06-18 13:58:47', '2020-06-18 13:58:47'),
(2053, 2027, 362, NULL, NULL, 'In Process', 'To: ywyatt@humana.com, KMoten4@humana.com  Sub: (Kourouma , Odette Tiranke)-(Columbus Urgent Care PA)-(Tricare)  May i know the current status of the provider enrollment. Details are mentioned below: Provider Name:  Kourouma , Odette Tiranke  Provider NPI# 1134525868 Group Name: Columbus Urgent Care PA Group Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-07-09 15:45:32', '2020-07-09 15:45:32'),
(2054, 2027, 362, NULL, NULL, 'In Process', 'From: KMoten4@humana.com  Good Afternoon,     This application was submitted on 6/24/20; please allow 90 days for processing.     Respectfully,', NULL, NULL, '2020-07-09 15:50:46', '2020-07-09 15:50:46'),
(2055, 2027, 362, NULL, '2020-10-15 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Kourouma , Odette Tiranke)-(Columbus Urgent Care PA)-(Tricare)  May i know the current status of the provider enrollment. Details are mentioned below: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Group Name: Columbus Urgent Care PA Group Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-10-08 13:29:16', '2020-10-08 13:29:16'),
(2056, 2027, 362, NULL, '2020-10-15 00:00:00.000', 'Approved', 'Provider is showing linked with insurance and effective date is 7/28/2020', NULL, NULL, '2020-10-08 14:28:50', '2020-10-08 14:28:50'),
(2057, 2027, 363, NULL, NULL, 'In Process', '\'ywyatt@humana.com  Provider-Odette Tiranke Kourouma -Need Status   Hello,Hope you are doing great, I want to know about the current status of the provider.Following are the details.Provider Name: Odette Tiranke KouroumaNPI# 1134525868.Group Name:Normandy Urgent Care CenterTax ID: 27-0796429 Thanks.', NULL, NULL, '2020-06-15 17:59:06', '2020-06-15 17:59:06'),
(2058, 2027, 363, NULL, NULL, 'In Process', 'Yvonne Wyatt ywyatt@humana.com to:	Martin Rodriguez mk@claimsmedinc.com,  RE: Provider-Odette Tiranke Kourouma -Need Status     \"Hello Martin,      We show this provider need to be credential to activate as network. I have attached a credentialing  application for you to complete and email back to me\"', NULL, NULL, '2020-06-16 10:54:31', '2020-06-16 10:54:31'),
(2059, 2027, 363, NULL, NULL, 'In Process', ' ywyatt@humana.com  Re: Provider-Odette Tiranke Kourouma -Need Status  \"Hello,    Hope you are doing great, I have filled the application you have asked for please find the attachment.      Thanks\"', NULL, NULL, '2020-06-16 17:26:26', '2020-06-16 17:26:26'),
(2060, 2027, 363, NULL, NULL, 'In Process', 'Yvonne Wyatt ywyatt@humana.com  Re: Provider-Odette Tiranke Kourouma -Need Status  Hello,    Hope you are doing great, I have filled the application you have asked for please find the attachment.      Thanks.', NULL, NULL, '2020-06-16 17:29:39', '2020-06-16 17:29:39'),
(2061, 2027, 363, NULL, NULL, 'In Process', 'To: ywyatt@humana.com  Sub; Need Status Update For The Provider Odette Tiranke Kourouma  Hello,																									 Hope you are doing great, I want to know about the current status of the provider Odette Tiranke Kourouma Following are the details:  Group Name: Normandy Urgent Care Center   Provider NPI: 1134525868   Group Tax ID: 27-0796429   We have already sent the credentialing application You have requested for. Thanks.', NULL, NULL, '2020-06-23 14:36:20', '2020-06-23 14:36:20'),
(2062, 2027, 363, NULL, NULL, 'In Process', 'From: ywyatt@humana.com  TO: mk@claimsmedinc.com  Hello Martin,     We show this provider is in process with credentialing. Credentialing has up to 90 day to approve an application.              Thanks,  Yvonne W. Wyatt,', NULL, NULL, '2020-06-25 09:22:36', '2020-06-25 09:22:36'),
(2063, 2027, 363, NULL, NULL, 'In Process', 'To: ywyatt@humana.com  Sub: (Kourouma , Odette Tiranke)-(Normandy Urgent Care Center)-(Tricare)  Hello, Hope you are doing great, I want to know about the current status of the provider Odette Tiranke Kourouma Following are the details: Group Name: Normandy Urgent Care Center   Provider NPI: 1134525868   Group Tax ID: 27-0796429   We have already sent the credentialing application You have requested for. Thanks.', NULL, NULL, '2020-07-31 11:15:36', '2020-07-31 11:15:36'),
(2064, 2027, 363, NULL, '2020-08-20 00:00:00.000', 'Approved', 'Provider is now in network with the effective date 7/28/2020 welcome letter is attached', NULL, NULL, '2020-08-13 12:55:22', '2020-08-13 12:55:22'),
(2065, 2027, 364, NULL, NULL, 'In Process', 'talked to the representative his name is Torrey ref# 12023335 he said it takes some more time to be processed completely. ', NULL, NULL, '2020-06-18 14:51:26', '2020-06-18 14:51:26'),
(2066, 2027, 364, NULL, '2020-08-20 00:00:00.000', 'In Process', 'To: 	intake_pdm@cigna.com,         PDMCOGZ@cigna.com  Sub: (Kourouma , Odette Tiranke)-(Columbus Urgent Care PA)-(Cigna)  May I know the current status of the below mentioned provider. Provider Name:  Kourouma , Odette Tiranke  Provider NPI# 1134525868 Group Name: Columbus Urgent Care PA Tax ID: 471914151  Thanks. ', NULL, NULL, '2020-08-13 17:19:21', '2020-08-13 17:19:21'),
(2067, 2027, 364, NULL, '2020-08-21 00:00:00.000', 'In Process', 'Call to insurance talk to a representative his name is james he gave me a ref#james8/14 and said that there was a confusion in this application that is why they have closed this application but now they have again opened it and the application is still in process it may take up till september', NULL, NULL, '2020-08-14 15:23:14', '2020-08-14 15:23:14'),
(2068, 2027, 364, NULL, '2020-08-26 00:00:00.000', 'In Process', 'From: ONBEloquaNotice@cigna.com  Sub: Re:	Reference number 12288880 Application to participate in the Cigna medical network  Dear ODETTE KOUROUMA,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.  What happens next?  Once the application review is complete, we will begin the credentialing process. This usually takes 90 business days from the date we receive your completed application. In some states, individual mandates may affect turnaround time. We will contact you if there is any missing information.  Once the credentialing process is complete, we’ll let you know if you’ve been approved as a participating provider in the network(s) for which you\'ve applied.  Sincerely,  Cigna', NULL, NULL, '2020-08-19 09:45:23', '2020-08-19 09:45:23'),
(2069, 1006, 364, NULL, '2020-08-28 00:00:00.000', 'In Process', 'Received following update from Cigna:   \"CREDENTIALING STATUS UPDATE	 Status: Application complete. Credentialing process to begin.	 Re:	Reference number 12288880 Application complete: Credentialing process to begin Dear ODETTE KOUROUMA,  We have confirmed that your application is complete, and have forwarded it for credentialing review\"', NULL, NULL, '2020-08-21 10:56:08', '2020-08-21 10:56:08'),
(2070, 2027, 364, NULL, '2020-09-17 00:00:00.000', 'Approved', 'This provider is now linked with insurance and effective date is 09/04/2020. Welcome letter is attached', NULL, NULL, '2020-09-10 12:21:12', '2020-09-10 12:21:12'),
(2071, 2027, 365, NULL, '2020-10-18 00:00:00.000', 'In Process', 'To: 	intake_pdm@cigna.com, 9PSSCENT@cigna.com  May i know the current application status of this provider, her details are mentioned below: Provider Name: Kourouma , Odette Tiranke   Provider NPI#  1134525868   Thanks.  ', NULL, NULL, '2020-10-11 16:02:12', '2020-10-11 16:02:12'),
(2072, 2027, 365, NULL, '2020-10-21 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 09/04/2020', NULL, NULL, '2020-10-14 12:20:41', '2020-10-14 12:20:41'),
(2073, 2027, 366, NULL, NULL, 'In Process', 'Cigna contract has been signed and attached', NULL, NULL, '2020-06-16 10:23:05', '2020-06-16 10:23:05'),
(2074, 2027, 366, NULL, NULL, 'In Process', 'To: PSSCentral@cigna.com  Sub: Need Status Update Of Provider Odette Tiranke Kourouma  Hello,																									 Hope you are doing great, I want to know about the current status of the provider Odette Tiranke Kourouma Following are the details:  Group Name: Normandy Urgent Care Center   Provider NPI: 1134525868   Group Tax ID: 27-0796429   We have already signed and attached the cigna contract in the last follow up on 06/16/2020.  Thanks.', NULL, NULL, '2020-06-23 14:47:29', '2020-06-23 14:47:29'),
(2075, 2027, 366, NULL, NULL, 'In Process', 'From: PSU Inquiry (Non-Claim)  Good Morning Martin,     Thank you for contacting Cigna Healthcare.     We apologize for our delayed response. Our email volumes are higher than normal impacting our response times. We appreciate your patience.     The providers credentialing process was started with another tax id on 05012020 with Application # 12023335. Your information has been added to the providers current process. The credentialing/contracting process takes up to 90 business days     Provider: ODETTE KOUROUMA  Tax ID: 270796429        Sincerely,', NULL, NULL, '2020-07-10 12:57:25', '2020-07-10 12:57:25'),
(2076, 2027, 366, NULL, '2020-09-09 00:00:00.000', 'In Process', 'To: PSSCentral@cigna.com  Sub: (Kourouma , Odette Tiranke)-(Normandy Urgent Care Center)-(Cigna)  May I know the current status of the provider mentioned below: Provider Name- Kourouma , Odette Tiranke Provider NPI# 1134525868 Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429  Thanks. ', NULL, NULL, '2020-09-02 17:20:00', '2020-09-02 17:20:00'),
(2077, 1005, 366, NULL, '2020-10-01 00:00:00.000', 'In Process', 'Sent a reminder. Currently in process', NULL, NULL, '2020-09-24 13:41:11', '2020-09-24 13:41:11'),
(2078, 2027, 366, NULL, '2020-10-27 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 09/04/2020. Confirmation screenshot is attached.', NULL, NULL, '2020-10-20 12:53:41', '2020-10-20 12:53:41'),
(2079, 2027, 372, NULL, NULL, 'In Process', 'To: CHC.Contracting@communityhealthchoice.org  Sub: Need Status Update of Provider Odette Tiranke Kourouma  Hello,    Hope you are doing great, I want to know about the current status of the provider.  Following are the details:  Provider Name: Odette Tiranke Kourouma  NPI# 1134525868  Group Name: Normandy Urgent Care Center  Tax ID: 27-0796429  Thanks.', NULL, NULL, '2020-06-18 12:37:06', '2020-06-18 12:37:06'),
(2080, 2027, 372, NULL, NULL, 'In Process', 'Talk to the representative of CHC her name is jaquiline she said this provider is now in their network and the effective date is  04/29/2020 but welcome letter is still pending. So she gave an email address to send the request for welcome letter of this provider. ', NULL, NULL, '2020-06-24 12:06:46', '2020-06-24 12:06:46'),
(2081, 2027, 372, NULL, NULL, 'In Process', 'To: 	chc.contracting@communityhealthchoice.org  Sub: Need Welcome Letter For Kourouma , Odette Tiranke  Hello, Hope you are doing well. I have talked to one of the representative of Community Health Choice-CHC her name is jacqueline, I have confirmed with her that the provider Kourouma , Odette Tiranke is already in network and effective date is 04/29/2020 but she didn\'t have the access or authorisation to send us the welcome letter. So she told us to send a request for a welcome letter to you, kindly reply to me as soon as you get this email. Provider Details are as follows: Provider Name: Kourouma , Odette Tiranke Provider NPI:  1134525868  Group Name: Normandy Urgent Care Center Group Tax ID: 27-0796429  Thanks.', NULL, NULL, '2020-06-24 12:24:24', '2020-06-24 12:24:24'),
(2082, 2027, 372, NULL, NULL, 'Approved', 'From: Kris.Olier@communityhealthchoice.org  To: mk@claimsmedinc.com  Please see attached welcome letter and profile.', NULL, NULL, '2020-06-25 09:34:37', '2020-06-25 09:34:37'),
(2083, 2027, 372, NULL, NULL, 'Approved', 'sent email to insurance for the confirmation of the permission to accept new patients option the profile ', NULL, NULL, '2020-06-26 11:00:12', '2020-06-26 11:00:12'),
(2084, 2027, 372, NULL, NULL, 'In Process', 'To: Kris.Olier@communityhealthchoice.org  Sub: Re: Need Welcome Letter For Kourouma , Odette Tiranke  Hello, Hope you are doing well, Yesterday i received your email in which you have attached two documents, One is a welcome letter and the other is a profile for the provider Odette kourouma. So my question is why she is not allowed to accept new patients because I see no check in the dialogue box in front of that option in the profile you sent. Kindly look into this and reply to me as soon as you get this email.  Thanks. ', NULL, NULL, '2020-07-06 13:42:58', '2020-07-06 13:42:58'),
(2085, 2027, 372, NULL, NULL, 'Approved', 'From: Kris.Olier@communityhealthchoice.org  The providers for urgent care are not listed as pcp’s accepting new patients, they are loaded for the purpose of making sure we have the rendering providers loaded for the Urgent care. All providers can see members for Community but will not listed as accepting patients.', NULL, NULL, '2020-07-06 14:00:47', '2020-07-06 14:00:47'),
(2086, 2027, 375, NULL, NULL, 'In Process', 'txcredentialing@amerigroup.com  Need credentialing status update of Odette Tiranke Kourouma    Hello,  Hope you are doing great, I want to know about the current status of the provider. Following are the details: Provider Name: Odette Tiranke KouroumaNPI# 1134525868Group Name: Normandy Urgent Care CenterTax-ID: 27-0796429 Kindly update me how much time is required for the completion of this request. Thanks.', NULL, NULL, '2020-06-17 12:32:32', '2020-06-17 12:32:32'),
(2087, 2027, 375, NULL, NULL, 'In Process', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Need credentialing status update of Odette Tiranke Kourouma  Not par yet', NULL, NULL, '2020-06-22 09:15:39', '2020-06-22 09:15:39'),
(2088, 2027, 375, NULL, NULL, 'In Process', 'To: txcredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Need credentialing status update of Odette Tiranke Kourouma  Hello  Hope You are doing well. may i know the completion time for this request. or tell me if you need any document to complete this request.  Thanks.', NULL, NULL, '2020-06-22 09:16:58', '2020-06-22 09:16:58'),
(2089, 2027, 375, NULL, NULL, 'In Process', 'To: txcredentialing@amerigroup.com  Sub: Need Status For provider Odette Kourouma  Hello, last week i received an email from you that this provider has not participated yet. May I know how much time is required to complete this request. Her details are as follows: Provider Name: Odette Kourouma Provider NPI# 1134525868 Group Name: Normandy Urgent Care Center Group Tax ID:  27-0796429   Thanks. ', NULL, NULL, '2020-06-30 17:15:31', '2020-06-30 17:15:31'),
(2090, 2027, 375, NULL, '2020-09-09 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  Sub: (Kourouma , Odette Tiranke)-(Normandy Urgent Care Center)-(Amerigroup)  May I know the current status of the provider mentioned below: Provider Name- Kourouma , Odette Tiranke Provider NPI# 1134525868 Group Name- Normandy Urgent Care Center Group Tax-ID- 27-0796429  Thanks.', NULL, NULL, '2020-09-02 15:53:25', '2020-09-02 15:53:25'),
(2091, 1005, 375, NULL, '2020-10-01 00:00:00.000', 'In Process', 'Sent a reminder. Awaiting response.', NULL, NULL, '2020-09-24 13:34:16', '2020-09-24 13:34:16'),
(2092, 2027, 375, NULL, '2020-10-29 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  Sub: (Kourouma , Odette Tiranke)-(Normandy Urgent Care Center)-(Amerigroup)  May I know the current enrollment status of the below mentioned provider:  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks.', NULL, NULL, '2020-10-22 09:53:35', '2020-10-22 09:53:35'),
(2093, 2027, 375, NULL, '2020-11-06 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  Sub: (Kourouma , Odette Tiranke)-(Normandy Urgent Care Center)-(Amerigroup)  May I know the current enrollment status of the below mentioned provider:  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429  Thanks.', NULL, NULL, '2020-10-30 14:05:43', '2020-10-30 14:05:43'),
(2094, 2027, 375, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-06 15:31:32', '2020-11-06 15:31:32'),
(2095, 2037, 375, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Follow up email sent to txcredentialing@amerigroup.com and Jason.Hughes@amerigroup.com for the current status after the credentialing application Submission.', NULL, NULL, '2020-11-13 15:37:29', '2020-11-13 15:37:29'),
(2096, 2037, 375, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Another follow up email sent', NULL, NULL, '2020-11-30 17:50:19', '2020-11-30 17:50:19'),
(2097, 2027, 375, NULL, '2020-12-17 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  Please find the (LOI) attached in this email as per your request.  Thanks.', NULL, NULL, '2020-12-10 14:55:34', '2020-12-10 14:55:34'),
(2098, 2037, 375, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-17 16:49:07', '2020-12-17 16:49:07'),
(2099, 2037, 375, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-29 15:46:45', '2020-12-29 15:46:45'),
(2100, 1006, 375, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Sent a follow-up email @ TX Credentialing txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com ', NULL, NULL, '2021-01-20 09:48:02', '2021-01-20 09:48:02'),
(2101, 1006, 375, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent another follow-up @ TX Credentialing txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com ', NULL, NULL, '2021-02-16 15:20:37', '2021-02-16 15:20:37'),
(2102, 3040, 375, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Provider Enrollment Status - Normandy Urgent Care Center  Hello,   I want an update regarding the status of enrollment for the following providers under our group as their enrollment requests have been in process since the start of last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Vibitha Joseph Provider NPI# 1952931560  Provider Name: Odette Kourouma Provider NPI# 1134525868  Provider Name: Jeena Abaham Provider NPI# 1467901587  Provider Name: Ani Stephen  Provider NPI# 1588959118  Provider Name: Chennemkara, Mini Philip Provider NPI#  1841755956  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you. ', NULL, NULL, '2021-02-26 14:14:10', '2021-02-26 14:14:10'),
(2103, 1006, 375, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:04:46', '2021-05-31 15:04:46'),
(2104, 11056, 375, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 12:19:30', '2021-06-17 12:19:30');
