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
(34253, 3040, 25833, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:12', '2021-04-30 09:16:12'),
(34254, 3040, 25838, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:18:43', '2021-04-26 14:18:43'),
(34255, 3040, 25838, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group Valley Med Urgent Care PLLC under all three 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  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:23:51', '2021-04-30 10:23:51'),
(34256, 3040, 25838, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227  www.christushealthplan.org', NULL, NULL, '2021-05-03 11:02:56', '2021-05-03 11:02:56'),
(34257, 3040, 25839, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:03', '2021-04-26 14:19:03'),
(34258, 3040, 25839, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:01:45', '2021-04-29 16:01:45'),
(34259, 3040, 25840, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:03', '2021-04-26 14:19:03'),
(34260, 3040, 25840, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three 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  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:53:00', '2021-04-30 08:53:00'),
(34261, 3040, 25840, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.  If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:01:54', '2021-05-28 11:01:54'),
(34262, 3040, 25840, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. Please find the attached ancillary contract request for the below mentioned group under all three 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      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-16 16:18:15', '2021-06-16 16:18:15'),
(34263, 3040, 25840, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below 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      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-07-05 13:31:01', '2021-07-05 13:31:01'),
(34264, 3040, 25840, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email rcvd from: MHHPContracting@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Good morning. This group will be presented to our committee on Friday. I will have an update for you on Monday.  Thank you.  Camilla  ---------------------------------------------------------------------------------------------------------------------------------- Good morning. If during the tele-health call it is determined that the patient needs to be seen in an office, where would you refer the patient to? Please advise.  Thank you.  Camilla  ----------------------------------------------------------------------------------------------------------------------------------', NULL, NULL, '2021-07-23 14:25:35', '2021-07-23 14:25:35'),
(34265, 3040, 25840, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: MHHPContracting@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello Camilla,   Thank you for the update. Please find below the information that you requested in your previous email. We can refer the patient to the below hospital.   Hospital Name: Memorial Hermann Memorial City Medical Center Address: 921 Gessner Rd, Houston, TX 77024  If you need further information please let me know. Waiting to hear from you soon.   Thank you   Hello Camilla,   Please find below the information that you requested in your previous email. We can refer the patient to the below hospital as well.   Hospital Name: Valley Baptist Medical Center-Harlingen Address: 2101 Pease St, Harlingen, TX 78550  If you need further information please let me know. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-23 14:26:50', '2021-07-23 14:26:50'),
(34266, 3040, 25840, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: MHHPContracting@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I hope you will present our group to the Committee today.   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      Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-07-23 14:43:32', '2021-07-23 14:43:32'),
(34267, 3040, 25840, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Email rcvd From: MHHPContracting@memorialhermann.org  Subject: RE: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  July 27, 2021  Valley Med Urgent Care 2534 Boca Chica Blvd Brownsville, TX 78521 Dear Valley Med Urgent Care: We would like to thank you for your interest in participating in the Memorial Hermann Health Plan network; however, we do not currently have a network need for the specialty and/or services which you provide. We will keep your Request for Participation on file and notify you if our needs change in the future. Should you have questions or need additional assistance, please contact our Provider Relations Department at 713.338.4801 or you can send an email to: Providerservices@memorialhermann.org. Thank you again for your interest in Memorial Hermann Health Plan Provider Network.  Kind regards,  Memorial Hermann Health Plan Provider Relations', NULL, NULL, '2021-07-27 16:20:37', '2021-07-27 16:20:37'),
(34268, 3040, 25842, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:03', '2021-04-26 14:19:03'),
(34269, 1006, 25842, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"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.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:11:43', '2021-04-30 16:11:43'),
(34270, 3040, 25842, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:16', '2021-06-01 12:54:16'),
(34271, 3040, 25842, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I had a word with (Kebra G)  Wellcare representative and she sent the follow up request again to provider rep. She said allow us more time to contact. The reason to not contacting may be that Wellcare don\'t need the services in the area.   Ref: 518700144 ', NULL, NULL, '2021-06-18 16:18:24', '2021-06-18 16:18:24'),
(34272, 3040, 25842, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   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      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 15:00:00', '2021-07-05 15:00:00'),
(34273, 3040, 25842, NULL, '2021-07-30 00:00:00.000', 'Approved', 'Group is contracted with Wellcare. Please see attachment. ', NULL, NULL, '2021-07-23 15:30:00', '2021-07-23 15:30:00'),
(34274, 3040, 25843, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:03', '2021-04-26 14:19:03'),
(34275, 1006, 25843, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary 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 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:48:39', '2021-04-30 15:48:39'),
(34276, 3040, 25843, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  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  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:48:00', '2021-06-01 09:48:00'),
(34277, 11056, 25843, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:33:50', '2021-06-18 16:33:50'),
(34278, 3040, 25843, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject; Re: Provider Update Information Form- TRPN  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:47:47', '2021-07-05 14:47:47'),
(34279, 3040, 25843, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-22 16:41:31', '2021-07-22 16:41:31'),
(34280, 3040, 25844, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:03', '2021-04-26 14:19:03'),
(34281, 3040, 25844, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below 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  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:44:55', '2021-05-03 07:44:55'),
(34282, 3040, 25844, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:45:41', '2021-05-27 10:45:41'),
(34283, 3040, 25844, NULL, '2021-06-22 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-15 13:23:51', '2021-06-15 13:23:51'),
(34284, 11056, 25844, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below 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      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:37:02', '2021-07-01 13:37:02'),
(34285, 3040, 25844, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:52:40', '2021-07-08 16:52:40'),
(34286, 3040, 25845, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:03', '2021-04-26 14:19:03'),
(34287, 3040, 25845, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  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  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:12:07', '2021-05-05 14:12:07'),
(34288, 3040, 25845, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   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  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:31:20', '2021-06-01 09:31:20'),
(34289, 3040, 25845, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Request Id: 151181; Request was successfully saved.  Group enrollment request sent out through online. Please see attachment. ', NULL, NULL, '2021-06-18 15:35:30', '2021-06-18 15:35:30'),
(34290, 3040, 25845, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form and we received a request ID 151181.   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      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 14:54:24', '2021-07-05 14:54:24'),
(34291, 3040, 25845, NULL, '2021-07-23 00:00:00.000', 'Approved', 'I had a word with (Marcy) triwest representative and she advised our group is participating under all three locations with the effective date: 07/14/2021.   Ref: PH1360207-Q9K4M6 ', NULL, NULL, '2021-07-16 11:21:35', '2021-07-16 11:21:35'),
(34292, 3040, 25846, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:03', '2021-04-26 14:19:03'),
(34293, 3040, 25846, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:11', '2021-04-30 09:16:11'),
(34294, 3040, 25851, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:03', '2021-04-26 14:19:03'),
(34295, 1006, 25851, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-04-30 13:55:51', '2021-04-30 13:55:51'),
(34296, 3040, 25852, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:03', '2021-04-26 14:19:03'),
(34297, 3040, 25852, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group Valley Med Urgent Care PLLC under all three 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  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:23:43', '2021-04-30 10:23:43'),
(34298, 3040, 25852, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227  www.christushealthplan.org', NULL, NULL, '2021-05-03 11:02:51', '2021-05-03 11:02:51'),
(34299, 3040, 25853, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:11', '2021-04-26 14:19:11'),
(34300, 3040, 25853, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'TCHP does not cover Hidalgo or Cameron County for VMUC.', NULL, NULL, '2021-04-29 16:01:51', '2021-04-29 16:01:51'),
(34301, 3040, 25854, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:11', '2021-04-26 14:19:11'),
(34302, 3040, 25854, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'From: txcredentialing@amerigroup.com  To: mk@claimsmedinc.com  Sub: RE: {EXTERNAL} Request to add new service location  HI There, Amerigroup does not service that region.  Please find below link from Amerigroup Website in which it shows they do not cover the counties for VMUC i.e. Hidalgo & Cameron: https://www.myamerigroup.com/tx/apply/know-your-service-area.html  ', NULL, NULL, '2021-04-26 14:58:51', '2021-04-26 14:58:51'),
(34303, 3040, 25855, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:11', '2021-04-26 14:19:11'),
(34304, 3040, 25855, NULL, '2021-05-06 00:00:00.000', 'Rejected', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @  https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference. ', NULL, NULL, '2021-04-29 08:23:08', '2021-04-29 08:23:08'),
(34305, 3040, 25856, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:11', '2021-04-26 14:19:11'),
(34306, 3040, 25856, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group Valley Med Urgent Care PLLC under all three 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  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-04-30 08:53:05', '2021-04-30 08:53:05'),
(34307, 3040, 25856, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.   If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:07:31', '2021-05-28 11:07:31'),
(34308, 3040, 25856, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Good morning,  Are these requests for Memorial Hermann Health Plan only? If yes, please submit a request for application form for each practitioners. Below is the link:  CLICK HERE to access and complete the Request for Application form for Memorial Hermann hospitals, affiliated hospitals, surgery centers, MHMD membership or Health Plan participation. To avoid any delays, please submit the form in its entirety (via link above) or email the form to enterprise.credentialing@memorialhermann.org. If the pre-screening qualifications are met, you should receive both your eCredentialing Portal and application username and password via email or additional communication within 3 business days.   If you have any questions, please contact us at enterprise.credentialing@memorialhermann.org.  Memorial Hermann Central Credentialing Team', NULL, NULL, '2021-05-28 11:12:06', '2021-05-28 11:12:06'),
(34309, 3040, 25856, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Greetings,  Hope you are doing well. Please find the attached ancillary contract request for the below mentioned group under all three 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      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-16 16:18:10', '2021-06-16 16:18:10'),
(34310, 3040, 25856, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann in our group Valley Med Urgent Care PLLC under the below 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      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-07-05 13:30:54', '2021-07-05 13:30:54'),
(34311, 3040, 25856, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email rcvd from: MHHPContracting@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Good morning. This group will be presented to our committee on Friday. I will have an update for you on Monday.  Thank you.  Camilla  ---------------------------------------------------------------------------------------------------------------------------------- Good morning. If during the tele-health call it is determined that the patient needs to be seen in an office, where would you refer the patient to? Please advise.  Thank you.  Camilla  ----------------------------------------------------------------------------------------------------------------------------------', NULL, NULL, '2021-07-23 14:25:33', '2021-07-23 14:25:33'),
(34312, 3040, 25856, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: MHHPContracting@memorialhermann.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello Camilla,   Thank you for the update. Please find below the information that you requested in your previous email. We can refer the patient to the below hospital.   Hospital Name: Memorial Hermann Memorial City Medical Center Address: 921 Gessner Rd, Houston, TX 77024  If you need further information please let me know. Waiting to hear from you soon.   Thank you    Hello Camilla,   Please find below the information that you requested in your previous email. We can refer the patient to the below hospital as well.   Hospital Name: Valley Baptist Medical Center-Harlingen Address: 2101 Pease St, Harlingen, TX 78550  If you need further information please let me know. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-07-23 14:26:48', '2021-07-23 14:26:48'),
(34313, 3040, 25856, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: MHHPContracting@memorialhermann.org  Subject: Re: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  Hello,  Hope you are doing well. I hope you will present our group to the Committee today.   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      Please get back to me as soon as you can get a chance. Waiting for your reply.   Thanks ', NULL, NULL, '2021-07-23 14:43:31', '2021-07-23 14:43:31'),
(34314, 3040, 25856, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Email rcvd From: MHHPContracting@memorialhermann.org  Subject: RE: [EXTERNAL] Group & Providers || Valley Med Urgent Care PLLC || Group & Provider || Memorial Hermann ||  July 27, 2021  Valley Med Urgent Care 2534 Boca Chica Blvd Brownsville, TX 78521 Dear Valley Med Urgent Care: We would like to thank you for your interest in participating in the Memorial Hermann Health Plan network; however, we do not currently have a network need for the specialty and/or services which you provide. We will keep your Request for Participation on file and notify you if our needs change in the future. Should you have questions or need additional assistance, please contact our Provider Relations Department at 713.338.4801 or you can send an email to: Providerservices@memorialhermann.org. Thank you again for your interest in Memorial Hermann Health Plan Provider Network.  Kind regards,  Memorial Hermann Health Plan Provider Relations', NULL, NULL, '2021-07-27 16:20:37', '2021-07-27 16:20:37'),
(34315, 3040, 25858, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:11', '2021-04-26 14:19:11'),
(34316, 1006, 25858, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Submitted an online enrollment form for group enrollment:  \"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.\"  Form attached in main group task.', NULL, NULL, '2021-04-30 16:12:46', '2021-04-30 16:12:46'),
(34317, 3040, 25858, NULL, '2021-06-08 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828', NULL, NULL, '2021-06-01 12:54:59', '2021-06-01 12:54:59'),
(34318, 3040, 25858, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I had a word with (Kebra G)  Wellcare representative and she sent the follow up request again to provider rep. She said allow us more time to contact. The reason to not contacting may be that Wellcare don\'t need the services in the area.   Ref: 518700144 ', NULL, NULL, '2021-06-18 16:18:19', '2021-06-18 16:18:19'),
(34319, 3040, 25858, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   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      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 15:00:04', '2021-07-05 15:00:04'),
(34320, 3040, 25858, NULL, '2021-07-30 00:00:00.000', 'Approved', 'Group is contracted with Wellcare. Please see attachment. ', NULL, NULL, '2021-07-23 15:30:00', '2021-07-23 15:30:00'),
(34321, 3040, 25859, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:11', '2021-04-26 14:19:11');
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
(34322, 1006, 25859, NULL, '2021-05-07 00:00:00.000', 'Initiated', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - VMUC - TRPN  \"Hello,   We want to get the following providers and group enrolled with TRPN, their information is as follows:  Practice Details:  Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631Primary 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 Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857 Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053 Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702 Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment timeframe is?  Thank you.\"', NULL, NULL, '2021-04-30 15:49:52', '2021-04-30 15:49:52'),
(34323, 3040, 25859, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || TRPN ||  Hello Max,   I wanted to get the following providers and group enrolled with TRPN, their information is as follows:  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  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?  Thank you. ', NULL, NULL, '2021-06-01 09:49:22', '2021-06-01 09:49:22'),
(34324, 11056, 25859, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  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: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:42:19', '2021-06-18 16:42:19'),
(34325, 3040, 25859, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject; Re: Provider Update Information Form- TRPN  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-05 14:47:46', '2021-07-05 14:47:46'),
(34326, 3040, 25859, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN  Hi,  Provider Jeniece Wert is Active, effective date 04/30/2021,  Provider Arturo Lira is Active, effective date 04/30/2021,  Provider Deborah Potter is Active, effective date 04/30/2021,  Provider Larry Wright is Active, effective date 04/30/2021,  Provider Diego Naranjo is Active, effective date 10/01/2019,  Provider Mayra Lopez is Active, effective date 09/24/2019,  Provider Cynthia Rodriguez is Active, effective date 06/24/2019,  Provider Homero Garcia is Active, effective date 10/16/2018,  Provider Angiollet Escobar is Active, effective date 10/01/2019,  Provider Eder Hernandez is Active, effective date 02/01/2016,  Provider Teresa Saavedra is Active, effective date 04/30/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-07-22 16:41:33', '2021-07-22 16:41:33'),
(34327, 3040, 25860, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:11', '2021-04-26 14:19:11'),
(34328, 3040, 25860, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below 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  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-03 07:45:00', '2021-05-03 07:45:00'),
(34329, 3040, 25860, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Christus Spohn ||  Hello,   Can you please advise the process for credentialing?  Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-05-27 10:47:59', '2021-05-27 10:47:59'),
(34330, 3040, 25860, NULL, '2021-06-22 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance. ', NULL, NULL, '2021-06-15 13:22:22', '2021-06-15 13:22:22'),
(34331, 11056, 25860, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under below 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      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:37:26', '2021-07-01 13:37:26'),
(34332, 3040, 25860, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:52:39', '2021-07-08 16:52:39'),
(34333, 3040, 25861, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:11', '2021-04-26 14:19:11'),
(34334, 3040, 25861, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   We want to get the following providers and group enrolled with Triwest, their information is as follows:  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  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please let me know what is required to initiate this request and what the enrollment time frame is?', NULL, NULL, '2021-05-05 14:12:15', '2021-05-05 14:12:15'),
(34335, 3040, 25861, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Greetings,   I wanted to enroll the below mentioned group and providers in our group Valley Med Urgent Care PLLC under the below locations. The request was directed to state representative and I didn\'t hear from them.   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  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-01 09:32:13', '2021-06-01 09:32:13'),
(34336, 3040, 25861, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Request Id: 151181; Request was successfully saved.  Group enrollment request sent out through online. Please see attachment. ', NULL, NULL, '2021-06-18 15:35:25', '2021-06-18 15:35:25'),
(34337, 3040, 25861, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Re: Enrollment Request || Group & Providers || VMUC || Triwest  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form and we received a request ID 151181.   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      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 14:54:21', '2021-07-05 14:54:21'),
(34338, 3040, 25861, NULL, '2021-07-23 00:00:00.000', 'Approved', 'I had a word with (Marcy) triwest representative and she advised our group is participating under all three locations with the effective date: 07/14/2021.   Ref: PH1360207-Q9K4M6', NULL, NULL, '2021-07-16 11:21:37', '2021-07-16 11:21:37'),
(34339, 3040, 25862, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:11', '2021-04-26 14:19:11'),
(34340, 3040, 25862, NULL, '2021-05-07 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-04-30 09:16:13', '2021-04-30 09:16:13'),
(34341, 3040, 25867, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:12', '2021-04-26 14:19:12'),
(34342, 1006, 25867, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Brownsville or McAllen, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-04-30 13:58:34', '2021-04-30 13:58:34'),
(34343, 3040, 25868, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-26 14:19:12', '2021-04-26 14:19:12'),
(34344, 3040, 25868, NULL, '2021-05-07 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group Valley Med Urgent Care PLLC under all three 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  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-30 10:23:47', '2021-04-30 10:23:47'),
(34345, 3040, 25868, NULL, '2021-05-10 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227  www.christushealthplan.org', NULL, NULL, '2021-05-03 11:03:01', '2021-05-03 11:03:01'),
(34346, 1019, 26227, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:16', '2021-04-27 08:41:16'),
(34347, 1019, 26227, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:38:01', '2021-05-03 08:38:01'),
(34348, 1019, 26227, NULL, '2021-05-25 00:00:00.000', 'Initiated', 'Sent the following email to providerapplicationstatus@bcbsma.com, Debra.Draheim@bcbsma.com SUB: Enrollment Query || Jessica Hartman || SNBCARE || BCBS MA  Hello, We need to add the following provider under our group, provider information is mentioned below, let us know with the next steps.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Information:  Jessica Hartman NPI: 1326665472 Additional Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Additional Location: 100 New State Highway, Raynham, MA, 02767.  Let me know for the next steps ASAP so we get her linked ASAP.  Thank You,', NULL, NULL, '2021-05-18 08:16:37', '2021-05-18 08:16:37'),
(34349, 1019, 26227, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to  providerapplicationstatus@bcbsma.com,  Debra.Draheim@bcbsma.com SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA  Hello Debra, Hope you\'re doing good, I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I sent a couple of emails to BCBS MA regarding enrollments, can you please look into my request and help out with enrollment status for our providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-05-20 08:52:53', '2021-05-20 08:52:53'),
(34350, 1019, 26227, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, provider-enrollment@bcbsma.com, debra.draheim@bcbsma.com  SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA 3rd Atttempt  Hello,  We need the enrollment status for the following providers under our group, also I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I have sent couple of emails to BCBS MA regarding enrollments query.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Regards, Alex ', NULL, NULL, '2021-06-03 10:51:34', '2021-06-03 10:51:34'),
(34351, 1019, 26227, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Received the following email from providerapplicationstatus@bcbsma.com  Dear Alex,     Please see the links you requested.      Please see the link below for information in regards to participating with Blue Cross Blue Shield of Massachusetts and guidance through the application process.  https://provider.bluecrossma.com/ProviderHome/portal/home/office-resources/enrollment/become-a-blue-cross-provider  Please see the link below for a contract update form. Please click on Contract Updates on the left side of the screen to locate. Please fill out and fax to the number found on the top of the form.   https://provider.bluecrossma.com/ProviderHome/portal/home/forms/forms/forms-library   Best,  Network Management Services Blue Cross and Blue Shield of Massachusetts', NULL, NULL, '2021-07-13 08:36:03', '2021-07-13 08:36:03'),
(34352, 1019, 26227, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Faxed the Attached filled enrollment application to (617) 246-4227   ', NULL, NULL, '2021-07-13 08:38:54', '2021-07-13 08:38:54'),
(34353, 1019, 26227, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Faxed the Attached form to BCBS MA at 617-246-5053.', NULL, NULL, '2021-07-13 09:21:00', '2021-07-13 09:21:00'),
(34354, 11056, 26227, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to: providerapplicationstatus@bcbsma.com  Sub:  Enrollment Status Updates - SNBCARE - BCBS  Good afternoon!  Hope this email finds you well. Please provide me with the latest updates on the below-mentioned providers under the facility TIN with both locations with BCBS.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jessica Hartman	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Jessica Hartman	1326665472	100 New State Highway, Raynham, MA, 02767. Jonathan Schubert	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Jonathan Schubert	1235755505	100 New State Highway, Raynham, MA, 02767.  If you have any concerns or queries feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-12-02 17:12:32', '2021-12-02 17:12:32'),
(34355, 11056, 26227, NULL, '2021-12-10 00:00:00.000', 'In Process', 'RE: Infosecure RE: Enrollment Status Updates - SNBCARE - BCBS', NULL, NULL, '2021-12-03 10:10:55', '2021-12-03 10:10:55'),
(34356, 19067, 26227, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Enrollment Status || SNBCARE || Providers || BCBS ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond to me in a timely manner,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:54:21', '2021-12-15 17:54:21'),
(34357, 19067, 26227, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Secure email received from: providerapplicationstatus@bcbsma.com  Subject: Infosecure RE: Enrollment Status || SNBCARE || Providers || BCBS ||     Hello,     The application for Jessica Hartman was received and, after review, denied due to incorrect certification. Outreach was performed on 7/29/21 for explain the denial.     Credentialing for Jonathan Shubert was discontinued due to the provider holding the incorrect license. Provider is licensed as a LCSW and Blur Cross Blue Shield of Massachusetts currently only credentials LICSW.        We apologize that we were not able to reply to this email sooner. Due to Covid, our staffing has been impacted.     Regards,     Network Management Services  Blue Cross Blue Shield of Massachusetts     JB', NULL, NULL, '2021-12-28 13:59:58', '2021-12-28 13:59:58'),
(34358, 19067, 26227, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Re: Enrollment Status || SNBCARE || Providers || BCBS ||   Greetings!  If any provider mentioned before is enrolled then provide us a welcome letter. It will be very helpful for us.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:58:42', '2022-01-10 11:58:42'),
(34359, 19067, 26227, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Re: Enrollment Status || SNBCARE || Providers || BCBS ||    Hello!  Hope this email finds you well.  Any updates on the request below?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 09:34:47', '2022-02-04 09:34:47'),
(34360, 19067, 26227, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: ProviderApplicationStatus@bcbsma.com  Subject: Enrollment Status || SNBCARE || Providers || BCBS ||     The application for Jessica Hartman was received and, after review, denied due to incorrect certifications. Outreached was performed on 7/29/21 to let provider know this.     We did receive Jonathan Schubert’s application last year but credentialing was not able to be completed due to the provider not having the correct licensing for credentialing with Blue Cross Blue Shield of Massachusetts. Outreach was performed at that time to inform the provider of this.', NULL, NULL, '2022-02-10 16:03:39', '2022-02-10 16:03:39'),
(34361, 19067, 26227, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: ProviderApplicationStatus@bcbsma.com  Subject: RE: Enrollment Status || SNBCARE || Providers || BCBS ||    Hi,     I just received this message this morning that Jonathan Schubert has been credentialed, we will send out a welcome letter once this process has been completed.     When was Jessica Hartman submitted, I don’t show a record of the file in our credentialing system?     Deb Draheim, CPCS  Credentialing Manager, Provider Operations|Blue Cross Blue Shield of Massachusetts', NULL, NULL, '2022-02-10 16:05:59', '2022-02-10 16:05:59'),
(34362, 19067, 26227, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Re: Enrollment Status || SNBCARE || Providers || BCBS ||   Hello,  We faxed the application at 617-246-5053 on 07/13/2021.  Thanks.', NULL, NULL, '2022-02-11 09:50:59', '2022-02-11 09:50:59'),
(34363, 19067, 26227, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Secure email received from: providerapplicationstatus@bcbsma.com  Subject: Infosecure:  RE: Enrollment Status || SNBCARE || Providers || BCBS ||     The application for Jessica Hartman was received and, after review, denied due to incorrect certifications. Outreached was performed on 7/29/21 to let the provider know this.  We did receive Jonathan Schubert’s application last year but credentialing was not able to be completed due to the provider not having the correct licensing for credentialing with Blue Cross Blue Shield of Massachusetts. Outreach was performed at that time to inform the provider of this.     Best,  Network Management Services  Blue Cross and Blue Shield of Massachusetts', NULL, NULL, '2022-02-17 10:55:29', '2022-02-17 10:55:29'),
(34364, 19067, 26227, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Left a voicemail @713-663-1149', NULL, NULL, '2022-03-17 10:00:07', '2022-03-17 10:00:07'),
(34365, 22077, 26227, NULL, '2022-04-13 00:00:00.000', 'In Process', 'Email sent to: ProviderApplicationStatus@bcbsma.com  Subject: Re: Enrollment Status || SNBCARE || Providers || BCBS ||  Hello,  Is there any way we can enroll the provider,  Jessica Hartman  NPI: 1326665472  Thanks', NULL, NULL, '2022-04-06 11:33:02', '2022-04-06 11:33:02'),
(34366, 22077, 26227, NULL, '2022-04-13 00:00:00.000', 'Not Eligible', 'Email received from: providerapplicationstatus@bcbsma.com  Subject: RE: Enrollment Status || SNBCARE || Providers || BCBS ||   The provider can not be credentialed unless she has the correct certifications.  You can go to the provider central website and review how to become a provider for any additional information.     https://provider.bluecrossma.com/ProviderHome/portal/home/office-resources/enrollment/become-a-blue-cross-provider      Best,  Network Management Services  ', NULL, NULL, '2022-04-06 14:28:27', '2022-04-06 14:28:27'),
(34367, 1019, 26228, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:16', '2021-04-27 08:41:16'),
(34368, 1019, 26228, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:37:51', '2021-05-03 08:37:51'),
(34369, 1019, 26228, NULL, '2021-05-24 00:00:00.000', 'Initiated', 'Faxed the LOI to (859) 455-8650 to add Jessica under MA locations.', NULL, NULL, '2021-05-17 13:57:17', '2021-05-17 13:57:17'),
(34370, 1019, 26228, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 07:59:49', '2021-05-20 07:59:49'),
(34371, 1019, 26228, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon, Please see my below comments. Thank you  Mary Gibbons, 9080253 – application was not received NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman, 6715913 – credentialed for RI only, please submit an app for MA NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell, 6712207 – 01/01/2021 effective date 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.       Jonathan Schubert, 6249193 – 06/15/2021 effective date 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.        Katie Tawakol, 6120037 – 01/01/2021 effective date 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Jennifer Ullrich, 6913357 – 05/01/2021 effective date 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Justin Souliere, 6893422 – 05/017/2021 effective date 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva, 4841425 – waiting to be linked 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health', NULL, NULL, '2021-05-31 11:52:21', '2021-05-31 11:52:21'),
(34372, 1019, 26228, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-06-16 07:56:05', '2021-06-16 07:56:05'),
(34373, 1019, 26228, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson  NPI: 1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman  NPI: 1326665472  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland  NPI: 1598163602  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Jonathan Schubert  NPI: 1235755505   Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Kerry Smith  NPI: 1275083230  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jennifer Ullrich  NPI: 1710489760  Secondary Location: 100 New State Highway, Raynham, MA, 02767      Regards, Alex G.', NULL, NULL, '2021-08-24 11:11:12', '2021-08-24 11:11:12'),
(34374, 1019, 26228, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Resubmitted the application as Aetna didn\'t receive it Request ID for this Submission: 26688357  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.', NULL, NULL, '2021-11-01 08:34:53', '2021-11-01 08:34:53'),
(34375, 1019, 26228, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Resubmitted the application as Aetna didn\'t receive it Request ID for this Submission: 26688357  Your request to join the network has been received.  We have sent a copy of your Request ID and submission confirmation to the submitter email entered in your request. If you have not heard from us within 60 days, you can call us at 1-800-353-1232. You can provide your Request ID to assist in locating your submission.', NULL, NULL, '2021-11-01 08:35:02', '2021-11-01 08:35:02'),
(34376, 1019, 26228, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Hello,  Hartman, Jessica – waiting to be linked to the group contract  Halterman, Helena – early in the credentialing process  Filoteo-Nichols, Dina – waiting to be linked to the group contract  Rodrigues, Eliza – early in the credentialing process  Hignite, Barbara – only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Loveland, Lynnetta - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Schubert, Jonathan - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Ullrich, Jennifer - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-11-16 09:05:56', '2021-11-16 09:05:56'),
(34377, 1019, 26228, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Received the following email from Laura Bevin.  Hello,  Hartman, Jessica – waiting to be linked to the group contract  Halterman, Helena – early in the credentialing process  Filoteo-Nichols, Dina – waiting to be linked to the group contract  Rodrigues, Eliza – early in the credentialing process  Hignite, Barbara – only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Loveland, Lynnetta - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Schubert, Jonathan - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Ullrich, Jennifer - only service location is 61 Lincoln Street Suite 203 Framingham, MA 01702  Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-11-16 09:06:06', '2021-11-16 09:06:06'),
(34378, 11056, 26228, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub : Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Hello,  Can you please get back to me with an update on the following providers credentialing? as I have submitted the applications for address addition as well.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Regards', NULL, NULL, '2021-12-01 17:07:43', '2021-12-01 17:07:43'),
(34379, 19067, 26228, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:13:20', '2021-12-15 17:13:20');
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
(34380, 19067, 26228, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:56:37', '2021-12-16 10:56:37'),
(34381, 19067, 26228, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:30:33', '2021-12-20 10:30:33'),
(34382, 19067, 26228, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:20:49', '2021-12-28 13:20:49'),
(34383, 19067, 26228, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:33:51', '2022-01-10 11:33:51'),
(34384, 19067, 26228, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  There are no changes for the providers listed below.  Thank you', NULL, NULL, '2022-01-30 12:13:44', '2022-01-30 12:13:44'),
(34385, 1019, 26228, NULL, '2022-02-08 00:00:00.000', 'In Process', 'Hello Laura,  Did the providers get linked on which we were waiting, and if yes please provide me there effective dates     Thank You, Hammad.', NULL, NULL, '2022-02-01 12:20:01', '2022-02-01 12:20:01'),
(34386, 19067, 26228, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Thank you', NULL, NULL, '2022-02-10 15:12:34', '2022-02-10 15:12:34'),
(34387, 19067, 26228, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Aetna Provider Communications  Subject: Welcome to our network. Let’s get started.  Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  Ready to get started? To help make your onboarding easy, just check out the attached welcome kit.    Register here to attend our new provider onboarding webinar - Doing business with Aetna® . Sessions are held on the second Tuesday and third Wednesday of each month from 1:00 p.m. – 2:15 p.m. ET. You\'ll discover additional online tools and resources to make your day-to-day Aetna tasks quick and simple.   ', NULL, NULL, '2022-02-10 16:01:13', '2022-02-10 16:01:13'),
(34388, 19067, 26228, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Spoke with Anne B. The application is in process of completing have to contact them after 15 days.  Ref# 62078350613', NULL, NULL, '2022-03-07 11:57:06', '2022-03-07 11:57:06'),
(34389, 22077, 26228, NULL, '2022-04-13 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: 	Re: [EXTERNAL] Re: Enrollment Status || SNBCARE || Providers || Aetna ||  Hello, I would like to know the enrollment process for the following provider   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Ullrich Jennifer	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423  Thanks', NULL, NULL, '2022-04-06 10:57:43', '2022-04-06 10:57:43'),
(34390, 1019, 26229, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:16', '2021-04-27 08:41:16'),
(34391, 1019, 26229, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:37:41', '2021-05-03 08:37:41'),
(34392, 1019, 26229, NULL, '2021-06-10 00:00:00.000', 'Initiated', 'Spoken with Cigna Rep Jenny Initiate the request to add Jessica Under MA locations, also did send her the copy of her MA license by fax at 8606877257  for Contracting it will take up to 14 business days to load in there systems.  Ref: Jenny D - 05/24/2021', NULL, NULL, '2021-05-24 10:25:11', '2021-05-24 10:25:11'),
(34393, 1019, 26229, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:30:38', '2021-06-03 15:30:38'),
(34394, 1019, 26229, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:31:38', '2021-06-03 15:31:38'),
(34395, 1019, 26229, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Provider added under new location effective date 02/18/2021. Attached is the group roster for ref. ', NULL, NULL, '2021-07-15 08:04:11', '2021-07-15 08:04:11'),
(34396, 1019, 26230, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:16', '2021-04-27 08:41:16'),
(34397, 1019, 26230, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:37:31', '2021-05-03 08:37:31'),
(34398, 1019, 26230, NULL, '2021-06-29 00:00:00.000', 'Initiated', 'Sent the following email to behavioralhealthproviderservices@humana.com  SUB: RI-Spectrum Neuro Behavioral Care LLC­-Status_PAEG  Hello Alyssa, I have attached the roster, we need to add the following providers under our group, which are mentioned in the group roster. Let me know if you have any questions.  Regards, Alex', NULL, NULL, '2021-06-11 13:48:13', '2021-06-11 13:48:13'),
(34399, 11056, 26230, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:35:34', '2021-12-09 17:35:34'),
(34400, 19067, 26230, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:32:27', '2021-12-15 15:32:27'),
(34401, 19067, 26230, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||    Hello,     This information can be verified on Humana website under Physician Finder, Approval letters are sent to providers upon completion, Humana preferred provider resource is AVAILALITY, you can obtain: provider demographic update, status, claims etc.,     Thanks,     Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2021-12-16 12:26:07', '2021-12-16 12:26:07'),
(34402, 19067, 26230, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:37:30', '2021-12-29 14:37:30'),
(34403, 19067, 26230, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:17:37', '2022-01-10 13:17:37'),
(34404, 19067, 26230, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:14:36', '2022-01-30 13:14:36'),
(34405, 19067, 26230, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:22:48', '2022-02-08 14:22:48'),
(34406, 19067, 26230, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:56:37', '2022-03-09 14:56:37'),
(34407, 19067, 26230, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:49:24', '2022-03-10 10:49:24'),
(34408, 22077, 26230, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:53:50', '2022-04-04 13:53:50'),
(34409, 1019, 26231, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:16', '2021-04-27 08:41:16'),
(34410, 1019, 26231, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:37:15', '2021-05-03 08:37:15'),
(34411, 1019, 26231, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Waiting to get credentialed with Aetna first.', NULL, NULL, '2021-05-24 10:27:37', '2021-05-24 10:27:37'),
(34412, 1019, 26232, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:16', '2021-04-27 08:41:16'),
(34413, 1019, 26232, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:37:04', '2021-05-03 08:37:04'),
(34414, 1019, 26232, NULL, '2021-06-10 00:00:00.000', 'Initiated', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Good Morning Anne,  Hope you are doing well, and had a good weekend, I need to add one more provider under our MA locations, I have mentioned the information below,  Group Information:  Spectrum Neuro Behavioral Care LLC NPI: 1356906572 Address 1: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Address 2: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Jessica Hartman NPI: 1326665472  Let me know if anything else is required.  Thank You,', NULL, NULL, '2021-05-24 10:57:45', '2021-05-24 10:57:45'),
(34415, 1019, 26232, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  The information has been received and loaded to add the practitioner to the 2 locations as requested.  ', NULL, NULL, '2021-05-25 08:24:20', '2021-05-25 08:24:20'),
(34416, 1019, 26232, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:00:23', '2021-06-16 08:00:23'),
(34417, 19067, 26232, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:10:17', '2021-12-16 14:10:17'),
(34418, 19067, 26232, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:07:06', '2021-12-29 12:07:06'),
(34419, 19067, 26232, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:14:03', '2022-01-10 14:14:03'),
(34420, 19067, 26232, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:37:24', '2022-01-11 09:37:24'),
(34421, 19067, 26232, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:46:59', '2022-01-11 10:46:59'),
(34422, 19067, 26232, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:16:13', '2022-02-11 11:16:13'),
(34423, 19067, 26232, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:22:56', '2022-02-11 11:22:56'),
(34424, 19067, 26232, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:49:00', '2022-03-17 09:49:00'),
(34425, 19067, 26232, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:34:05', '2022-03-17 10:34:05'),
(34426, 19067, 26232, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:36:15', '2022-03-17 10:36:15'),
(34427, 1019, 26233, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:16', '2021-04-27 08:41:16'),
(34428, 1019, 26233, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:36:37', '2021-05-03 08:36:37'),
(34429, 1019, 26233, NULL, '2021-05-25 00:00:00.000', 'On Hold', 'Waiting for Medicare PTAN to fully load in there systems.', NULL, NULL, '2021-05-18 08:54:28', '2021-05-18 08:54:28'),
(34430, 1019, 26233, NULL, '2021-06-10 00:00:00.000', 'Initiated', 'Request for Railroad PTAN has been initiated thru there website, attached is the copy for reference.', NULL, NULL, '2021-05-24 10:43:58', '2021-05-24 10:43:58'),
(34431, 1019, 26233, NULL, '2021-06-12 00:00:00.000', 'Approved', 'PTAN has been active effective from 02/19/2021. see attachment for approval Also sent test email', NULL, NULL, '2021-06-05 12:24:22', '2021-06-05 12:24:22'),
(34432, 1019, 26234, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:16', '2021-04-27 08:41:16'),
(34433, 1019, 26234, NULL, '2021-05-04 00:00:00.000', 'Initiated', 'Application Submitted through PECOS  To: SNBC@CLAIMSMEDINC.COM,JLH6690@GMAIL.COM  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T042720210001010)  Sent: 04/27/2021 11:20 AM  This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:   ---------------------------------------------------------------------------------------------------------------------- Application Tracking ID: T042720210001010 NPI: 1326665472 Medicare ID: Name: JESSICA  HARTMAN State: MA Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC. INDIANAPOLIS,IN,46207-7149', NULL, NULL, '2021-04-27 10:27:43', '2021-04-27 10:27:43'),
(34434, 1019, 26234, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Received the following email from customerservice-donotreply@cms.hhs.gov SUB:Request for Corrections for Medicare Enrollment Application (Tracking ID: T042720210001010)  To:  jlh6690@gmail.com,snbc@claimsmedinc.com   Subject:  Request for Corrections for Medicare Enrollment Application (Tracking ID: T042720210001010)  Date:   04/30/2021 16:35 PM  This message is in response to your Medicare enrollment application that was submitted from https://pecos.cms.hhs.gov. You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T042720210001010. The information provided below indicates areas of your application requiring corrections as determined by your fee-for-service contractor.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T042720210001010   NPI ID: 1326665472   Medicare ID:    Name: JESSICA HARTMAN   State: MA  Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Other Comments  BOARD CERTIFICATION -A copy or clear photograph of your board certification from an accreditation board for nurse practitioners (ANCC, AANP, etc.) is required. Please upload this information to PECOS as a supporting document.  DEGREE/ DIPLOMA          -A copy or clear photograph of your Master\'s degree in nursing or a Doctor of Nursing Practice (DNP) Doctoral degree is required. Please upload this information to PECOS as a supporting document.  *Please log into PECOS, select \"My Associates\", scroll down and select \"View Enrollments\", and select the application under Return for Corrections. Make all of the appropriate changes as requested. Be sure to fully re-submit the application after the changes are made, with completed e-signatures. If faxing supporting documentation, fax to 315-442-4234.  *We may reject your application(s) if you do not furnish complete information within 30 calendar days from the postmarked date of this email pursuant to 42 CFR 424.525.  You must submit the requested revisions and/or supply the requested information/supporting documentation within your allotted 30 days.   *If you have any questions regarding this development request please contact me directly at 781-741-3040 and reference case number: PE0000263367   Thank you,  Kathleen O\'Brien  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Please retain this e-mail for your records.  This email message is an automated notification. Do not reply to this message as it is sent from an unmonitored account.  If you have any questions about this identifier, you may:  1.) Refer to the Web site at https://pecos.cms.hhs.gov, or  2.) Contact your fee-for-service contractor listed above.  Please note:  The information provided in the Enrollment application may be shared with and used by others only in accordance with the privacy notice to which you agreed at the time of application. In addition, you agreed to keep the PECOS updated with any changes to data listed on the enrollment application within 30 days of the effective date of the change. If you are not the provider, you are required to inform the provider of the information in this e-mail.  Unauthorized interception of this communication could be a violation of Federal and State Law. This communication and any files transmitted with it are confidential and may contain protected health information. This communication is solely for the use of the person or entity to whom it was addressed. If you are not the intended recipient, any use, distribution, printing or acting in reliance on the contents for this message is strictly prohibited. If you have received this message in error, please notify the sender and destroy any and all copies.', NULL, NULL, '2021-05-03 07:12:17', '2021-05-03 07:12:17'),
(34435, 1019, 26234, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Received the following email from customerservice-donotreply@cms.hhs.gov Sub: Medicare Enrollment Application Receipt Notification (Tracking ID: T042720210001010 )  To: SNBC@CLAIMSMEDINC.COM,JLH6690@GMAIL.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T042720210001010)   Sent: 05/03/2021 08:13 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T042720210001010        NPI: 1326665472        Medicare ID:         Name: JESSICA  HARTMAN          State: MA        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.                 INDIANAPOLIS,IN,46207-7149   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.  Please retain this e-mail for your records.  This email message is an automated notification. Do not reply to this message as it is sent from an unmonitored account. If you have any questions about this application:  1.) Refer to the Web site at (https://pecos.cms.hhs.gov), or   2.) Contact your fee-for-service contractor listed above   Please note: The information provided in this application may be shared with and used by others only in accordance with the privacy notice to which you agreed at the time of the application. In addition, you agreed to keep Medicare updated with any changes to data listed on the enrollment application form within 30 days of the effective date of the change. If you are not the provider, you are required to inform the provider of the information in this e-mail.   Unauthorized interception of this communication could be a violation of Federal and State Law. This communication and any files transmitted with it are confidential and may contain protected health information. This communication is solely for the use of the person or entity to whom it was addressed. If you are not the intended recipient, any use, distribution, printing or acting in reliance on the contents for this message is strictly prohibited. If you have received this message in error, please notify the sender and destroy all copies of the message. ', NULL, NULL, '2021-05-03 07:16:49', '2021-05-03 07:16:49'),
(34436, 1019, 26234, NULL, '2021-05-21 00:00:00.000', 'Approved', 'Received the following email from customerservice-donotreply@cms.hhs.gov SUB: Medicare Enrollment Application Status Change Notification (Tracking ID: T042720210001010)  Application Tracking ID: T042720210001010   NPI ID: 1326665472   Medicare ID: S400748327   Name: JESSICA HARTMAN  State: MA   Form Type: 855I  Date: 05/14/2021  Status: APPROVED', NULL, NULL, '2021-05-14 13:00:18', '2021-05-14 13:00:18'),
(34437, 1019, 26235, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:16', '2021-04-27 08:41:16'),
(34438, 1019, 26235, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:36:26', '2021-05-03 08:36:26'),
(34439, 1019, 26235, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Waiting to get credentialed first as Application already in process for NSF location, once done then will send application for Location Additions.', NULL, NULL, '2021-05-24 09:03:50', '2021-05-24 09:03:50'),
(34440, 1019, 26236, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:16', '2021-04-27 08:41:16'),
(34441, 1019, 26236, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:34:20', '2021-05-03 08:34:20'),
(34442, 1019, 26237, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:16', '2021-04-27 08:41:16'),
(34443, 1019, 26237, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:34:09', '2021-05-03 08:34:09'),
(34444, 1019, 26237, NULL, '2021-06-10 00:00:00.000', 'Initiated', 'Sent the following email to  provider_data_request@tufts-health.com SUB: Location Addition || Jessica Hartman || SNBCARE || Tufts Health Plans  Hello, Attached is the Provider Information form, for Jessica Hartman to add her under our group. Let me know if you need further assistance. Thank You,', NULL, NULL, '2021-05-25 08:44:25', '2021-05-25 08:44:25'),
(34445, 1019, 26237, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 12:58:07', '2021-06-05 12:58:07');
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
(34446, 1019, 26237, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:25:44', '2021-06-23 09:25:44'),
(34447, 1019, 26237, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 12/31/2020 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 09:29:58', '2021-07-07 09:29:58'),
(34448, 1019, 26238, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:16', '2021-04-27 08:41:16'),
(34449, 1019, 26238, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:33:58', '2021-05-03 08:33:58'),
(34450, 1019, 26238, NULL, '2021-07-01 00:00:00.000', 'On Hold', 'On Hold because Jessica is working part time and she doesn\'t have MA DEA, so cannot start credentialing due to DEA #.', NULL, NULL, '2021-05-31 09:22:26', '2021-05-31 09:22:26'),
(34451, 1019, 26238, NULL, '2021-07-05 00:00:00.000', 'Initiated', 'Initiated application thru Provider Portal, see attachment of Application Submission.', NULL, NULL, '2021-06-22 13:33:42', '2021-06-22 13:33:42'),
(34452, 1019, 26238, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Received the following email from PEC@maximus.com  On 06/25/21, we reached out to you regarding your incomplete FFS application. As of the date of this e-mail, we still have not received the requested item(s) listed below:  Data Collection Form (DCF) The Data Collection Form (DCF) is required. This form must be filled out in its entirety. FRDF for Individual Practitioners The Federally Required Disclosures form for Individual Practitioners (PE-FRD-IN) is required. The form must be completed in its entirety. Medical Practitioner Application We have received an initial application via the Provider Online Service Center (POSC), however additional information is required. Please complete the required sections of the paper application for Medical Practitioners (PE-MP). Provider Contract The MassHealth Provider Contract for Individuals is required. The form must be signed by the individual applicant. At this time, we cannot process your application to become a participating Mass Health Provider.  All items must be accounted for and processed in order to complete your application within 60 days of the initial request or the application will be denied. Therefore, the missing information listed above must be sent to us immediately to avoid a denial of your application. Once denied you will be required to resubmit a new application and all new documents.  Please note that effective 11/3/2017, Massachusetts Law (M.G.L. c. 112, §§ 2 and 9) require that all applicants for a limited license and all applicants for an initial license, or a renewal license must enroll with MassHealth as either billing or non-billing providers. Therefore, a denied application can prevent prospective healthcare providers from being issued a MA professional license as well as preventing already licensed healthcare providers from being able to renew their MA professional license.  If a submission/re-submission of a document is being requested, please make sure to indicate the Application Tracking Number (ATN) on the top of each document. You can submit the item(s) to us by either:  Mailing the requested item(s) to the address below,  MassHealth Attn: Provider Enrollment and Credentialing (PEC) P.O. Box 121205 Boston, MA 02112-1205  *Replying to this e-mail with the requested item(s) attached or; *Please note that any e-mail submissions containing Personally Identifiable Information (PII) or Protected Health Information (PHI) should be sent encrypted and secured  *Uploading the requested item(s) to your ATN directly through the MassHealth Provider Online Service Center (POSC) *This option is only available if you initially obtained an ATN by applying through the POSC; you have the option of logging into the POSC and uploading the requested documents (in .pdf format) directly into the ATN. Please note that you are not a MassHealth provider until you receive your MassHealth Welcome Letter notifying you of your approval with an approval effective date.  MassHealth cannot pay for services provided before the effective date of an approved MassHealth contract. MassHealth has the authority to determine the effective date of the provider contract according to the MassHealth regulations at 130 CMR 450.223 and is therefore, not obligated to retroactively approve an enrollment application.  To view our provider regulations as pertaining to you provider type (PT), please visit: https://www.mass.gov/service-details/masshealth-provider-regulations.  To obtain MassHealth application forms as related to your enrollment, please visit: https://www.mass.gov/masshealth-provider-forms  If you have any questions or concerns about what we are requesting or the application process in general, you can reach out to us by calling the MassHealth Customer Service Center at 1 (800) 841-2900 or by e-mailing PEC@maximus.com.  Sincerely,   MassHealth Provider Enrollment and Credentialing (PEC)', NULL, NULL, '2021-07-05 07:58:03', '2021-07-05 07:58:03'),
(34453, 1019, 26238, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent the following email to PEC@maximus.com  Hello, Attached are filled and signed documents for Jessica Hartman as we have filled her application before through Portal, also uploaded these forms there as well.   Let me know if something else is required.   Regards,', NULL, NULL, '2021-07-05 07:59:09', '2021-07-05 07:59:09'),
(34454, 1019, 26238, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Sent the following email to KaihengJiang@maximus.com Hello Kaiheng,  Here are the filled and signed forms. Let me know if anything else is required.   Regards, Alex ', NULL, NULL, '2021-07-30 08:37:14', '2021-07-30 08:37:14'),
(34455, 1019, 26238, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Received the following email from KaihengJiang@maximus.com Hi,  Jessica application have been complete and we create the PID 110174406A. The effective date should be 08/11/2021.  Thanks,  Kaiheng', NULL, NULL, '2021-08-27 08:46:07', '2021-08-27 08:46:07'),
(34456, 1019, 26239, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:16', '2021-04-27 08:41:16'),
(34457, 1019, 26239, NULL, '2021-05-04 00:00:00.000', 'Initiated', 'License has been updated thru Online Portal, it will take up to 10 business days for Magellan to update in their system, will sent the request for Location addition once license has been updated. ', NULL, NULL, '2021-04-27 15:13:02', '2021-04-27 15:13:02'),
(34458, 1019, 26239, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to JWright@magellanhealth.com SUB: Enrollment Query || Providers || SNBCARE || Magellan  Hello Judith, Hope you\'re doing good, we need the Credentialing Status for the following providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-05-20 10:10:39', '2021-05-20 10:10:39'),
(34459, 1019, 26239, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Request submitted online through Magellan Provider for New Location additions.', NULL, NULL, '2021-05-27 08:36:07', '2021-05-27 08:36:07'),
(34460, 1019, 26239, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to JWright@magellanhealth.com  Hello Judith, We already have updated their MA & RI license info for the following provider\'s can you please look into it.  Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards, Alex', NULL, NULL, '2021-06-14 07:34:15', '2021-06-14 07:34:15'),
(34461, 1019, 26239, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Provider is enrolled with Magellan Eff date 10/26/2020. See attachment for approval confirmation', NULL, NULL, '2021-07-13 13:40:21', '2021-07-13 13:40:21'),
(34462, 1019, 26240, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:17', '2021-04-27 08:41:17'),
(34463, 1019, 26240, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:33:49', '2021-05-03 08:33:49'),
(34464, 1019, 26240, NULL, '2021-06-10 00:00:00.000', 'Initiated', 'Sent the following email to  provider_data_request@tufts-health.com SUB: Location Addition || Jessica Hartman || SNBCARE || Tufts Public Plans  Hello, Attached is the Provider Information form, for Jessica Hartman to add her under our group. Let me know if you need further assistance. Thank You,', NULL, NULL, '2021-05-25 08:41:09', '2021-05-25 08:41:09'),
(34465, 1019, 26240, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:53:13', '2021-06-07 07:53:13'),
(34466, 1019, 26240, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:27:14', '2021-06-23 09:27:14'),
(34467, 1019, 26240, NULL, '2021-08-18 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 05/25/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:11:08', '2021-08-10 23:11:08'),
(34468, 1019, 26241, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:17', '2021-04-27 08:41:17'),
(34469, 1019, 26241, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:33:35', '2021-05-03 08:33:35'),
(34470, 1019, 26241, NULL, '2021-05-25 00:00:00.000', 'Initiated', 'Sent the following email to PNMDepartment@commonwealthcare.org, Credentialing@commonwealthcare.org SUB: Enrollment Query || Jessica Hartman || SNBCARE || CCA  Hello, We want to enroll the following provider with CCA under our group, I have attached the HCAS form with W9. Let me know if something else is required.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Information:  Jessica Hartman NPI: 1326665472 Additional Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Additional Location: 100 New State Highway, Raynham, MA, 02767. ', NULL, NULL, '2021-05-18 08:42:32', '2021-05-18 08:42:32'),
(34471, 1019, 26241, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:04:57', '2021-06-03 16:04:57'),
(34472, 1019, 26241, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org SUB: Enrollment Query || Jessica Hartman || SNBCARE || CCA  Hello,   Provider Jessica Hartman, FNP effective 05/18/2021     Thank you    Sivakumar Kesava Provider Network Management Commonwealth Care Alliance 2 Avenue De Lafayette 5th Floor Boston MA 02111 ', NULL, NULL, '2021-06-04 16:17:51', '2021-06-04 16:17:51'),
(34473, 1019, 26242, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:17', '2021-04-27 08:41:17'),
(34474, 1019, 26242, NULL, '2021-05-07 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-30 07:51:07', '2021-04-30 07:51:07'),
(34475, 1019, 26243, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:41:17', '2021-04-27 08:41:17'),
(34476, 1019, 26243, NULL, '2021-05-05 00:00:00.000', 'On Hold', 'Provider cannot enroll, because New Health England doesn\'t enroll provider from Framingham. ', NULL, NULL, '2021-04-28 14:56:41', '2021-04-28 14:56:41'),
(34477, 1019, 26244, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:52', '2021-04-27 08:43:52'),
(34478, 1019, 26244, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:41:08', '2021-05-03 08:41:08'),
(34479, 1019, 26244, NULL, '2021-05-25 00:00:00.000', 'Initiated', 'Sent the following email to providerapplicationstatus@bcbsma.com, Debra.Draheim@bcbsma.com SUB: Enrollment Query || Jessica Hartman || SNBCARE || BCBS MA  Hello, We need to add the following provider under our group, provider information is mentioned below, let us know with the next steps.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Information:  Jessica Hartman NPI: 1326665472 Additional Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Additional Location: 100 New State Highway, Raynham, MA, 02767.  Let me know for the next steps ASAP so we get her linked ASAP.  Thank You,', NULL, NULL, '2021-05-18 08:17:30', '2021-05-18 08:17:30'),
(34480, 1019, 26244, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to  providerapplicationstatus@bcbsma.com,  Debra.Draheim@bcbsma.com SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA  Hello Debra, Hope you\'re doing good, I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I sent a couple of emails to BCBS MA regarding enrollments, can you please look into my request and help out with enrollment status for our providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-05-20 08:53:57', '2021-05-20 08:53:57'),
(34481, 1019, 26244, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, provider-enrollment@bcbsma.com, debra.draheim@bcbsma.com  SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA 3rd Atttempt  Hello,  We need the enrollment status for the following providers under our group, also I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I have sent couple of emails to BCBS MA regarding enrollments query.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Regards, Alex ', NULL, NULL, '2021-06-03 10:51:26', '2021-06-03 10:51:26'),
(34482, 1019, 26244, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Received the following email from providerapplicationstatus@bcbsma.com  Dear Alex,     Please see the links you requested.      Please see the link below for information in regards to participating with Blue Cross Blue Shield of Massachusetts and guidance through the application process.  https://provider.bluecrossma.com/ProviderHome/portal/home/office-resources/enrollment/become-a-blue-cross-provider  Please see the link below for a contract update form. Please click on Contract Updates on the left side of the screen to locate. Please fill out and fax to the number found on the top of the form.   https://provider.bluecrossma.com/ProviderHome/portal/home/forms/forms/forms-library   Best,  Network Management Services Blue Cross and Blue Shield of Massachusetts', NULL, NULL, '2021-07-13 08:37:45', '2021-07-13 08:37:45'),
(34483, 1019, 26244, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Faxed the Attached filled enrollment application to (617) 246-4227 ', NULL, NULL, '2021-07-13 08:39:32', '2021-07-13 08:39:32'),
(34484, 1019, 26244, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Faxed the Attached form to BCBS MA at 617-246-5053.', NULL, NULL, '2021-07-13 09:19:41', '2021-07-13 09:19:41'),
(34485, 11056, 26244, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to: providerapplicationstatus@bcbsma.com  Sub:  Enrollment Status Updates - SNBCARE - BCBS  Good afternoon!  Hope this email finds you well. Please provide me with the latest updates on the below-mentioned providers under the facility TIN with both locations with BCBS.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jessica Hartman	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Jessica Hartman	1326665472	100 New State Highway, Raynham, MA, 02767. Jonathan Schubert	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Jonathan Schubert	1235755505	100 New State Highway, Raynham, MA, 02767.  If you have any concerns or queries feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-12-02 17:12:13', '2021-12-02 17:12:13'),
(34486, 11056, 26244, NULL, '2021-12-10 00:00:00.000', 'In Process', 'RE: Infosecure RE: Enrollment Status Updates - SNBCARE - BCBS', NULL, NULL, '2021-12-03 10:10:50', '2021-12-03 10:10:50'),
(34487, 19067, 26244, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Enrollment Status || SNBCARE || Providers || BCBS ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond to me in a timely manner,  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:54:34', '2021-12-15 17:54:34'),
(34488, 19067, 26244, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Secure email received from: providerapplicationstatus@bcbsma.com  Subject: Infosecure RE: Enrollment Status || SNBCARE || Providers || BCBS ||     Hello,     The application for Jessica Hartman was received and, after review, denied due to incorrect certification. Outreach was performed on 7/29/21 for explain the denial.     Credentialing for Jonathan Shubert was discontinued due to the provider holding the incorrect license. Provider is licensed as a LCSW and Blur Cross Blue Shield of Massachusetts currently only credentials LICSW.        We apologize that we were not able to reply to this email sooner. Due to Covid, our staffing has been impacted.     Regards,     Network Management Services  Blue Cross Blue Shield of Massachusetts     JB', NULL, NULL, '2021-12-28 13:59:50', '2021-12-28 13:59:50'),
(34489, 19067, 26244, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Re: Enrollment Status || SNBCARE || Providers || BCBS ||   Greetings!  If any provider mentioned before is enrolled then provide us a welcome letter. It will be very helpful for us.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:58:34', '2022-01-10 11:58:34'),
(34490, 19067, 26244, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Re: Enrollment Status || SNBCARE || Providers || BCBS ||    Hello!  Hope this email finds you well.  Any updates on the request below?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-04 09:34:53', '2022-02-04 09:34:53'),
(34491, 19067, 26244, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: ProviderApplicationStatus@bcbsma.com  Subject: Enrollment Status || SNBCARE || Providers || BCBS ||     The application for Jessica Hartman was received and, after review, denied due to incorrect certifications. Outreached was performed on 7/29/21 to let provider know this.     We did receive Jonathan Schubert’s application last year but credentialing was not able to be completed due to the provider not having the correct licensing for credentialing with Blue Cross Blue Shield of Massachusetts. Outreach was performed at that time to inform the provider of this.', NULL, NULL, '2022-02-10 16:03:45', '2022-02-10 16:03:45'),
(34492, 19067, 26244, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: ProviderApplicationStatus@bcbsma.com  Subject: RE: Enrollment Status || SNBCARE || Providers || BCBS ||    Hi,     I just received this message this morning that Jonathan Schubert has been credentialed, we will send out a welcome letter once this process has been completed.     When was Jessica Hartman submitted, I don’t show a record of the file in our credentialing system?     Deb Draheim, CPCS  Credentialing Manager, Provider Operations|Blue Cross Blue Shield of Massachusetts', NULL, NULL, '2022-02-10 16:06:08', '2022-02-10 16:06:08'),
(34493, 19067, 26244, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: providerapplicationstatus@bcbsma.com  Subject: Re: Enrollment Status || SNBCARE || Providers || BCBS ||   Hello,  We faxed the application at 617-246-5053 on 07/13/2021.  Thanks.', NULL, NULL, '2022-02-11 09:51:05', '2022-02-11 09:51:05'),
(34494, 19067, 26244, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Secure email received from: providerapplicationstatus@bcbsma.com  Subject: Infosecure:  RE: Enrollment Status || SNBCARE || Providers || BCBS ||     The application for Jessica Hartman was received and, after review, denied due to incorrect certifications. Outreached was performed on 7/29/21 to let the provider know this.  We did receive Jonathan Schubert’s application last year but credentialing was not able to be completed due to the provider not having the correct licensing for credentialing with Blue Cross Blue Shield of Massachusetts. Outreach was performed at that time to inform the provider of this.     Best,  Network Management Services  Blue Cross and Blue Shield of Massachusetts', NULL, NULL, '2022-02-17 10:55:23', '2022-02-17 10:55:23'),
(34495, 19067, 26244, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Left a voicemail @713-663-1149', NULL, NULL, '2022-03-17 10:00:02', '2022-03-17 10:00:02'),
(34496, 22077, 26244, NULL, '2022-04-13 00:00:00.000', 'In Process', 'Email sent to: ProviderApplicationStatus@bcbsma.com  Subject: Re: Enrollment Status || SNBCARE || Providers || BCBS ||  Hello,  Is there any way we can enroll the provider,  Jessica Hartman  NPI: 1326665472  Thanks', NULL, NULL, '2022-04-06 11:32:42', '2022-04-06 11:32:42'),
(34497, 22077, 26244, NULL, '2022-04-13 00:00:00.000', 'Not Eligible', 'Email received from: providerapplicationstatus@bcbsma.com  Subject: RE: Enrollment Status || SNBCARE || Providers || BCBS ||   The provider can not be credentialed unless she has the correct certifications.  You can go to the provider central website and review how to become a provider for any additional information.     https://provider.bluecrossma.com/ProviderHome/portal/home/office-resources/enrollment/become-a-blue-cross-provider      Best,  Network Management Services  ', NULL, NULL, '2022-04-06 14:28:10', '2022-04-06 14:28:10'),
(34498, 1019, 26245, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:52', '2021-04-27 08:43:52'),
(34499, 1019, 26245, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:40:57', '2021-05-03 08:40:57'),
(34500, 1019, 26245, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Faxed the LOI to (859) 455-8650 to add Jessica under MA locations.', NULL, NULL, '2021-05-17 13:57:51', '2021-05-17 13:57:51'),
(34501, 1019, 26245, NULL, '2021-05-24 00:00:00.000', 'Initiated', 'Faxed the LOI to (859) 455-8650 to add Jessica under MA locations.', NULL, NULL, '2021-05-17 13:58:06', '2021-05-17 13:58:06'),
(34502, 1019, 26245, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:01:05', '2021-05-20 08:01:05'),
(34503, 1019, 26245, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon, Please see my below comments. Thank you  Mary Gibbons, 9080253 – application was not received NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman, 6715913 – credentialed for RI only, please submit an app for MA NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell, 6712207 – 01/01/2021 effective date 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.       Jonathan Schubert, 6249193 – 06/15/2021 effective date 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.        Katie Tawakol, 6120037 – 01/01/2021 effective date 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Jennifer Ullrich, 6913357 – 05/01/2021 effective date 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Justin Souliere, 6893422 – 05/017/2021 effective date 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva, 4841425 – waiting to be linked 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health', NULL, NULL, '2021-05-31 11:52:35', '2021-05-31 11:52:35'),
(34504, 1019, 26245, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-06-16 07:55:58', '2021-06-16 07:55:58'),
(34505, 1019, 26245, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson  NPI: 1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman  NPI: 1326665472  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland  NPI: 1598163602  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Jonathan Schubert  NPI: 1235755505   Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Kerry Smith  NPI: 1275083230  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jennifer Ullrich  NPI: 1710489760  Secondary Location: 100 New State Highway, Raynham, MA, 02767      Regards, Alex G.', NULL, NULL, '2021-08-24 11:11:03', '2021-08-24 11:11:03'),
(34506, 11056, 26245, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Laura.Bevin@aetna.com  Sub : Fwd: Enrollment Query || Providers || SNBCARE || Aetna  Hello,  Can you please get back to me with an update on the following providers credentialing? as I have submitted the applications for address addition as well.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Regards', NULL, NULL, '2021-12-01 17:07:33', '2021-12-01 17:07:33'),
(34507, 19067, 26245, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations.  If any Provider is enrolled provide us with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Powell, Lauren	1285304980	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Powell, Lauren	1285304980	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896. Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767. Ullrich, Jennifer	1710489760	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:13:15', '2021-12-15 17:13:15');
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
(34508, 19067, 26245, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Good morning,     Powell, Lauren waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     DiCostanzo, Allie waiting to be linked to the contract  63 Eddie Dowling Highway, Suite 8, North Smithfield, RI, 02896     Dina, Filoteo-Nichols waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Halterman, Helena waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hartman, Jessica waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Hignite, Barbara not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Loveland, Lynnetta not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Rodrigues, Eliza waiting to be linked to the contract  61 Lincoln Street, Suite 203, Framingham, MA, 01702  100 New State Highway, Raynham, MA, 02767     Schubert, Jonathan  61 Lincoln Street, Suite 203, Framingham, MA, 01702 06/15/2021 effective date  100 New State Highway, Raynham, MA, 02767 not linked to this address yet     Ullrich, Jennifer not linked to this address yet  100 New State Highway, Raynham, MA, 02767     Thank you     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-16 10:56:30', '2021-12-16 10:56:30'),
(34509, 19067, 26245, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Good Morning!  Hope you had a great weekend,  I would like to know the enrollment status for mentioned providers.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jonathan Schubert	1235755505	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lynnetta Loveland	1598163602	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Dina Filoteo-Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo-Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702 Lauren Powell	1285304980	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Lauren Powell	1285304980	61 Lincoln St., Suite 203, Framingham, MA 01702   Kindly respond promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-20 10:30:28', '2021-12-20 10:30:28'),
(34510, 19067, 26245, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com   Subject: Enrollment Status || SNBCARE || Providers || Aetna ||   Hello,  Please see my below comments.  Thank you     Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Lynnetta Loveland - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 12/16/2021 effective date  Barbara Hignite - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - 12/16/2021 effective date  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Allie DiCostanzo - 63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 – 11/12/2021 effective date  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – waiting to be linked  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – waiting to be linked  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked     Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-12-28 13:20:45', '2021-12-28 13:20:45'),
(34511, 19067, 26245, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Greetings Laura!  Any updates on the providers which were waiting to be linked?   Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 11:33:45', '2022-01-10 11:33:45'),
(34512, 19067, 26245, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  There are no changes for the providers listed below.  Thank you', NULL, NULL, '2022-01-30 12:13:54', '2022-01-30 12:13:54'),
(34513, 1019, 26245, NULL, '2022-02-08 00:00:00.000', 'In Process', 'Hello Laura,  Did the providers get linked on which we were waiting, and if yes please provide me there effective dates     Thank You, Hammad.', NULL, NULL, '2022-02-01 12:19:55', '2022-02-01 12:19:55'),
(34514, 19067, 26245, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Laura.Bevin@aetna.com  Subject: Enrollment Status || SNBCARE || Providers || Aetna ||    Hello,  Jennifer Ullrich - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – not linked to this address  Jonathan Schubert - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - not linked to this address  Jessica Hartman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Jessica Hartman - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Helena Halterman - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Helena Halterman - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Dina Filoteo-Nichols - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 – 02/15/2022 effective date  Dina Filoteo-Nichols - 61 Lincoln St., Suite 203, Framingham, MA 01702 – 02/15/2022 effective date  Eliza Rodrigues -  100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Eliza Rodrigues - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Lauren Powell - 100 NEW STATE HWY RAYNHAM, MA 02767-5423 - waiting to be linked  Lauren Powell - 61 Lincoln St., Suite 203, Framingham, MA 01702 - waiting to be linked  Thank you', NULL, NULL, '2022-02-10 15:12:41', '2022-02-10 15:12:41'),
(34515, 19067, 26245, NULL, '2022-02-17 00:00:00.000', 'In Process', 'Email received from: Aetna Provider Communications  Subject: Welcome to our network. Let’s get started.  Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  Ready to get started? To help make your onboarding easy, just check out the attached welcome kit.    Register here to attend our new provider onboarding webinar - Doing business with Aetna® . Sessions are held on the second Tuesday and third Wednesday of each month from 1:00 p.m. – 2:15 p.m. ET. You\'ll discover additional online tools and resources to make your day-to-day Aetna tasks quick and simple.   ', NULL, NULL, '2022-02-10 16:01:18', '2022-02-10 16:01:18'),
(34516, 19067, 26245, NULL, '2022-02-21 00:00:00.000', 'Approved', 'Received the following email     Greetings,  We’d like to welcome the following providers to our network:  Dina Filoteo-Nichols - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6184053.  Helena Halterman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6145563.  Jessica Hartman - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6661129.  Lauren Powell - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 4806753.  Eliza Rodrigues - Effective Feb 15 2022 12:00AM. Your identification Number (PIN) is: 6939115.  ', NULL, NULL, '2022-02-14 14:03:14', '2022-02-14 14:03:14'),
(34517, 19067, 26245, NULL, '2022-02-21 00:00:00.000', 'Approved', 'See attachment of provider directory for location confirmation.', NULL, NULL, '2022-02-14 14:08:01', '2022-02-14 14:08:01'),
(34518, 1019, 26246, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:52', '2021-04-27 08:43:52'),
(34519, 1019, 26246, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:40:49', '2021-05-03 08:40:49'),
(34520, 1019, 26246, NULL, '2021-06-10 00:00:00.000', 'Initiated', 'Spoken with Cigna Rep Jenny Initiate the request to add Jessica Under MA locations, also did send her the copy of her MA license by fax at 8606877257  for Contracting it will take up to 14 business days to load in there systems.  Ref: Jenny D - 05/24/2021', NULL, NULL, '2021-05-24 10:25:51', '2021-05-24 10:25:51'),
(34521, 1019, 26246, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com  SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:30:23', '2021-06-03 15:30:23'),
(34522, 1019, 26246, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:31:31', '2021-06-03 15:31:31'),
(34523, 1019, 26246, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Provider added under new location effective date 02/18/2021. Attached is the group roster for ref. ', NULL, NULL, '2021-07-15 08:04:30', '2021-07-15 08:04:30'),
(34524, 1019, 26247, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:52', '2021-04-27 08:43:52'),
(34525, 1019, 26247, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:40:35', '2021-05-03 08:40:35'),
(34526, 1019, 26247, NULL, '2021-06-29 00:00:00.000', 'Initiated', 'Sent the following email to behavioralhealthproviderservices@humana.com  SUB: RI-Spectrum Neuro Behavioral Care LLC­-Status_PAEG  Hello Alyssa, I have attached the roster, we need to add the following providers under our group, which are mentioned in the group roster. Let me know if you have any questions.  Regards, Alex', NULL, NULL, '2021-06-11 13:47:58', '2021-06-11 13:47:58'),
(34527, 11056, 26247, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Sub:  Fwd: Enrollment || Providers || SNBCARE || Humana  Good afternoon!  Hope this email finds you well. Please provide us with the welcome or approval letters for those providers whose credentialing processes are completed. Also, provide the updates related to the secondary location of the providers.  Kindly, also list these providers in the Humana provider directory. Please get back to me soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-09 17:35:02', '2021-12-09 17:35:02'),
(34528, 19067, 26247, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||  Hello,  Hope this email finds you well.  I want to know the enrollment status for the following providers under mentioned locations and also the group credentialing status.  If any Provider is enrolled provide me with their Effective date and Welcome letter.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Halterman, Helena	1801473749	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Halterman, Helena	1801473749	100 New State Highway, Raynham, MA, 02767. Smith, Kerry	1275083230	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Smith, Kerry	1275083230	100 New State Highway, Raynham, MA, 02767. Hignite, Barbara	1982617262	100 New State Highway, Raynham, MA, 02767. Hartman, Jessica	1326665472	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Hartman, Jessica	1326665472	100 New State Highway, Raynham, MA, 02767. DiCostanzo, Allie	1669045738	63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Filoteo-Nichols, Dina	1770021099	100 New State Highway, Raynham, MA, 02767. Filoteo-Nichols, Dina	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Rodrigues, Eliza	1821751405	100 New State Highway, Raynham, MA, 02767. Rodrigues, Eliza	1821751405	61 Lincoln Street, Suite 203, Framingham, MA, 01702.  Kindly respond me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 15:32:33', '2021-12-15 15:32:33'),
(34529, 19067, 26247, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Humana ||    Hello,     This information can be verified on Humana website under Physician Finder, Approval letters are sent to providers upon completion, Humana preferred provider resource is AVAILALITY, you can obtain: provider demographic update, status, claims etc.,     Thanks,     Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2021-12-16 12:26:00', '2021-12-16 12:26:00'),
(34530, 19067, 26247, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:37:26', '2021-12-29 14:37:26'),
(34531, 19067, 26247, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Greetings!  Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks,  Hammad Ahmed.', NULL, NULL, '2022-01-10 13:17:31', '2022-01-10 13:17:31'),
(34532, 19067, 26247, NULL, '2022-02-06 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hello!  Hope this email finds you well.  This is my Second Reminder on the request mentioned below. Kindly look into this.  Kindly reply as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-01-30 13:15:56', '2022-01-30 13:15:56'),
(34533, 19067, 26247, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||  Hi Hammad,  Humana standard process, credential specialist mail approval letters are mailed to providers upon completion/approval.   Providers can also utilize the Availity Web Portal located at www.availity.com   Thank you,  Monica', NULL, NULL, '2022-02-08 14:22:54', '2022-02-08 14:22:54'),
(34534, 19067, 26247, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Re: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||   Hi Monica,  I haven\'t received a welcome letter yet. Kindly advise on how much time will it take?   Regards, Hammad Ahmed.', NULL, NULL, '2022-03-09 14:56:44', '2022-03-09 14:56:44'),
(34535, 19067, 26247, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || || HUMANA ||    Here are Humana standard process if approval letters are NOT received:     ·       system will not generate approval letters, if providers have existing records with (Humana/Choice Care), To check status you may call into customer service at 800-448-6262. Please also feel free to use Availity or the Humana directory. And/or verify with the provider,  if approval letter was received.     Reasons why provider credentialing will be denied:      CAQH application:  · Practice location missing  · Copy of license or license listed on application is not set to expire in the next 45 days  · Copy of insurance and/or insurance listed on application is not set to expire in the next 45 days  · At least 5 years of work history with gaps greater than 6 months explained on the application  · Education        Thank you,  Monica Tasby-Lafayette  Provider Contracting Professional II |Network Operations     Humana logo, return to homepage     * E-Mail: mtasby2@humana.com | : Web: www.humana.com', NULL, NULL, '2022-03-10 10:49:17', '2022-03-10 10:49:17'),
(34536, 22077, 26247, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: mtasby2@humana.com  Subject: Enrollment Status || Group & Providers || SNBCARE || HUMANA ||   Hello!  Hope you are doing really well.  I would like to know the enrollment status of the following Group and Providers with Humana. If any provider is enrolled provide us with their effective dates.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Jessica Hartman	1326665472	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Jessica Hartman	1326665472	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Dina Filoteo Nichols	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Dina Filoteo Nichols	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Eliza Rodrigues	1821751405	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Eliza Rodrigues	1821751405	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Helena Halterman	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Kerry Smith	1275083230	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Kerry Smith	1275083230	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Barbara Hignite	1982617262	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Allie DiCostanzo	1669045738	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322   Waiting to hear from you soon!  Thanks & Regards,', NULL, NULL, '2022-04-04 13:53:31', '2022-04-04 13:53:31'),
(34537, 1019, 26248, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:52', '2021-04-27 08:43:52'),
(34538, 1019, 26248, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:40:21', '2021-05-03 08:40:21'),
(34539, 1019, 26248, NULL, '2021-05-27 00:00:00.000', 'On Hold', 'Waiting for Aetna', NULL, NULL, '2021-05-20 09:34:01', '2021-05-20 09:34:01'),
(34540, 1019, 26249, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:52', '2021-04-27 08:43:52'),
(34541, 1019, 26249, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:40:13', '2021-05-03 08:40:13'),
(34542, 1019, 26249, NULL, '2021-06-10 00:00:00.000', 'Initiated', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Good Morning Anne,  Hope you are doing well, and had a good weekend, I need to add one more provider under our MA locations, I have mentioned the information below,  Group Information:  Spectrum Neuro Behavioral Care LLC NPI: 1356906572 Address 1: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Address 2: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Jessica Hartman NPI: 1326665472  Let me know if anything else is required.  Thank You,', NULL, NULL, '2021-05-24 10:58:10', '2021-05-24 10:58:10'),
(34543, 1019, 26249, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  The information has been received and loaded to add the practitioner to the 2 locations as requested.  ', NULL, NULL, '2021-05-25 08:24:45', '2021-05-25 08:24:45'),
(34544, 1019, 26249, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:00:17', '2021-06-16 08:00:17'),
(34545, 19067, 26249, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:10:11', '2021-12-16 14:10:11'),
(34546, 19067, 26249, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:07:00', '2021-12-29 12:07:00'),
(34547, 19067, 26249, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:13:57', '2022-01-10 14:13:57'),
(34548, 19067, 26249, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:37:29', '2022-01-11 09:37:29'),
(34549, 19067, 26249, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:46:53', '2022-01-11 10:46:53'),
(34550, 19067, 26249, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:16:18', '2022-02-11 11:16:18'),
(34551, 19067, 26249, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:22:52', '2022-02-11 11:22:52'),
(34552, 19067, 26249, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:48:55', '2022-03-17 09:48:55'),
(34553, 19067, 26249, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:33:59', '2022-03-17 10:33:59'),
(34554, 19067, 26249, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:36:11', '2022-03-17 10:36:11'),
(34555, 1019, 26250, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:52', '2021-04-27 08:43:52'),
(34556, 1019, 26250, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:40:05', '2021-05-03 08:40:05'),
(34557, 1019, 26250, NULL, '2021-05-25 00:00:00.000', 'On Hold', 'Waiting for Medicare PTAN to fully load in there systems.', NULL, NULL, '2021-05-18 08:54:53', '2021-05-18 08:54:53'),
(34558, 1019, 26250, NULL, '2021-06-10 00:00:00.000', 'Initiated', 'Request for Railroad PTAN has been initiated thru there website, attached is the copy for reference.', NULL, NULL, '2021-05-24 10:44:31', '2021-05-24 10:44:31'),
(34559, 1019, 26250, NULL, '2021-06-12 00:00:00.000', 'Approved', 'PTAN has been active effective from 02/19/2021. see attachment for approval Also sent test email', NULL, NULL, '2021-06-05 12:23:59', '2021-06-05 12:23:59'),
(34560, 1019, 26251, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:52', '2021-04-27 08:43:52'),
(34561, 1019, 26251, NULL, '2021-05-04 00:00:00.000', 'Initiated', 'Application Submitted through PECOS  To: SNBC@CLAIMSMEDINC.COM,JLH6690@GMAIL.COM  Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T042720210001010)  Sent: 04/27/2021 11:20 AM  This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:   ---------------------------------------------------------------------------------------------------------------------- Application Tracking ID: T042720210001010 NPI: 1326665472 Medicare ID: Name: JESSICA  HARTMAN State: MA Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC. INDIANAPOLIS,IN,46207-7149 ', NULL, NULL, '2021-04-27 10:27:17', '2021-04-27 10:27:17'),
(34562, 1019, 26251, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Received the following email from customerservice-donotreply@cms.hhs.gov SUB:Request for Corrections for Medicare Enrollment Application (Tracking ID: T042720210001010)  To:  jlh6690@gmail.com,snbc@claimsmedinc.com   Subject:  Request for Corrections for Medicare Enrollment Application (Tracking ID: T042720210001010)  Date:   04/30/2021 16:35 PM  This message is in response to your Medicare enrollment application that was submitted from https://pecos.cms.hhs.gov. You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T042720210001010. The information provided below indicates areas of your application requiring corrections as determined by your fee-for-service contractor.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T042720210001010   NPI ID: 1326665472   Medicare ID:    Name: JESSICA HARTMAN   State: MA  Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Other Comments  BOARD CERTIFICATION -A copy or clear photograph of your board certification from an accreditation board for nurse practitioners (ANCC, AANP, etc.) is required. Please upload this information to PECOS as a supporting document.  DEGREE/ DIPLOMA          -A copy or clear photograph of your Master\'s degree in nursing or a Doctor of Nursing Practice (DNP) Doctoral degree is required. Please upload this information to PECOS as a supporting document.  *Please log into PECOS, select \"My Associates\", scroll down and select \"View Enrollments\", and select the application under Return for Corrections. Make all of the appropriate changes as requested. Be sure to fully re-submit the application after the changes are made, with completed e-signatures. If faxing supporting documentation, fax to 315-442-4234.  *We may reject your application(s) if you do not furnish complete information within 30 calendar days from the postmarked date of this email pursuant to 42 CFR 424.525.  You must submit the requested revisions and/or supply the requested information/supporting documentation within your allotted 30 days.   *If you have any questions regarding this development request please contact me directly at 781-741-3040 and reference case number: PE0000263367   Thank you,  Kathleen O\'Brien  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Please retain this e-mail for your records.  This email message is an automated notification. Do not reply to this message as it is sent from an unmonitored account.  If you have any questions about this identifier, you may:  1.) Refer to the Web site at https://pecos.cms.hhs.gov, or  2.) Contact your fee-for-service contractor listed above.  Please note:  The information provided in the Enrollment application may be shared with and used by others only in accordance with the privacy notice to which you agreed at the time of application. In addition, you agreed to keep the PECOS updated with any changes to data listed on the enrollment application within 30 days of the effective date of the change. If you are not the provider, you are required to inform the provider of the information in this e-mail.  Unauthorized interception of this communication could be a violation of Federal and State Law. This communication and any files transmitted with it are confidential and may contain protected health information. This communication is solely for the use of the person or entity to whom it was addressed. If you are not the intended recipient, any use, distribution, printing or acting in reliance on the contents for this message is strictly prohibited. If you have received this message in error, please notify the sender and destroy any and all copies.', NULL, NULL, '2021-05-03 07:12:45', '2021-05-03 07:12:45'),
(34563, 1019, 26251, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Received the following email from customerservice-donotreply@cms.hhs.gov Sub: Medicare Enrollment Application Receipt Notification (Tracking ID: T042720210001010 )  To: SNBC@CLAIMSMEDINC.COM,JLH6690@GMAIL.COM   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T042720210001010)   Sent: 05/03/2021 08:13 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T042720210001010        NPI: 1326665472        Medicare ID:         Name: JESSICA  HARTMAN          State: MA        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.                 INDIANAPOLIS,IN,46207-7149   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.  Please retain this e-mail for your records.  This email message is an automated notification. Do not reply to this message as it is sent from an unmonitored account. If you have any questions about this application:  1.) Refer to the Web site at (https://pecos.cms.hhs.gov), or   2.) Contact your fee-for-service contractor listed above   Please note: The information provided in this application may be shared with and used by others only in accordance with the privacy notice to which you agreed at the time of the application. In addition, you agreed to keep Medicare updated with any changes to data listed on the enrollment application form within 30 days of the effective date of the change. If you are not the provider, you are required to inform the provider of the information in this e-mail.   Unauthorized interception of this communication could be a violation of Federal and State Law. This communication and any files transmitted with it are confidential and may contain protected health information. This communication is solely for the use of the person or entity to whom it was addressed. If you are not the intended recipient, any use, distribution, printing or acting in reliance on the contents for this message is strictly prohibited. If you have received this message in error, please notify the sender and destroy all copies of the message.', NULL, NULL, '2021-05-03 07:17:20', '2021-05-03 07:17:20'),
(34564, 1019, 26251, NULL, '2021-05-21 00:00:00.000', 'Approved', 'Received the following email from customerservice-donotreply@cms.hhs.gov SUB: Medicare Enrollment Application Status Change Notification (Tracking ID: T042720210001010)  Application Tracking ID: T042720210001010   NPI ID: 1326665472   Medicare ID: S400748327   Name: JESSICA HARTMAN  State: MA   Form Type: 855I  Date: 05/14/2021  Status: APPROVED', NULL, NULL, '2021-05-14 13:01:30', '2021-05-14 13:01:30'),
(34565, 1019, 26252, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:52', '2021-04-27 08:43:52'),
(34566, 1019, 26252, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:39:52', '2021-05-03 08:39:52'),
(34567, 1019, 26252, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Waiting to get credentialed first as Application already in process for NSF location, once done then will send application for Location Additions.', NULL, NULL, '2021-05-24 09:04:08', '2021-05-24 09:04:08'),
(34568, 1019, 26253, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:52', '2021-04-27 08:43:52'),
(34569, 1019, 26253, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:39:44', '2021-05-03 08:39:44'),
(34570, 1019, 26254, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:53', '2021-04-27 08:43:53'),
(34571, 1019, 26254, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:39:36', '2021-05-03 08:39:36'),
(34572, 1019, 26254, NULL, '2021-06-10 00:00:00.000', 'Initiated', 'Sent the following email to  provider_data_request@tufts-health.com SUB: Location Addition || Jessica Hartman || SNBCARE || Tufts Health Plans  Hello, Attached is the Provider Information form, for Jessica Hartman to add her under our group. Let me know if you need further assistance. Thank You,', NULL, NULL, '2021-05-25 08:44:54', '2021-05-25 08:44:54'),
(34573, 1019, 26254, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 12:58:01', '2021-06-05 12:58:01');
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
(34574, 1019, 26254, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:34:14', '2021-06-23 09:34:14'),
(34575, 1019, 26254, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 12/31/2020 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 09:29:09', '2021-07-07 09:29:09'),
(34576, 1019, 26255, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:53', '2021-04-27 08:43:53'),
(34577, 1019, 26255, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:39:27', '2021-05-03 08:39:27'),
(34578, 1019, 26255, NULL, '2021-07-01 00:00:00.000', 'On Hold', 'On Hold because Jessica is working part time and she doesn\'t have MA DEA, so cannot start credentialing due to DEA #.', NULL, NULL, '2021-05-31 09:22:41', '2021-05-31 09:22:41'),
(34579, 1019, 26255, NULL, '2021-07-05 00:00:00.000', 'Initiated', 'Initiated application thru Provider Portal, see attachment of Application Submission. ', NULL, NULL, '2021-06-22 13:34:23', '2021-06-22 13:34:23'),
(34580, 1019, 26255, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Received the following email from PEC@maximus.com  On 06/25/21, we reached out to you regarding your incomplete FFS application. As of the date of this e-mail, we still have not received the requested item(s) listed below:  Data Collection Form (DCF) The Data Collection Form (DCF) is required. This form must be filled out in its entirety. FRDF for Individual Practitioners The Federally Required Disclosures form for Individual Practitioners (PE-FRD-IN) is required. The form must be completed in its entirety. Medical Practitioner Application We have received an initial application via the Provider Online Service Center (POSC), however additional information is required. Please complete the required sections of the paper application for Medical Practitioners (PE-MP). Provider Contract The MassHealth Provider Contract for Individuals is required. The form must be signed by the individual applicant. At this time, we cannot process your application to become a participating Mass Health Provider.  All items must be accounted for and processed in order to complete your application within 60 days of the initial request or the application will be denied. Therefore, the missing information listed above must be sent to us immediately to avoid a denial of your application. Once denied you will be required to resubmit a new application and all new documents.  Please note that effective 11/3/2017, Massachusetts Law (M.G.L. c. 112, §§ 2 and 9) require that all applicants for a limited license and all applicants for an initial license, or a renewal license must enroll with MassHealth as either billing or non-billing providers. Therefore, a denied application can prevent prospective healthcare providers from being issued a MA professional license as well as preventing already licensed healthcare providers from being able to renew their MA professional license.  If a submission/re-submission of a document is being requested, please make sure to indicate the Application Tracking Number (ATN) on the top of each document. You can submit the item(s) to us by either:  Mailing the requested item(s) to the address below,  MassHealth Attn: Provider Enrollment and Credentialing (PEC) P.O. Box 121205 Boston, MA 02112-1205  *Replying to this e-mail with the requested item(s) attached or; *Please note that any e-mail submissions containing Personally Identifiable Information (PII) or Protected Health Information (PHI) should be sent encrypted and secured  *Uploading the requested item(s) to your ATN directly through the MassHealth Provider Online Service Center (POSC) *This option is only available if you initially obtained an ATN by applying through the POSC; you have the option of logging into the POSC and uploading the requested documents (in .pdf format) directly into the ATN. Please note that you are not a MassHealth provider until you receive your MassHealth Welcome Letter notifying you of your approval with an approval effective date.  MassHealth cannot pay for services provided before the effective date of an approved MassHealth contract. MassHealth has the authority to determine the effective date of the provider contract according to the MassHealth regulations at 130 CMR 450.223 and is therefore, not obligated to retroactively approve an enrollment application.  To view our provider regulations as pertaining to you provider type (PT), please visit: https://www.mass.gov/service-details/masshealth-provider-regulations.  To obtain MassHealth application forms as related to your enrollment, please visit: https://www.mass.gov/masshealth-provider-forms  If you have any questions or concerns about what we are requesting or the application process in general, you can reach out to us by calling the MassHealth Customer Service Center at 1 (800) 841-2900 or by e-mailing PEC@maximus.com.  Sincerely,   MassHealth Provider Enrollment and Credentialing (PEC) ', NULL, NULL, '2021-07-05 07:57:41', '2021-07-05 07:57:41'),
(34581, 1019, 26255, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent the following email to PEC@maximus.com  Hello, Attached are filled and signed documents for Jessica Hartman as we have filled her application before through Portal, also uploaded these forms there as well.   Let me know if something else is required.   Regards,', NULL, NULL, '2021-07-05 07:59:15', '2021-07-05 07:59:15'),
(34582, 1019, 26255, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Sent the following email to KaihengJiang@maximus.com Hello Kaiheng,  Here are the filled and signed forms. Let me know if anything else is required.   Regards, Alex ', NULL, NULL, '2021-07-30 08:36:57', '2021-07-30 08:36:57'),
(34583, 1019, 26255, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Received the following email from KaihengJiang@maximus.com Hi,  Jessica application have been complete and we create the PID 110174406A. The effective date should be 08/11/2021.  Thanks,  Kaiheng', NULL, NULL, '2021-08-27 08:45:32', '2021-08-27 08:45:32'),
(34584, 1019, 26256, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:53', '2021-04-27 08:43:53'),
(34585, 1019, 26256, NULL, '2021-05-04 00:00:00.000', 'Initiated', 'License has been updated thru Online Portal, it will take up to 10 business days for Magellan to update in their system, will sent the request for Location addition once license has been updated. ', NULL, NULL, '2021-04-27 15:12:54', '2021-04-27 15:12:54'),
(34586, 1019, 26256, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to JWright@magellanhealth.com SUB: Enrollment Query || Providers || SNBCARE || Magellan  Hello Judith, Hope you\'re doing good, we need the Credentialing Status for the following providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-05-20 10:11:21', '2021-05-20 10:11:21'),
(34587, 1019, 26256, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Request submitted online through Magellan Provider for New Location additions.', NULL, NULL, '2021-05-27 08:36:32', '2021-05-27 08:36:32'),
(34588, 1019, 26256, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to JWright@magellanhealth.com  Hello Judith, We already have updated their MA & RI license info for the following provider\'s can you please look into it.  Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702.Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards, Alex', NULL, NULL, '2021-06-14 07:34:05', '2021-06-14 07:34:05'),
(34589, 1019, 26256, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Provider is enrolled with Magellan Eff date 10/26/2020. See attachment for approval confirmation', NULL, NULL, '2021-07-13 13:42:55', '2021-07-13 13:42:55'),
(34590, 1019, 26257, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:53', '2021-04-27 08:43:53'),
(34591, 1019, 26257, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:39:19', '2021-05-03 08:39:19'),
(34592, 1019, 26257, NULL, '2021-06-10 00:00:00.000', 'Initiated', 'Sent the following email to  provider_data_request@tufts-health.com SUB: Location Addition || Jessica Hartman || SNBCARE || Tufts Public Plans  Hello, Attached is the Provider Information form, for Jessica Hartman to add her under our group. Let me know if you need further assistance. Thank You,', NULL, NULL, '2021-05-25 08:41:34', '2021-05-25 08:41:34'),
(34593, 1019, 26257, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:52:42', '2021-06-07 07:52:42'),
(34594, 1019, 26257, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:36:31', '2021-06-23 09:36:31'),
(34595, 1019, 26257, NULL, '2021-08-18 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 05/25/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:09:57', '2021-08-10 23:09:57'),
(34596, 1019, 26258, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:53', '2021-04-27 08:43:53'),
(34597, 1019, 26258, NULL, '2021-05-10 00:00:00.000', 'On Hold', 'Waiting for Medicare.', NULL, NULL, '2021-05-03 08:39:10', '2021-05-03 08:39:10'),
(34598, 1019, 26258, NULL, '2021-05-25 00:00:00.000', 'Initiated', 'Sent the following email to PNMDepartment@commonwealthcare.org, Credentialing@commonwealthcare.org SUB: Enrollment Query || Jessica Hartman || SNBCARE || CCA  Hello, We want to enroll the following provider with CCA under our group, I have attached the HCAS form with W9. Let me know if something else is required.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Information:  Jessica Hartman NPI: 1326665472 Additional Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Additional Location: 100 New State Highway, Raynham, MA, 02767. ', NULL, NULL, '2021-05-18 08:42:59', '2021-05-18 08:42:59'),
(34599, 1019, 26258, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:04:45', '2021-06-03 16:04:45'),
(34600, 1019, 26258, NULL, '2021-06-28 00:00:00.000', 'Approved', 'See Attached for the email SS received from CCA for Approval Confirmation.  Also spoken with Rep Gilsen F, as per rep the provider is linked under both (Framingham & Raynham) locations.  Call ref #: Gislen F - 06/21/2021 ', NULL, NULL, '2021-06-21 09:01:02', '2021-06-21 09:01:02'),
(34601, 1019, 26259, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:53', '2021-04-27 08:43:53'),
(34602, 1019, 26259, NULL, '2021-05-07 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-30 07:50:53', '2021-04-30 07:50:53'),
(34603, 1019, 26260, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-27 08:43:53', '2021-04-27 08:43:53'),
(34604, 1019, 26260, NULL, '2021-05-05 00:00:00.000', 'On Hold', 'Waiting for response from Health New England as they don\'t credential in every city in MA. ', NULL, NULL, '2021-04-28 14:57:01', '2021-04-28 14:57:01'),
(34605, 1006, 26261, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-29 13:44:29', '2021-04-29 13:44:29'),
(34606, 1019, 26261, NULL, '2021-05-28 00:00:00.000', 'Initiated', 'Sent the following email to jointchp@texaschildrens.org     Sub: Enrollment Application || Tameka Birts || MBS || TCHP    Hello, We want to enroll our provider with TCHP attached is the LOI form along with the W9  form. Let me know if something else is required.', NULL, NULL, '2021-05-19 15:09:29', '2021-05-19 15:09:29'),
(34607, 1019, 26261, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Received the following email from bxhickma@texaschildrens.org SUB: LOI Additional information is needed process your LOI. Please provide  Driver’s License or Signed lease in your  name  Thank You.  Belinda Hickman Contract Specialist', NULL, NULL, '2021-05-24 16:21:05', '2021-05-24 16:21:05'),
(34608, 1019, 26261, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Sent the following email to bxhickma@texaschildrens.org SUB: LOI ello Belinda,Hope you\'re doing well, I have attached the copy of her Driving License, Let me know if anything else is needed,   Thank You,', NULL, NULL, '2021-05-24 16:24:05', '2021-05-24 16:24:05'),
(34609, 1019, 26261, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Sent the following email to bxhickma@texaschildrens.org  Good Afternoon Belinda,  Hope you are doing good, I want enrollment status for the following provider as her application is in process for a while now.  Tameka Birts NPI: 1508211079  Regards, Alex', NULL, NULL, '2021-06-07 14:35:21', '2021-06-07 14:35:21'),
(34610, 1019, 26261, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Received the following email from bxhickma@texaschildrens.org  Please submit a picture ID or signed lease of business.  Thank You.', NULL, NULL, '2021-06-15 13:24:53', '2021-06-15 13:24:53'),
(34611, 1019, 26261, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to bxhickma@texaschildrens.org  Hello Belinda, Any update on Tameka Birt\'s Application?  Regards, Alex', NULL, NULL, '2021-06-15 13:26:10', '2021-06-15 13:26:10'),
(34612, 1019, 26261, NULL, '2021-07-10 00:00:00.000', 'In Process', 'Received the following denial Letter from TCHP.  Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We are unable to process your request for participation at this time. The information submitted with your letter of interest questionnaire does not match the business registry with the Secretary of State’s office. Please review the business entity name and the principal address associated with your business by visiting the following website:', NULL, NULL, '2021-06-30 09:34:58', '2021-06-30 09:34:58'),
(34613, 1019, 26261, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent the following email to jointchp@texaschildrens.org  Hello Debra, Attached is the updated LOI for Tameka, as we have updated our address with SOS now, can you reprocess this application now.      Regards, Alex ', NULL, NULL, '2021-07-27 08:58:01', '2021-07-27 08:58:01'),
(34614, 1019, 26261, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Received the following document to sign and sent it back attached is the copy for Reference.', NULL, NULL, '2021-09-15 08:38:50', '2021-09-15 08:38:50'),
(34615, 1019, 26261, NULL, '2022-02-07 00:00:00.000', 'Approved', 'Attached is the Welcome Letter for Tameka from TCHP.  Eff Date : 02/01/2022', NULL, NULL, '2022-01-31 15:24:06', '2022-01-31 15:24:06'),
(34616, 1006, 26262, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-29 13:44:29', '2021-04-29 13:44:29'),
(34617, 1019, 26262, NULL, '2021-05-19 00:00:00.000', 'Initiated', 'Sent the following email to dhpcontracting@dchstx.org Sub :Enrollment Query || Tameka Birts || MBS || Driscoll  Hello, We want to enroll our provider with Driscoll, I have attached the Proof for Medicaid Enrollment and other details mentioned below,  Provider Information:  Tameka Birts NPI: 1508211079 Medicaid TPI :  356799205  State License:  75495 Let me know if anything else is required  ', NULL, NULL, '2021-05-12 13:13:21', '2021-05-12 13:13:21'),
(34618, 1019, 26262, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Received the following email from Karla.Claunch@dchstx.org SUB: Enrollment Query || Tameka Birts || MBS || Driscoll  Good afternoon,  Thank you for your interest.  Please complete the attached documents and email them directly to me once completed.  I do need to ask', NULL, NULL, '2021-05-24 13:41:08', '2021-05-24 13:41:08'),
(34619, 1019, 26262, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Sent the following email to Karla.Claunch@dchstx.org SUB: Enrollment Query || Tameka Birts || MBS || Driscoll Good Afternoon Karla,  Attached are the filled documents as you requested, let me know if anything else is needed. Also can you please let me know the time frame for credentialing?   Thank you, ', NULL, NULL, '2021-05-24 16:18:56', '2021-05-24 16:18:56'),
(34620, 1019, 26262, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Received the following email from Karla.Claunch@dchstx.org Hi Alex,  I need one more thing from you.  Please email a current W9 directly to me.  Once received, I will soon follow with a DHP contract proposal.  Do you have any other providers?  I will be glad to process additional if you have the need.  If you need any further assistance, please let me know. Karla Claunch      ', NULL, NULL, '2021-05-28 07:31:11', '2021-05-28 07:31:11'),
(34621, 1019, 26262, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Sent the following email to Karla.Claunch@dchstx.org  Good Morning Karla, Hope you are doing well, I have attached the copy of the W9 form. Let me know if anything else is required.  Thank you,', NULL, NULL, '2021-05-28 07:33:28', '2021-05-28 07:33:28'),
(34622, 1019, 26262, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Received the following email from Karla.Claunch@dchstx.org SUB: Mind Body and Soul LLC  Good morning,  Please find the attached DHP contract proposal.  Once signed please email the signature pages directly to me.  Your prompt response is most appreciated, I look forward to hearing back from you soon. Karla Claunch  Karla Claunch, C.M.A. Driscoll Health Plan  Provider Contracting and Credentialing Intake Specialist 4525 Ayers St Corpus Christi TX 78415-1401 Phone: 361-694-6554 Fax: 361-808-2182 Email: karla.claunch@dchstx.org', NULL, NULL, '2021-06-15 13:09:02', '2021-06-15 13:09:02'),
(34623, 1019, 26262, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to Karla.Claunch@dchstx.org SUB: Mind Body and Soul LLC   Good Afternoon Karla,  Hope you are doing good, I have attached the signed Contract. Let me know if anything else is required and how much more time it will take to complete.   Regards. Alex ', NULL, NULL, '2021-06-15 13:23:15', '2021-06-15 13:23:15'),
(34624, 1019, 26262, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Eff Date 10/01/2021, attached is the welcome letter received.', NULL, NULL, '2021-11-30 17:45:41', '2021-11-30 17:45:41'),
(34625, 1006, 26263, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-29 13:44:29', '2021-04-29 13:44:29'),
(34626, 1019, 26263, NULL, '2021-05-21 00:00:00.000', 'Initiated', 'Sent the following email to networkhelp@uhc.com SUB: Enrollment Query || Tameka Birts || MBS || UBH  Hello we want to enroll the following provider with United Behavioral Health, Provider information is mentioned below, Let me know with the next steps ASAP.  Provider Information:  Tameka Birts NPI: 1508211079 Tax ID: 273243629  Thank You,', NULL, NULL, '2021-05-14 13:36:37', '2021-05-14 13:36:37'),
(34627, 1019, 26263, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Submitted the Enrollment form Thru Provider Express', NULL, NULL, '2021-05-18 13:59:58', '2021-05-18 13:59:58'),
(34628, 1019, 26263, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Submitted the Application Online through Provider Express, attached is the copy of the Application for reference.', NULL, NULL, '2021-05-24 16:40:45', '2021-05-24 16:40:45'),
(34629, 1019, 26263, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Received the following email from kim.wise@optum.com  SUB: Optum Application Received Notification- Tameka Birts  NPI: 1508211079 Re: Tameka Birts  Optum Application Received Notification  Hello, Tameka Birts. Optum is in receipt of your Network Participation Request Form and have requested a contract be sent to you at the email listed on the application. Review, sign and return your Individual Agreement via DocuSign (Adobe Sign). Be sure to review the contract, have it signed by the individual clinician (not Administrator) and return your Individual Agreement via (Adobe Sign).  Please note the information on the CAQH application and Network forms must be identical. If additional information is needed or if there are application discrepancies, you will be notified detailing the information needed to proceed with the process.  The fee schedule is non-negotiable. Once the contract has been signed, your application and contract will be sent to the credentialing team. The credentialing process can take up to 90-120 days. The credentialing process includes:  ? Primary Source Verification: Optum completes verification of provider credentials from the original sources of specific credentials  .? Quality Review by Optum: Following completion of the above steps, applications are sent to our Quality Assurance (QA) team for a comprehensive review to verify accuracy and policy compliance.  ? Committee Review by Optum: Following QA review and approval, applications are sent to our Credentialing Committee for review and decision. After you have been approved by credentialing, they will send a welcome letter to your attention along with your effective date. Please remember that you are not contracted and active until you are fully credentialed.  ? Optum Data Loading: Upon Credentialing Committee approval, the provider’s practice information and data elements needed for claims payment are loaded into our provider database, which, in turn, populates all other applicable systems and provider directories .  Note: Loading of data can take additional 5-30 business days from the approval letter date. You can easily track the status of your online submission as it moves through the application and credentialing process using the Credentialing Status Toolbar in the Secure area of providerexpress.com. This online tool lets you see at-a-glance where you are in the credentialing process.  Thank you for your interest in joining our network. We look forward to working with you.  Thank you,  Kim M. Wise Onboarding Contract Associate | Specialty Networks TX Provider Contract Recruitment Email: kim.wise@optum.com Phone: 763-340-7275  Optum l United Behavioral Health ', NULL, NULL, '2021-06-07 14:24:03', '2021-06-07 14:24:03'),
(34630, 1019, 26263, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to kim.wise@optum.com  Good Afternoon Kim,  We haven\'t received any contact to sign for the following provider. Please advise  Tameka Birts NPI: 1508211079  Regards, Alex', NULL, NULL, '2021-06-07 14:26:07', '2021-06-07 14:26:07'),
(34631, 1019, 26263, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Signed the Online Agreement thru DocuSign. Attached is the copy of the agreement for Ref.', NULL, NULL, '2021-06-15 13:30:25', '2021-06-15 13:30:25'),
(34632, 1005, 26263, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Received the following email from credentialing@claimsmedinc.com  SUB: Optum Application to Aperture for Tameka Birts  6/30/2021     Tameka Birts  Email:  mbs@claimsmedinc.com  Email:  mbs@claimsmedinc.com     Dear Tameka Birts,     Optum is in receipt of your request for network participation. Your application is now in process for credentialing.  Optum utilizes Aperture, LLC, (a credentialing verification organization) to retrieve your information and perform primary source verification of your credentials. You may receive requests from Aperture for additional information.     Once a decision has been made as to your credentialing status, you will receive a notification to include a decision letter outlining your effective date with Optum.  You can track the status of your credentialing by going to providerexpress.com > Our Network > Initial Credentialing Status, and then follow instructions for provider type.     Please note that once your CAQH application and contract documents are submitted, you have the right to:  Review information submitted to support your credentialing application; Correct erroneous information; Be informed, upon request, of the status of your credentialing or recredentialing application             If you identify any incorrect information, please contact the              Provider Services Line at 1-877-614-0484 within 10 business               days.                Thank you,               Optum Behavioral Health Credentialing Department   ', NULL, NULL, '2021-06-30 13:56:20', '2021-06-30 13:56:20'),
(34633, 1019, 26263, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Receive the following email from kim.wise@optum.com  It hasn’t been sent yet.  Will take a few days.  It is system generated.     Kim     Kim M. Wise  Onboarding Contract Associate | Specialty Networks  AL, AR, TX  Provider Contract Recruitment  Email: kim.wise@optum.com  Phone: 763-340-7275', NULL, NULL, '2021-07-20 08:26:42', '2021-07-20 08:26:42'),
(34634, 1019, 26263, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Sent the following email to kim.wise@optum.com  Hello Kim,  Still waiting for the contract, can you please look into it to avoid any credentialing delay, due to that.  Regards, Alex', NULL, NULL, '2021-07-20 08:27:58', '2021-07-20 08:27:58'),
(34635, 1019, 26263, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Received the following email from kim.wise@optum.com   It is signed and in Credentialing.  See attached.     Kim M. Wise  Onboarding Contract Associate | Specialty Networks  AL, AR, TX  Provider Contract Recruitment  Email: kim.wise@optum.com  Phone: 763-340-7275', NULL, NULL, '2021-07-20 09:32:47', '2021-07-20 09:32:47'),
(34636, 1019, 26263, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Received the following email from Optum.  7/26/2021    000690749    Tameka Birts  msbirts33@yahoo.com  mbs@claimsmedinc.com    Dear Tameka Birts:    I am pleased to inform you that our Credentialing Committee approved your participation in our network effective 7/23/2021.  You are now a contracted provider eligible to receive Member referrals from Optum and brands covered by other Payors, in accordance with your Agreement.  The information below will help you get started.    Provider Express: You and/or administrative staff should self-register to obtain your Login ID at providerexpress.com > \"First-time User\". Please allow 5 business days from the date of this notification before attempting to register. Please review your provider profile for accuracy in Provider Express and submit corrections within 10 business days. Provider Express allows access to information and services you need 24/7, including:    Authorization: for routine outpatient services, when required, is typically obtained by the Member prior to their first visit.  Please verify that the authorization is in place prior to providing services through Provider Express.     ALERT: Provide a Wellness Assessment (WA) to each member at the initial session and between the third and fifth sessions to participate in ALERT (ALgorithms for Effective Reporting and Treatment).  Achievements in Clinical Excellence (ACE): an Optum provider recognition program. ACE is a quality-focused measurement program that recognizes and rewards excellent service from our network clinicians and creates more transparency for care advocates and our Members. Using nationally-based, regionally-adjusted metrics, Optum identifies clinicians and groups who deliver both effective and efficient care for Members.    Recredentialing: Optum recredentials all providers every 36 months or as required by law.  We will send materials to the recredentialing contact you provide; please be sure to update your demographic information as needed.     We appreciate and value your participation in our clinical network.       Sincerely,', NULL, NULL, '2021-11-30 17:51:40', '2021-11-30 17:51:40'),
(34637, 1006, 26264, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-29 13:44:29', '2021-04-29 13:44:29'),
(34638, 1019, 26264, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Initiated thru Website below is the reference details for the submission. 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: ec316354-f65d-4e15-9b0f-a01824e5f205', NULL, NULL, '2021-05-28 08:03:15', '2021-05-28 08:03:15'),
(34639, 1006, 26265, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-29 13:44:29', '2021-04-29 13:44:29'),
(34640, 1019, 26265, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Duplicate task as First Care and Right care both are same enrolled thru Scott and White health plans.', NULL, NULL, '2021-06-01 14:36:09', '2021-06-01 14:36:09'),
(34641, 1006, 26266, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-29 13:44:29', '2021-04-29 13:44:29'),
(34642, 1019, 26266, NULL, '2021-05-20 00:00:00.000', 'Initiated', 'Sent the following email to  nmcfhp@cfhp.com  ----      Hello, We want to enroll our provider with Community First Health Plans, attached is the LOI along with W9 form.     Thank You', NULL, NULL, '2021-05-11 13:31:29', '2021-05-11 13:31:29'),
(34643, 1019, 26266, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from NManagement@cfhp.com  Hello,  We just spoke on the phone I was returning your call. This provider Mind body and soul should we reviewed on the Next Network Access Review committee, to see if you have been accepted into our network, I did notice you are outside of our service area so that is something that will need to be reviewed. Thank you.     Alyssa Short  Provider Operations Coordinator  Network Management', NULL, NULL, '2021-06-07 14:29:30', '2021-06-07 14:29:30'),
(34644, 1019, 26266, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to NManagement@cfhp.com  Hello Alyssa, Any update on our application, of Tameka Birts, has it been reviewed yet or not.   Regards, Alex', NULL, NULL, '2021-06-15 13:33:48', '2021-06-15 13:33:48'),
(34645, 1019, 26266, NULL, '2021-07-10 00:00:00.000', 'In Process', 'Sent the following email to NManagement@cfhp.com  Hello Alyssa, Still waiting for your response for my previous email. Please get back to ASAP.  Regards, Alex', NULL, NULL, '2021-06-30 09:32:26', '2021-06-30 09:32:26'),
(34646, 1019, 26266, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Resubmitted the Application thru there website now, as they have changed there options to receive application and are not accepting our application submitted via fax back in May.', NULL, NULL, '2021-08-31 11:40:06', '2021-08-31 11:40:06'),
(34647, 1006, 27227, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:29:34', '2021-04-30 10:29:34'),
(34648, 1006, 27227, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:31:43', '2021-04-30 13:31:43'),
(34649, 1006, 27229, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:00', '2021-04-30 10:30:00'),
(34650, 1006, 27229, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:35:56', '2021-04-30 13:35:56'),
(34651, 1006, 27230, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:00', '2021-04-30 10:30:00'),
(34652, 1006, 27230, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:35:52', '2021-04-30 13:35:52'),
(34653, 1006, 27231, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:00', '2021-04-30 10:30:00'),
(34654, 1006, 27231, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:35:49', '2021-04-30 13:35:49'),
(34655, 1006, 27232, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:00', '2021-04-30 10:30:00'),
(34656, 1006, 27232, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:35:32', '2021-04-30 13:35:32'),
(34657, 1006, 27233, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:00', '2021-04-30 10:30:00'),
(34658, 1006, 27233, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:35:27', '2021-04-30 13:35:27'),
(34659, 1006, 27234, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:00', '2021-04-30 10:30:00'),
(34660, 1006, 27234, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:35:23', '2021-04-30 13:35:23'),
(34661, 1006, 27235, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:00', '2021-04-30 10:30:00'),
(34662, 1006, 27235, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:35:20', '2021-04-30 13:35:20'),
(34663, 1006, 27236, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:00', '2021-04-30 10:30:00'),
(34664, 1006, 27236, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:35:17', '2021-04-30 13:35:17'),
(34665, 1006, 27237, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:00', '2021-04-30 10:30:00'),
(34666, 1006, 27237, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:35:13', '2021-04-30 13:35:13'),
(34667, 1006, 27238, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:01', '2021-04-30 10:30:01'),
(34668, 1006, 27238, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:35:10', '2021-04-30 13:35:10'),
(34669, 1006, 27239, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:01', '2021-04-30 10:30:01'),
(34670, 1006, 27239, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:35:07', '2021-04-30 13:35:07'),
(34671, 1006, 27240, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:01', '2021-04-30 10:30:01'),
(34672, 1006, 27240, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:35:04', '2021-04-30 13:35:04'),
(34673, 1006, 27247, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:01', '2021-04-30 10:30:01'),
(34674, 1006, 27247, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 13:34:05', '2021-04-30 13:34:05'),
(34675, 1006, 27248, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:07', '2021-04-30 10:30:07'),
(34676, 1006, 27248, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 10:47:06', '2021-04-30 10:47:06'),
(34677, 1006, 27249, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:07', '2021-04-30 10:30:07'),
(34678, 1006, 27249, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 10:47:03', '2021-04-30 10:47:03'),
(34679, 1006, 27250, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:07', '2021-04-30 10:30:07'),
(34680, 1006, 27250, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 10:46:55', '2021-04-30 10:46:55'),
(34681, 1006, 27251, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:07', '2021-04-30 10:30:07'),
(34682, 1006, 27251, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 10:46:53', '2021-04-30 10:46:53'),
(34683, 1006, 27252, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:07', '2021-04-30 10:30:07'),
(34684, 1006, 27252, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 10:46:49', '2021-04-30 10:46:49'),
(34685, 1006, 27253, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:07', '2021-04-30 10:30:07');
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
(34686, 1006, 27253, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 10:46:23', '2021-04-30 10:46:23'),
(34687, 1006, 27254, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:07', '2021-04-30 10:30:07'),
(34688, 1006, 27254, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 10:46:19', '2021-04-30 10:46:19'),
(34689, 1006, 27255, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:07', '2021-04-30 10:30:07'),
(34690, 1006, 27255, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 10:46:16', '2021-04-30 10:46:16'),
(34691, 1006, 27256, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:07', '2021-04-30 10:30:07'),
(34692, 1006, 27256, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 10:44:35', '2021-04-30 10:44:35'),
(34693, 1006, 27257, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:07', '2021-04-30 10:30:07'),
(34694, 1006, 27257, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', NULL, NULL, NULL, '2021-04-30 10:44:28', '2021-04-30 10:44:28'),
(34695, 1006, 27257, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 10:44:33', '2021-04-30 10:44:33'),
(34696, 1006, 27258, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:07', '2021-04-30 10:30:07'),
(34697, 1006, 27258, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 10:44:27', '2021-04-30 10:44:27'),
(34698, 1006, 27259, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:07', '2021-04-30 10:30:07'),
(34699, 1006, 27259, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 10:44:09', '2021-04-30 10:44:09'),
(34700, 1006, 27266, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-04-30 10:30:08', '2021-04-30 10:30:08'),
(34701, 1006, 27266, NULL, '2021-05-07 00:00:00.000', 'Not Eligible', 'The provider is no longer participating under any VMUC locations, hence they are not eligible for enrollment.  ', NULL, NULL, '2021-04-30 10:42:38', '2021-04-30 10:42:38'),
(34702, 1019, 27267, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34703, 1019, 27267, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 09:58:44', '2021-05-04 09:58:44'),
(34704, 1019, 27267, NULL, '2021-05-17 00:00:00.000', 'Initiated', '	 Sent the following email to providerapplicationstatus@bcbsma.com , Debra.Draheim@bcbsma.com SUB:Enrollment Query || Mary Gibbons || SNBCARE || BCBS MA   Hello, We need to add the following provider under our group as she is already In - Network with Blue Cross Blue Shield, provider information is mentioned below.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Information:  Mary Gibbons NPI: 1942388483 Additional Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Additional Location: 100 New State Highway, Raynham, MA, 02767.  Let me know for the next steps ASAP so we get her linked ASAP.  Thank You,', NULL, NULL, '2021-05-10 14:44:10', '2021-05-10 14:44:10'),
(34705, 1019, 27267, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to  providerapplicationstatus@bcbsma.com,  Debra.Draheim@bcbsma.com SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA  Hello Debra, Hope you\'re doing good, I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I sent a couple of emails to BCBS MA regarding enrollments, can you please look into my request and help out with enrollment status for our providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-05-20 08:55:23', '2021-05-20 08:55:23'),
(34706, 1019, 27267, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, provider-enrollment@bcbsma.com, debra.draheim@bcbsma.com  SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA 3rd Atttempt  Hello,  We need the enrollment status for the following providers under our group, also I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I have sent couple of emails to BCBS MA regarding enrollments query.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Regards, Alex ', NULL, NULL, '2021-06-03 10:49:10', '2021-06-03 10:49:10'),
(34707, 1019, 27267, NULL, '2021-07-19 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE. ', NULL, NULL, '2021-07-12 14:19:48', '2021-07-12 14:19:48'),
(34708, 1019, 27268, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34709, 1019, 27268, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 09:58:32', '2021-05-04 09:58:32'),
(34710, 1019, 27268, NULL, '2021-05-17 00:00:00.000', 'Initiated', 'LOI  faxed @ 859 455-8650, to add this provider under our group for both locations. Attached is the copy of LOI ', NULL, NULL, '2021-05-10 13:15:26', '2021-05-10 13:15:26'),
(34711, 1019, 27268, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:02:01', '2021-05-20 08:02:01'),
(34712, 1019, 27268, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon, Please see my below comments. Thank you  Mary Gibbons, 9080253 – application was not received NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman, 6715913 – credentialed for RI only, please submit an app for MA NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell, 6712207 – 01/01/2021 effective date 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.       Jonathan Schubert, 6249193 – 06/15/2021 effective date 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.        Katie Tawakol, 6120037 – 01/01/2021 effective date 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Jennifer Ullrich, 6913357 – 05/01/2021 effective date 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Justin Souliere, 6893422 – 05/017/2021 effective date 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva, 4841425 – waiting to be linked 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health', NULL, NULL, '2021-05-31 11:51:03', '2021-05-31 11:51:03'),
(34713, 1019, 27268, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-06-16 07:55:51', '2021-06-16 07:55:51'),
(34714, 1019, 27268, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no Longer working with SNBCARE.', NULL, NULL, '2021-08-23 09:00:43', '2021-08-23 09:00:43'),
(34715, 1019, 27269, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34716, 1019, 27269, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 09:58:16', '2021-05-04 09:58:16'),
(34717, 1019, 27269, NULL, '2021-05-17 00:00:00.000', 'Initiated', 'Spoken with Cigna rep at (800) 926-2273 Rep: Matt W  - Requested to Add Mary under Framingham Address over the phone, it will take up to 10 business days, so she will be added under our Group.  Reference # Matt W 05/07/2021', NULL, NULL, '2021-05-10 11:16:51', '2021-05-10 11:16:51'),
(34718, 1019, 27269, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com SUB: Enrollment Status || Group & Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Secondary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Tertiary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Tawakol, Katie NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.      Hefti, Prisca NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 09:24:18', '2021-05-20 09:24:18'),
(34719, 1019, 27269, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:31:24', '2021-06-03 15:31:24'),
(34720, 1019, 27269, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Provider added under new location effective date 03/26/2020. Attached is the group roster for ref. ', NULL, NULL, '2021-07-15 08:07:35', '2021-07-15 08:07:35'),
(34721, 1019, 27270, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34722, 1019, 27270, NULL, NULL, 'On Hold', NULL, NULL, NULL, '2021-05-04 09:57:55', '2021-05-04 09:57:55'),
(34723, 1019, 27270, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.  ', NULL, NULL, '2021-11-09 08:55:54', '2021-11-09 08:55:54'),
(34724, 1019, 27271, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34725, 1019, 27271, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 09:57:43', '2021-05-04 09:57:43'),
(34726, 1019, 27271, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Waiting to enroll with Aetna first.', NULL, NULL, '2021-05-11 11:27:02', '2021-05-11 11:27:02'),
(34727, 1019, 27271, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.  ', NULL, NULL, '2021-11-09 08:55:17', '2021-11-09 08:55:17'),
(34728, 1019, 27272, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34729, 1019, 27272, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 09:57:29', '2021-05-04 09:57:29'),
(34730, 1019, 27272, NULL, '2021-05-20 00:00:00.000', 'Initiated', 'Sent the following email to asantulli@humana.com-----Good Morning Anne, Hope you are doing well, we want to add the following provider under our group for all locations, I have mentioned the provider details below, Let me know with the next steps, Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Individual Information: Mary Gibbons NPI: 1942388483 Additional Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Additional Location: 100 New State Highway, Raynham, MA, 02767. Thank you,', NULL, NULL, '2021-05-11 10:10:00', '2021-05-11 10:10:00'),
(34731, 1019, 27272, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com  Thank you, the request to add the practitioner has been submitted. The practitioner is not currently credentialed and requires credentialing to be network to your group. If the practitioner is a behavioral health provider by licensure, please email me the license, DOB, SSN and CAQH number for credentialing. If the practitioner is not a behavioral health provider by licensure, please email me a printed copy of the CAQH with a copy of the license, DEA & Malpractice Certificate reflecting the practitioner name and coverage for credentialing.    Respectfully, Anne Santulli Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations, Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com Find us on the web at www.humanamilitary.com Customer Service (800) 444-5445', NULL, NULL, '2021-05-12 07:14:10', '2021-05-12 07:14:10'),
(34732, 1019, 27272, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Mary Gibbons || SNBCARE || Tricare  Good Morning Anne, Hope you are doing well, yes she is a Licensed Independent  Clinical Social Worker, I have her details below as you requested,  DOB: 05/08/1958 SSN: 145-56-1706 CAQH #: 11406618 State License: 1015867 Let me know if anything else is needed.  Thank You, ', NULL, NULL, '2021-05-12 07:15:10', '2021-05-12 07:15:10'),
(34733, 1019, 27272, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com Sub: Enrollment Query || Mary Gibbons || SNBCARE || Tricare  Thank you, the information has been received and credentialing requested.     Anne Santulli Senior Consumer Operations Professional', NULL, NULL, '2021-05-12 07:17:28', '2021-05-12 07:17:28'),
(34734, 1019, 27272, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:19:50', '2021-05-20 11:19:50'),
(34735, 1019, 27272, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:47:43', '2021-05-31 10:47:43'),
(34736, 1019, 27272, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:00:04', '2021-06-16 08:00:04'),
(34737, 1019, 27272, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.  ', NULL, NULL, '2021-11-09 08:56:23', '2021-11-09 08:56:23'),
(34738, 1019, 27273, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34739, 1019, 27273, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 09:57:10', '2021-05-04 09:57:10'),
(34740, 1019, 27273, NULL, '2021-05-18 00:00:00.000', 'On Hold', 'Waiting for Medicare PTAN to load in Railroad systems, its showing up will f/u in 3 days.', NULL, NULL, '2021-05-11 07:19:36', '2021-05-11 07:19:36'),
(34741, 1019, 27273, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Request for Railroad PTAN has been initiated thru there website, attached is the copy for reference.', NULL, NULL, '2021-05-24 10:36:31', '2021-05-24 10:36:31'),
(34742, 1019, 27273, NULL, '2021-06-10 00:00:00.000', 'Initiated', 'Request for Railroad PTAN has been initiated thru there website, attached is the copy for reference.', NULL, NULL, '2021-05-24 10:36:53', '2021-05-24 10:36:53'),
(34743, 1019, 27273, NULL, '2021-06-12 00:00:00.000', 'Approved', 'PTAN has been active effective from 05/01/2021. see attachment for approval Also sent test email', NULL, NULL, '2021-06-05 12:19:15', '2021-06-05 12:19:15'),
(34744, 1019, 27274, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34745, 1019, 27274, NULL, '2021-05-10 00:00:00.000', 'Initiated', 'Received the following email from:  customerservice-donotreply@cms.hhs.gov SUB: Medicare Enrollment Application Receipt Notification (Tracking ID: T050320210000431 )   To: MFERNANDEZ@SSMH.ORG,CHERBERTS2@GMAIL.COM,SNBC@CLAIMSMEDINC.COM,CREDENTIALING@CFPSYCH.ORG   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T050320210000431)   Sent: 05/03/2021 10:00 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T050320210000431        NPI: 1942388483        Medicare ID: P0598801, S400624999        Name: MARY E GIBBONS          State: MA        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.                 INDIANAPOLIS,IN,46207-7149   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.  Please retain this e-mail for your records.  This email message is an automated notification. Do not reply to this message as it is sent from an unmonitored account. If you have any questions about this application:  1.) Refer to the Web site at (https://pecos.cms.hhs.gov), or   2.) Contact your fee-for-service contractor listed above   Please note: The information provided in this application may be shared with and used by others only in accordance with the privacy notice to which you agreed at the time of the application. In addition, you agreed to keep Medicare updated with any changes to data listed on the enrollment application form within 30 days of the effective date of the change. If you are not the provider, you are required to inform the provider of the information in this e-mail.   Unauthorized interception of this communication could be a violation of Federal and State Law. This communication and any files transmitted with it are confidential and may contain protected health information. This communication is solely for the use of the person or entity to whom it was addressed. If you are not the intended recipient, any use, distribution, printing or acting in reliance on the contents for this message is strictly prohibited. If you have received this message in error, please notify the sender and destroy all copies of the message.', NULL, NULL, '2021-05-03 10:07:14', '2021-05-03 10:07:14'),
(34746, 1019, 27274, NULL, '2021-05-07 00:00:00.000', 'Approved', 'Received the email for customerservice-donotreply@cms.hhs.gov        Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T050320210000431)  Date:  05/07/2021 14:20 PM  This message is in response to your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T050320210000431. The application listed below has reached a final status.  IMPORTANT NOTE: Please wait until you receive official notification from your Fee-for-Service Contractor before submitting claims. Claims submitted before official notification from your Fee-for-Service Contractor may be rejected.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T050320210000431   NPI ID: 1942388483   Medicare ID: P0598801, S400624999, S400746608   Name: MARY GIBBONS  State: MA   Form Type: 855I  Date: 05/07/2021  Status: APPROVED  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  You will receive a notification letter from the Fee-For-Service Contractor listed above.  This letter will provide you with valuable information regarding your enrollment information.  Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.     P.O. BOX 7149, INDIANAPOLIS, IN 46207-7149', NULL, NULL, '2021-05-07 13:59:01', '2021-05-07 13:59:01'),
(34747, 1019, 27275, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34748, 1019, 27275, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 09:56:15', '2021-05-04 09:56:15'),
(34749, 1019, 27275, NULL, '2021-05-17 00:00:00.000', 'Initiated', 'Sent the following email to provider.relations@beaconhealthoptions.com Hello Shashi,  We want to add the following under our group, I have attached the CAQH form for the provider. Let me know if you need anything else.  See attachment for reference', NULL, NULL, '2021-05-10 14:14:15', '2021-05-10 14:14:15'),
(34750, 1019, 27275, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com-------- Good morning Alex, The clinician form for Mary Gibbons has been received and submitted. Thank you, Shashi Seth Network Management Rep I, Northeast', NULL, NULL, '2021-05-11 10:03:27', '2021-05-11 10:03:27'),
(34751, 1019, 27275, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:26:27', '2021-05-20 08:26:27'),
(34752, 1019, 27275, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:15:24', '2021-06-05 11:15:24'),
(34753, 1019, 27275, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into it.    Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 07:58:51', '2021-06-24 07:58:51'),
(34754, 1019, 27275, NULL, '2021-08-31 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.', NULL, NULL, '2021-08-24 11:15:42', '2021-08-24 11:15:42'),
(34755, 1019, 27276, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34756, 1019, 27276, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 09:56:03', '2021-05-04 09:56:03'),
(34757, 1019, 27276, NULL, '2021-05-20 00:00:00.000', 'Initiated', 'Application Submitted online thru Provider Express', NULL, NULL, '2021-05-11 08:12:10', '2021-05-11 08:12:10'),
(34758, 1019, 27276, NULL, '2021-06-21 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.', NULL, NULL, '2021-06-14 07:26:50', '2021-06-14 07:26:50'),
(34759, 1019, 27277, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34760, 1019, 27277, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 09:55:49', '2021-05-04 09:55:49'),
(34761, 1019, 27277, NULL, '2021-05-18 00:00:00.000', 'Initiated', 'Sent the Enrollment application via email attached is the copy of the application form', NULL, NULL, '2021-05-11 11:19:08', '2021-05-11 11:19:08');
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
(34762, 1019, 27277, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 12:57:54', '2021-06-05 12:57:54'),
(34763, 1019, 27277, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:25:29', '2021-06-23 09:25:29'),
(34764, 1019, 27277, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 06/01/2021 Attached are the Location Addition and Provider Roster of Tufts ', NULL, NULL, '2021-07-07 09:26:41', '2021-07-07 09:26:41'),
(34765, 1019, 27278, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34766, 1019, 27278, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:59:19', '2021-05-04 08:59:19'),
(34767, 1019, 27278, NULL, '2021-08-17 00:00:00.000', 'Not Eligible', 'Provider will no longer be working SNBCARE', NULL, NULL, '2021-08-10 22:52:32', '2021-08-10 22:52:32'),
(34768, 1019, 27279, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34769, 1019, 27279, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:58:58', '2021-05-04 08:58:58'),
(34770, 1019, 27279, NULL, '2021-05-17 00:00:00.000', 'Initiated', 'Request Initiated thru Online Portal, see attachments for ref ', NULL, NULL, '2021-05-10 11:31:31', '2021-05-10 11:31:31'),
(34771, 1019, 27279, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Received the following email from ARViviano@magellanhealth.com SUB: SECURED1/057080-000 601382-159 SPECTRUM NEURO BHVRL  Thank you for your interest in the Magellan Health Services (Magellan)* provider network. We received a request via the web access to add the following providers to your group  In order for us to begin the credentialing process, we will need to have permission to access their CAQH applications. Please have the providers verify that their information loaded to the CAQH is current and includes your group and gives Magellan permission to access. Please let me know if you have any questions.  168233-000         MARY E GIBBONS', NULL, NULL, '2021-05-10 11:46:18', '2021-05-10 11:46:18'),
(34772, 1019, 27279, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Sent the following email to ARViviano@magellanhealth.com SUB: SECURED1/057080-000 601382-159 SPECTRUM NEURO BHVRL   Hello Angela, I have seen and it shows that you can authorize her information through CAQH, you can access it again and if you are still unable to access, let me know.    Thank You,', NULL, NULL, '2021-05-10 11:46:34', '2021-05-10 11:46:34'),
(34773, 1019, 27279, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to JWright@magellanhealth.com SUB: Enrollment Query || Providers || SNBCARE || Magellan  Hello Judith, Hope you\'re doing good, we need the Credentialing Status for the following providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-05-20 10:12:14', '2021-05-20 10:12:14'),
(34774, 1019, 27279, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from  JWright@magellanhealth.com Good Morning,  Kerry Smith: The provider is about 1-2 weeks from completion. NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson: Credentialing in process NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman: Has been linked to your group effective date 10/26/2020. Previously informed on 11/9/2020 NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile: Has been linked to your group effective date 12/9/2020. Previously informed on 12/21/2020. NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons: Credentialing in process. NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan: Has been linked to your group effective date 4/3/2020. NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-05-27 10:35:34', '2021-05-27 10:35:34'),
(34775, 1019, 27279, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Provider is enrolled with Magellan Eff date 06/28/2021. See attachment for approval confirmation', NULL, NULL, '2021-07-13 13:43:42', '2021-07-13 13:43:42'),
(34776, 1019, 27280, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34777, 1019, 27280, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:58:46', '2021-05-04 08:58:46'),
(34778, 1019, 27280, NULL, '2021-05-18 00:00:00.000', 'Initiated', 'Sent the Enrollment application via email attached is the copy of the application form', NULL, NULL, '2021-05-11 11:19:56', '2021-05-11 11:19:56'),
(34779, 1019, 27280, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com SUB: PRO0136706 - Request Received  Hello , We are in receipt of your request regarding Enrollment Application || Mary Gibbons || SNBCARE || Tufts Health Plan that was submitted on 2021-05-11 12:17:33 EDT.  Please reference ticket number PRO0136706 for further communications about this request.  Thank you,  Tufts Health Public Plans, Provider Information Management Team    Ref:MSG6929073 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907). thpwatsmr2.tufts-health.com made the following annotations', NULL, NULL, '2021-05-17 08:23:48', '2021-05-17 08:23:48'),
(34780, 1019, 27280, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:55:23', '2021-06-07 07:55:23'),
(34781, 1019, 27280, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:27:07', '2021-06-23 09:27:07'),
(34782, 1019, 27280, NULL, '2021-08-18 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 05/11/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:21:49', '2021-08-10 23:21:49'),
(34783, 1019, 27281, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:44', '2021-05-03 09:55:44'),
(34784, 1019, 27281, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:58:30', '2021-05-04 08:58:30'),
(34785, 1019, 27281, NULL, '2021-05-18 00:00:00.000', 'Initiated', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org-----------Hello, We want to enroll the following provider with CCA under our group, please let me know the process for that as she is already In Network with CCA. Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Individual Information: Mary Gibbons NPI: 1942388483 Additional Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Additional Location: 100 New State Highway, Raynham, MA, 02767. Thank You,', NULL, NULL, '2021-05-11 07:13:45', '2021-05-11 07:13:45'),
(34786, 1019, 27281, NULL, '2021-05-20 00:00:00.000', 'In Process', 'Sent the following email to PNMDepartment@commonwealthcare.org, Credentialing@commonwealthcare.org------ Hello, I have attached the HCAS form for Mary Gibbons to add her under our Group. Let us know if you need anything else. Thank you,', NULL, NULL, '2021-05-11 09:50:22', '2021-05-11 09:50:22'),
(34787, 1019, 27281, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:09:03', '2021-06-03 16:09:03'),
(34788, 1019, 27281, NULL, '2021-06-28 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Hello,  Provider Mary Gibbons, LICSW effective 05/11/2021 at Spectrum Neuro Behavioral Care LLC  Thank you', NULL, NULL, '2021-06-21 08:58:02', '2021-06-21 08:58:02'),
(34789, 1019, 27282, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:45', '2021-05-03 09:55:45'),
(34790, 1019, 27282, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:58:19', '2021-05-04 08:58:19'),
(34791, 1019, 27282, NULL, '2021-05-18 00:00:00.000', 'On Hold', ' Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.', NULL, NULL, '2021-05-11 11:22:21', '2021-05-11 11:22:21'),
(34792, 1019, 27282, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.  ', NULL, NULL, '2021-11-09 08:56:13', '2021-11-09 08:56:13'),
(34793, 1019, 27283, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:55:45', '2021-05-03 09:55:45'),
(34794, 1019, 27283, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:58:05', '2021-05-04 08:58:05'),
(34795, 1019, 27283, NULL, '2021-05-18 00:00:00.000', 'On Hold', 'Provider cannot enroll, because New Health England doesn\'t enroll provider from Framingham.', NULL, NULL, '2021-05-11 11:23:45', '2021-05-11 11:23:45'),
(34796, 1019, 27283, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.  ', NULL, NULL, '2021-11-09 08:55:36', '2021-11-09 08:55:36'),
(34797, 1019, 27284, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34798, 1019, 27284, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:57:54', '2021-05-04 08:57:54'),
(34799, 1019, 27284, NULL, '2021-05-17 00:00:00.000', 'Initiated', 'Sent the following email to providerapplicationstatus@bcbsma.com , Debra.Draheim@bcbsma.com SUB:Enrollment Query || Mary Gibbons || SNBCARE || BCBS MA   Hello, We need to add the following provider under our group as she is already In - Network with Blue Cross Blue Shield, provider information is mentioned below.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Information:  Mary Gibbons NPI: 1942388483 Additional Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Additional Location: 100 New State Highway, Raynham, MA, 02767.  Let me know for the next steps ASAP so we get her linked ASAP.  Thank You,', NULL, NULL, '2021-05-10 14:43:13', '2021-05-10 14:43:13'),
(34800, 1019, 27284, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to  providerapplicationstatus@bcbsma.com,  Debra.Draheim@bcbsma.com SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA  Hello Debra, Hope you\'re doing good, I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I sent a couple of emails to BCBS MA regarding enrollments, can you please look into my request and help out with enrollment status for our providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-05-20 08:55:34', '2021-05-20 08:55:34'),
(34801, 1019, 27284, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to providerapplicationstatus@bcbsma.com, provider-enrollment@bcbsma.com, debra.draheim@bcbsma.com  SUB: Enrollment Query || Group & Provider || SNBCARE || BCBS MA 3rd Atttempt  Hello,  We need the enrollment status for the following providers under our group, also I want to bring this in your knowledge that I\'m not receiving timely responses on my queries as I have sent couple of emails to BCBS MA regarding enrollments query.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Individual Providers:  Edmundson, Rodesia NPI: 1124622667 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hefti, Prisca NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Tawakol, Katie NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Regards, Alex ', NULL, NULL, '2021-06-03 10:48:54', '2021-06-03 10:48:54'),
(34802, 1019, 27284, NULL, '2021-07-19 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE. ', NULL, NULL, '2021-07-12 14:19:38', '2021-07-12 14:19:38'),
(34803, 1019, 27285, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34804, 1019, 27285, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:57:43', '2021-05-04 08:57:43'),
(34805, 1019, 27285, NULL, '2021-05-24 00:00:00.000', 'Initiated', 'LOI  faxed @ 859 455-8650, to add this provider under our group for both locations. Attached is the copy of LOI', NULL, NULL, '2021-05-10 13:14:33', '2021-05-10 13:14:33'),
(34806, 1019, 27285, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:02:15', '2021-05-20 08:02:15'),
(34807, 1019, 27285, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon, Please see my below comments. Thank you  Mary Gibbons, 9080253 – application was not received NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman, 6715913 – credentialed for RI only, please submit an app for MA NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell, 6712207 – 01/01/2021 effective date 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.       Jonathan Schubert, 6249193 – 06/15/2021 effective date 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.        Katie Tawakol, 6120037 – 01/01/2021 effective date 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Jennifer Ullrich, 6913357 – 05/01/2021 effective date 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Justin Souliere, 6893422 – 05/017/2021 effective date 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva, 4841425 – waiting to be linked 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health', NULL, NULL, '2021-05-31 11:51:24', '2021-05-31 11:51:24'),
(34808, 1019, 27285, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-06-16 07:55:15', '2021-06-16 07:55:15'),
(34809, 1019, 27285, NULL, '2021-08-30 00:00:00.000', 'Not Eligible', 'Provider no Longer working with SNBCARE.', NULL, NULL, '2021-08-23 09:00:32', '2021-08-23 09:00:32'),
(34810, 1019, 27286, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34811, 1019, 27286, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:57:29', '2021-05-04 08:57:29'),
(34812, 1019, 27286, NULL, '2021-05-17 00:00:00.000', 'Initiated', 'Spoken with Cigna rep at (800) 926-2273 Rep: Matt W  - Requested to Add Mary under Framingham Address over the phone, it will take up to 10 business days, so she will be added under our Group.  Reference # Matt W 05/07/2021', NULL, NULL, '2021-05-10 11:16:26', '2021-05-10 11:16:26'),
(34813, 1019, 27286, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to BehavioralContracting@cigna.com SUB: Enrollment Status || Group & Providers || SNBCARE || CIGNA  Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Secondary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Tertiary Location: 100 New State Highway, Raynham, MA, 02767.    Hignite, Barbara NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.    Loveland, Lynnetta NPI: 1598163602 Location: 100 New State Highway, Raynham, MA, 02767.   Tawakol, Katie NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.    Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.    Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.      Hefti, Prisca NPI: 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 09:24:28', '2021-05-20 09:24:28'),
(34814, 1019, 27286, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to panplais.lor@cigna.com ​ SUB: Group Roster || Group & Providers || SNBCARE || CIGNA   Hello Pa,  Can you please send me our group provider roster ASAP. I have mentioned the group information below.  Group Information:  Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-03 15:31:14', '2021-06-03 15:31:14'),
(34815, 1019, 27286, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Provider added under new location effective date 03/26/2020. Attached is the group roster for ref. ', NULL, NULL, '2021-07-15 08:08:34', '2021-07-15 08:08:34'),
(34816, 1019, 27287, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34817, 1019, 27287, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:57:03', '2021-05-04 08:57:03'),
(34818, 1019, 27287, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.  ', NULL, NULL, '2021-11-09 08:55:44', '2021-11-09 08:55:44'),
(34819, 1019, 27288, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34820, 1019, 27288, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:56:46', '2021-05-04 08:56:46'),
(34821, 1019, 27288, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Waiting to enroll with Aetna first.', NULL, NULL, '2021-05-11 11:26:39', '2021-05-11 11:26:39'),
(34822, 1019, 27288, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.  ', NULL, NULL, '2021-11-09 08:55:07', '2021-11-09 08:55:07'),
(34823, 1019, 27289, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34824, 1019, 27289, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:56:30', '2021-05-04 08:56:30'),
(34825, 1019, 27289, NULL, '2021-05-18 00:00:00.000', 'Initiated', 'Sent the following email to asantulli@humana.com-----Good Morning Anne, Hope you are doing well, we want to add the following provider under our group for all locations, I have mentioned the provider details below, Let me know with the next steps,  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Information:  Mary Gibbons NPI: 1942388483 Additional Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Additional Location: 100 New State Highway, Raynham, MA, 02767.  Thank you,', NULL, NULL, '2021-05-11 10:09:24', '2021-05-11 10:09:24'),
(34826, 1019, 27289, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com  Thank you, the request to add the practitioner has been submitted. The practitioner is not currently credentialed and requires credentialing to be network to your group. If the practitioner is a behavioral health provider by licensure, please email me the license, DOB, SSN and CAQH number for credentialing. If the practitioner is not a behavioral health provider by licensure, please email me a printed copy of the CAQH with a copy of the license, DEA & Malpractice Certificate reflecting the practitioner name and coverage for credentialing.    Respectfully, Anne Santulli Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations, Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com Find us on the web at www.humanamilitary.com Customer Service (800) 444-5445', NULL, NULL, '2021-05-12 07:18:26', '2021-05-12 07:18:26'),
(34827, 1019, 27289, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Mary Gibbons || SNBCARE || Tricare  Good Morning Anne, Hope you are doing well, yes she is a Licensed Independent  Clinical Social Worker, I have her details below as you requested,  DOB: 05/08/1958 SSN: 145-56-1706 CAQH #: 11406618 State License: 1015867 Let me know if anything else is needed.  Thank You, ', NULL, NULL, '2021-05-12 07:18:37', '2021-05-12 07:18:37'),
(34828, 1019, 27289, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com Sub: Enrollment Query || Mary Gibbons || SNBCARE || Tricare  Thank you, the information has been received and credentialing requested.     Anne Santulli Senior Consumer Operations Professional', NULL, NULL, '2021-05-12 07:18:57', '2021-05-12 07:18:57'),
(34829, 1019, 27289, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:20:04', '2021-05-20 11:20:04');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(34830, 1019, 27289, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:47:56', '2021-05-31 10:47:56'),
(34831, 1019, 27289, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 07:59:57', '2021-06-16 07:59:57'),
(34832, 1019, 27289, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.  ', NULL, NULL, '2021-11-09 08:54:57', '2021-11-09 08:54:57'),
(34833, 1019, 27290, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34834, 1019, 27290, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:56:13', '2021-05-04 08:56:13'),
(34835, 1019, 27290, NULL, '2021-05-20 00:00:00.000', 'On Hold', 'Waiting for Medicare PTAN to load in Railroad systems, its showing up will f/u in 3 days.', NULL, NULL, '2021-05-11 07:18:49', '2021-05-11 07:18:49'),
(34836, 1019, 27290, NULL, '2021-06-10 00:00:00.000', 'Initiated', 'Request for Railroad PTAN has been initiated thru there website, attached is the copy for reference.', NULL, NULL, '2021-05-24 10:37:25', '2021-05-24 10:37:25'),
(34837, 1019, 27290, NULL, '2021-06-12 00:00:00.000', 'Approved', 'PTAN has been active effective from 05/01/2021. see attachment for approval Also sent test email', NULL, NULL, '2021-06-05 12:18:38', '2021-06-05 12:18:38'),
(34838, 1019, 27291, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34839, 1019, 27291, NULL, '2021-05-10 00:00:00.000', 'Initiated', 'Received the following email from:  customerservice-donotreply@cms.hhs.gov SUB: Medicare Enrollment Application Receipt Notification (Tracking ID: T050320210000431 )   To: MFERNANDEZ@SSMH.ORG,CHERBERTS2@GMAIL.COM,SNBC@CLAIMSMEDINC.COM,CREDENTIALING@CFPSYCH.ORG   Subject: Medicare Enrollment Application Receipt Notification (Tracking ID: T050320210000431)   Sent: 05/03/2021 10:00 AM   This message is to confirm receipt of your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. The information provided below is for your future reference:    ----------------------------------------------------------------------------------------------------------------------       Application Tracking ID: T050320210000431        NPI: 1942388483        Medicare ID: P0598801, S400624999        Name: MARY E GIBBONS          State: MA        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.                 INDIANAPOLIS,IN,46207-7149   ---------------------------------------------------------------------------------------------------------------------- IMPORTANT NOTE: Your application will not be processed for enrollment until all certification statements and other documents requiring a signature are signed and received by e-signature or upload. Please complete one (1) of the following (please do not do both):      * E-sign certification statements, and upload other documents requiring a signature, OR      * Upload certification statements, and upload other documents requiring a signature. To view and print a complete listing of documents that must be submitted, please log on to (https://pecos.cms.hhs.gov) and follow these instructions:      1) Navigate to the My Enrollments Page by clicking the My Enrollments button on the Home Page.     2) From the My Enrollments Page, click the View Enrollments button.     3) Select the desired submitted or in progress application.     4) Select the View Printable Supporting Documentation radio button and then click the Next Page button.     5) The printing instructions indicate which documents you will need to print, sign, and upload.          Click the View and Print link next to the document you would like to print.  Please retain this e-mail for your records.  This email message is an automated notification. Do not reply to this message as it is sent from an unmonitored account. If you have any questions about this application:  1.) Refer to the Web site at (https://pecos.cms.hhs.gov), or   2.) Contact your fee-for-service contractor listed above   Please note: The information provided in this application may be shared with and used by others only in accordance with the privacy notice to which you agreed at the time of the application. In addition, you agreed to keep Medicare updated with any changes to data listed on the enrollment application form within 30 days of the effective date of the change. If you are not the provider, you are required to inform the provider of the information in this e-mail.   Unauthorized interception of this communication could be a violation of Federal and State Law. This communication and any files transmitted with it are confidential and may contain protected health information. This communication is solely for the use of the person or entity to whom it was addressed. If you are not the intended recipient, any use, distribution, printing or acting in reliance on the contents for this message is strictly prohibited. If you have received this message in error, please notify the sender and destroy all copies of the message.', NULL, NULL, '2021-05-03 10:06:47', '2021-05-03 10:06:47'),
(34840, 1019, 27291, NULL, '2021-05-27 00:00:00.000', 'Approved', 'Received the email for customerservice-donotreply@cms.hhs.gov        Subject:  Medicare Enrollment Application Status Change Notification (Tracking ID: T050320210000431)  Date:  05/07/2021 14:20 PM  This message is in response to your Medicare enrollment application that was submitted from (https://pecos.cms.hhs.gov). You are listed as the contact person for this application. Your application is assigned the Tracking Identifier of T050320210000431. The application listed below has reached a final status.  IMPORTANT NOTE: Please wait until you receive official notification from your Fee-for-Service Contractor before submitting claims. Claims submitted before official notification from your Fee-for-Service Contractor may be rejected.  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  Application Tracking ID: T050320210000431   NPI ID: 1942388483   Medicare ID: P0598801, S400624999, S400746608   Name: MARY GIBBONS  State: MA   Form Type: 855I  Date: 05/07/2021  Status: APPROVED  ----------------------------------------------------------------------------------------------------------------------------------------------------------------------  You will receive a notification letter from the Fee-For-Service Contractor listed above.  This letter will provide you with valuable information regarding your enrollment information.  Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.     P.O. BOX 7149, INDIANAPOLIS, IN 46207-7149', NULL, NULL, '2021-05-20 09:37:16', '2021-05-20 09:37:16'),
(34841, 1019, 27292, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34842, 1019, 27292, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:55:49', '2021-05-04 08:55:49'),
(34843, 1019, 27292, NULL, '2021-05-17 00:00:00.000', 'Initiated', 'Sent the following email to provider.relations@beaconhealthoptions.com Hello Shashi,  We want to add the following under our group, I have attached the CAQH form for the provider. Let me know if you need anything else.  See attachment for reference', NULL, NULL, '2021-05-10 14:12:23', '2021-05-10 14:12:23'),
(34844, 1019, 27292, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com-------- Good morning Alex,     The clinician form for Mary Gibbons has been received and submitted.     Thank you,  Shashi Seth  Network Management Rep I, Northeast', NULL, NULL, '2021-05-11 10:01:24', '2021-05-11 10:01:24'),
(34845, 1019, 27292, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:26:50', '2021-05-20 08:26:50'),
(34846, 1019, 27292, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com  SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi 2nd Attempt  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-06-05 11:15:04', '2021-06-05 11:15:04'),
(34847, 1019, 27292, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Received the following email from provider.relations@beaconhealthoptions.com  Good afternoon Alex,  I am looking into it.    Thank you! Shashi Seth Network Management Rep I, Northeast Provider Relations', NULL, NULL, '2021-06-24 07:57:43', '2021-06-24 07:57:43'),
(34848, 1019, 27292, NULL, '2021-08-31 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.', NULL, NULL, '2021-08-24 11:15:31', '2021-08-24 11:15:31'),
(34849, 1019, 27293, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34850, 1019, 27293, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:55:23', '2021-05-04 08:55:23'),
(34851, 1019, 27293, NULL, '2021-05-18 00:00:00.000', 'New/Not Initiated', 'Application Submitted online thru Provider Express', NULL, NULL, '2021-05-11 08:10:51', '2021-05-11 08:10:51'),
(34852, 1019, 27293, NULL, '2021-05-18 00:00:00.000', 'Initiated', 'Application Submitted online thru Provider Express', NULL, NULL, '2021-05-11 08:11:18', '2021-05-11 08:11:18'),
(34853, 1019, 27293, NULL, '2021-06-21 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.', NULL, NULL, '2021-06-14 07:26:38', '2021-06-14 07:26:38'),
(34854, 1019, 27294, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34855, 1019, 27294, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:55:03', '2021-05-04 08:55:03'),
(34856, 1019, 27294, NULL, '2021-05-18 00:00:00.000', 'Initiated', 'Sent the Enrollment application via email attached is the copy of the application form.', NULL, NULL, '2021-05-11 11:18:44', '2021-05-11 11:18:44'),
(34857, 1019, 27294, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans  Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  ', NULL, NULL, '2021-06-05 12:57:46', '2021-06-05 12:57:46'),
(34858, 1019, 27294, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:34:06', '2021-06-23 09:34:06'),
(34859, 1019, 27294, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 06/01/2021 Attached are the Location Addition and Provider Roster of Tufts ', NULL, NULL, '2021-07-07 09:24:44', '2021-07-07 09:24:44'),
(34860, 1019, 27295, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34861, 1019, 27295, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:54:49', '2021-05-04 08:54:49'),
(34862, 1019, 27295, NULL, '2021-08-17 00:00:00.000', 'Not Eligible', 'Provider will no longer be working SNBCARE', NULL, NULL, '2021-08-10 22:52:18', '2021-08-10 22:52:18'),
(34863, 1019, 27296, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34864, 1019, 27296, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:54:29', '2021-05-04 08:54:29'),
(34865, 1019, 27296, NULL, '2021-05-17 00:00:00.000', 'Initiated', 'Request Initiated thru Online Portal, see attachments for ref', NULL, NULL, '2021-05-10 11:30:25', '2021-05-10 11:30:25'),
(34866, 1019, 27296, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Received the following email from ARViviano@magellanhealth.com SUB: SECURED1/057080-000 601382-159 SPECTRUM NEURO BHVRL  Thank you for your interest in the Magellan Health Services (Magellan)* provider network. We received a request via the web access to add the following providers to your group  In order for us to begin the credentialing process, we will need to have permission to access their CAQH applications. Please have the providers verify that their information loaded to the CAQH is current and includes your group and gives Magellan permission to access. Please let me know if you have any questions.  168233-000         MARY E GIBBONS', NULL, NULL, '2021-05-10 11:41:52', '2021-05-10 11:41:52'),
(34867, 1019, 27296, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Sent the following email to ARViviano@magellanhealth.com SUB: SECURED1/057080-000 601382-159 SPECTRUM NEURO BHVRL   Hello Angela, I have seen and it shows that you can authorize her information through CAQH, you can access it again and if you are still unable to access, let me know.    Thank You, ', NULL, NULL, '2021-05-10 11:45:49', '2021-05-10 11:45:49'),
(34868, 1019, 27296, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to JWright@magellanhealth.com SUB: Enrollment Query || Providers || SNBCARE || Magellan  Hello Judith, Hope you\'re doing good, we need the Credentialing Status for the following providers.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards,', NULL, NULL, '2021-05-20 10:12:30', '2021-05-20 10:12:30'),
(34869, 1019, 27296, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from  JWright@magellanhealth.com Good Morning,  Kerry Smith: The provider is about 1-2 weeks from completion. NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson: Credentialing in process NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jessica Hartman: Has been linked to your group effective date 10/26/2020. Previously informed on 11/9/2020 NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile: Has been linked to your group effective date 12/9/2020. Previously informed on 12/21/2020. NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons: Credentialing in process. NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan: Has been linked to your group effective date 4/3/2020. NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-05-27 10:35:54', '2021-05-27 10:35:54'),
(34870, 1019, 27296, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Provider is enrolled with Magellan Eff date 06/28/2021. See attachment for approval confirmation', NULL, NULL, '2021-07-13 13:44:08', '2021-07-13 13:44:08'),
(34871, 1019, 27297, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34872, 1019, 27297, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:54:15', '2021-05-04 08:54:15'),
(34873, 1019, 27297, NULL, '2021-05-18 00:00:00.000', 'Initiated', 'Sent the Enrollment application via email attached is the copy of the application form', NULL, NULL, '2021-05-11 11:19:39', '2021-05-11 11:19:39'),
(34874, 1019, 27297, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Received the following email from Provider_Data_Request@tufts-health.com SUB: PRO0136706 - Request Received  Hello , We are in receipt of your request regarding Enrollment Application || Mary Gibbons || SNBCARE || Tufts Health Plan that was submitted on 2021-05-11 12:17:33 EDT.  Please reference ticket number PRO0136706 for further communications about this request.  Thank you,  Tufts Health Public Plans, Provider Information Management Team    Ref:MSG6929073 REMINDER: Please limit PHI to the minimum necessary to process your request. For Tufts Health Plan Compliance policy on documentation guidelines, refer to the Corporate Confidentiality Policy Regarding Protected Health Information (DMS# 1020907). thpwatsmr2.tufts-health.com made the following annotations', NULL, NULL, '2021-05-17 08:23:09', '2021-05-17 08:23:09'),
(34875, 1019, 27297, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to provider_data_request@tufts-health.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tufts Health Plans   Hello, We need the enrollment status for the following providers under our group, as their applications have been in process for a while now.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert NPI: 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Regards,', NULL, NULL, '2021-06-07 07:55:15', '2021-06-07 07:55:15'),
(34876, 1019, 27297, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent the following email to Kody_Dunnett@tufts-health.com  Hello Kody,  We need to expedite the applications for the following providers of Credentialing and Contracting as it is In process since a while now as it is adversely affecting our business, also we are not getting proper responses on our emails.  Spectrum Neuro Behavioral Care LLC. 1356906572 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rodesia Edmundson  1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Mary Gibbons  NPI: 1942388483  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Lynnetta Loveland  NPI: 1598163602  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jonathan Schubert  NPI: 1235755505  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jennifer Ullrich NPI: 1710489760  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Peggy Pionke NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Mahreen Rashid NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.   Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Fauzia Wali Khan NPI: 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767  Regards, Alex G', NULL, NULL, '2021-06-23 09:36:19', '2021-06-23 09:36:19'),
(34877, 1019, 27297, NULL, '2021-08-18 00:00:00.000', 'Approved', 'Received the following email from Brady_Roche@tufts-health.com  Hi Alex,  My department can help with effective dates, I have provided them on the spreadsheet. I have included Katherine in Allied and Christine in Credentialing as one is still in cred process and the other needs to be linked to the group.  Thanks,  Effective Date is 05/11/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:21:34', '2021-08-10 23:21:34'),
(34878, 1019, 27298, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34879, 1019, 27298, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:54:01', '2021-05-04 08:54:01'),
(34880, 1019, 27298, NULL, '2021-05-20 00:00:00.000', 'Initiated', 'Sent the following email to Credentialing@commonwealthcare.org,    PNMDepartment@commonwealthcare.org-----------Hello, We want to enroll the following provider with CCA under our group, please let me know the process for that as she is already In Network with CCA.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Information:  Mary Gibbons NPI: 1942388483 Additional Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Additional Location: 100 New State Highway, Raynham, MA, 02767.   Thank You,', NULL, NULL, '2021-05-11 07:12:52', '2021-05-11 07:12:52'),
(34881, 1019, 27298, NULL, '2021-05-18 00:00:00.000', 'In Process', 'Sent the following email to PNMDepartment@commonwealthcare.org, Credentialing@commonwealthcare.org------ Hello, I have attached the HCAS form for Mary Gibbons to add her under our Group. Let us know if you need anything else.   Thank you,', NULL, NULL, '2021-05-11 09:01:46', '2021-05-11 09:01:46'),
(34882, 1019, 27298, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to Credentialing@commonwealthcare.org, PNMDepartment@commonwealthcare.org  SUB: Enrollment Query || Group & Providers || SNBCARE || CCA Hello, We want the enrollment status for our Group and Providers under our group, also please provide us the effective dates for the providers as well.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753   Locations: Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767.  Lynetta Loveland NPI:1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1356906572 Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Location: 100 New State Highway, Raynham, MA, 02767.', NULL, NULL, '2021-06-03 16:08:53', '2021-06-03 16:08:53'),
(34883, 1019, 27298, NULL, '2021-06-28 00:00:00.000', 'Approved', 'Received the following email from PNMDepartment@commonwealthcare.org  Hello,  Provider Mary Gibbons, LICSW effective 05/11/2021 at Spectrum Neuro Behavioral Care LLC  Thank you', NULL, NULL, '2021-06-21 08:57:38', '2021-06-21 08:57:38'),
(34884, 1019, 27299, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34885, 1019, 27299, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:53:41', '2021-05-04 08:53:41'),
(34886, 1019, 27299, NULL, '2021-05-18 00:00:00.000', 'On Hold', ' Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.', NULL, NULL, '2021-05-11 11:22:02', '2021-05-11 11:22:02'),
(34887, 1019, 27299, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.  ', NULL, NULL, '2021-11-09 08:56:03', '2021-11-09 08:56:03'),
(34888, 1019, 27300, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 09:57:50', '2021-05-03 09:57:50'),
(34889, 1019, 27300, NULL, NULL, 'On Hold', 'Waiting on Missing Info from provider, so we can start credentialing.', NULL, NULL, '2021-05-04 08:53:24', '2021-05-04 08:53:24'),
(34890, 1019, 27300, NULL, '2021-05-18 00:00:00.000', 'On Hold', ' Waiting for response from Health New England as they don\'t credential in every city in MA.', NULL, NULL, '2021-05-11 11:24:41', '2021-05-11 11:24:41'),
(34891, 1019, 27300, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCARE.  ', NULL, NULL, '2021-11-09 08:55:26', '2021-11-09 08:55:26'),
(34892, 3040, 27301, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-03 10:12:52', '2021-05-03 10:12:52'),
(34893, 3040, 27301, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Erica,   Hope you are doing well. Please find the attached Ancillary Credentialing application form for our group Valley Med Urgent Care under all three 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      If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-05-03 10:34:40', '2021-05-03 10:34:40'),
(34894, 3040, 27301, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task. ', NULL, NULL, '2021-06-01 11:10:30', '2021-06-01 11:10:30'),
(34895, 3040, 27301, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:35', '2021-07-20 09:22:35'),
(34896, 3040, 27301, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   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 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:37', '2021-08-17 09:20:37');
