TO: MHHPContracting@memorialhermann.org From: Re: Memorial Hermann Health Plan Request to Participate  Hello,  Following are the additional information which is required:  List of services provided. (Walk-in Urgent Care Clinic) Do you provide Virtual Health Services?  (Yes)  Current service area and/or list of locations. (3003 Texas Parkway, Unit# B, Missouri City, TX 77489)  List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) (Cyriaque, Stephane, NPI no. 1780192633) What age-population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years. (0-18+) Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. (Through supervising physician at Kingwood Medical Center) Link to website (N/A) Current W-9  (Attached is the W9) Current quality and outcomes data. (Could you please elaborate on this?)  Any additional information you would like presented to the Network Access and Adequacy Committee. (N/A) 