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
(22143, 11056, 22005, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:00:43', '2021-10-26 12:00:43'),
(22144, 11056, 22005, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:34:53', '2021-11-11 14:34:53'),
(22145, 11056, 22005, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:00:53', '2021-12-02 16:00:53'),
(22146, 11056, 22005, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:06:39', '2021-12-16 14:06:39'),
(22147, 11056, 22005, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective dates   Petina Rogers  KINGSVILLE - 6/1/2017 CALALLEN - 6/1/2017 SPID     - 6/1/2017  Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 14:02:43', '2021-12-21 14:02:43'),
(22148, 3046, 22006, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:42:22', '2021-03-16 12:42:22'),
(22149, 1006, 22006, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:14:50', '2021-04-08 18:14:50'),
(22150, 9057, 22006, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:17:10', '2021-05-25 16:17:10'),
(22151, 1006, 22006, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:43', '2021-06-11 16:44:43'),
(22152, 1006, 22006, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:37:26', '2021-06-30 09:37:26'),
(22153, 1006, 22006, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks. ', NULL, NULL, '2021-08-09 16:42:47', '2021-08-09 16:42:47'),
(22154, 1006, 22006, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:49:58', '2021-08-24 14:49:58'),
(22155, 11056, 22006, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:09:44', '2021-09-21 16:09:44'),
(22156, 11056, 22006, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:49:50', '2021-10-01 12:49:50'),
(22157, 11056, 22006, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:52:29', '2021-10-18 15:52:29'),
(22158, 11056, 22006, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:00:49', '2021-10-26 12:00:49'),
(22159, 11056, 22006, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:34:47', '2021-11-11 14:34:47'),
(22160, 11056, 22006, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:02:00', '2021-12-02 16:02:00'),
(22161, 11056, 22006, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:06:30', '2021-12-16 14:06:30'),
(22162, 11056, 22006, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective date  Maegan Svatek Np   KINGSVILLE - 6/1/2017 Staples - 6/1/2017   Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 14:54:16', '2021-12-21 14:54:16'),
(22163, 3046, 22007, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:42:24', '2021-03-16 12:42:24'),
(22164, 1006, 22007, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:14:54', '2021-04-08 18:14:54'),
(22165, 9057, 22007, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:12:40', '2021-05-25 16:12:40'),
(22166, 9057, 22007, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:18:09', '2021-05-25 16:18:09'),
(22167, 1006, 22007, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:41', '2021-06-11 16:44:41'),
(22168, 1006, 22007, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:35:53', '2021-06-30 09:35:53'),
(22169, 1006, 22007, NULL, '2021-08-16 00:00:00.000', 'Initiated', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks. ', NULL, NULL, '2021-08-09 16:42:34', '2021-08-09 16:42:34'),
(22170, 1006, 22007, NULL, '2021-08-16 00:00:00.000', 'In Process', '', NULL, NULL, '2021-08-09 16:42:42', '2021-08-09 16:42:42'),
(22171, 1006, 22007, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:50:03', '2021-08-24 14:50:03'),
(22172, 11056, 22007, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:09:49', '2021-09-21 16:09:49'),
(22173, 11056, 22007, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:49:44', '2021-10-01 12:49:44'),
(22174, 11056, 22007, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:52:36', '2021-10-18 15:52:36'),
(22175, 11056, 22007, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:00:56', '2021-10-26 12:00:56'),
(22176, 11056, 22007, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:34:42', '2021-11-11 14:34:42'),
(22177, 11056, 22007, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:02:20', '2021-12-02 16:02:20'),
(22178, 11056, 22007, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:06:15', '2021-12-16 14:06:15'),
(22179, 11056, 22007, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective date  Rose P Trevino Pa  Kingsville - 6/1/2017 Calallen - 6/1/2017 Staples - 6/1/2017   Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 15:10:20', '2021-12-21 15:10:20'),
(22180, 3046, 22008, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:42:47', '2021-03-16 12:42:47'),
(22181, 1006, 22008, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Group is approved, proof of enrollment and location is attached. ', NULL, NULL, '2021-04-08 17:20:30', '2021-04-08 17:20:30'),
(22182, 3046, 22009, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:44:47', '2021-03-16 12:44:47'),
(22183, 3040, 22009, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Provider participating with UHC. ', NULL, NULL, '2021-04-08 09:39:58', '2021-04-08 09:39:58'),
(22184, 3046, 22021, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:09:19', '2021-03-16 13:09:19'),
(22185, 1006, 22021, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted an LOI to Aetna @ (859) 455-8650 to update location on the Aetna directory, location addition will allow for approval of all individual providers tasks as it is an urgent-care contract. ', NULL, NULL, '2021-03-25 15:33:36', '2021-03-25 15:33:36'),
(22186, 3040, 22021, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Location added in Aetna provider directory.   Please see attachment. ', NULL, NULL, '2021-04-08 14:07:58', '2021-04-08 14:07:58'),
(22187, 3046, 22022, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:09:23', '2021-03-16 13:09:23'),
(22188, 1006, 22022, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted an LOI to Aetna @ (859) 455-8650 to update location on the Aetna directory, location addition will allow for approval of all individual providers tasks as it is an urgent-care contract. ', NULL, NULL, '2021-03-25 15:33:41', '2021-03-25 15:33:41'),
(22189, 3040, 22022, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Location added in Aetna provider directory. Since we have an ancillary contract we don\'t need to enroll the provider individually.   Please see group attachment. ', NULL, NULL, '2021-04-08 14:09:11', '2021-04-08 14:09:11'),
(22190, 3046, 22023, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:09:25', '2021-03-16 13:09:25'),
(22191, 1006, 22023, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted an LOI to Aetna @ (859) 455-8650 to update location on the Aetna directory, location addition will allow for approval of all individual providers tasks as it is an urgent-care contract. ', NULL, NULL, '2021-03-25 15:33:45', '2021-03-25 15:33:45'),
(22192, 3040, 22023, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Location added in Aetna provider directory. Since we have an ancillary contract we don\'t need to enroll the provider individually.   Please see group attachment. ', NULL, NULL, '2021-04-08 14:11:08', '2021-04-08 14:11:08'),
(22193, 3046, 22024, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:09:26', '2021-03-16 13:09:26'),
(22194, 1006, 22024, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted an LOI to Aetna @ (859) 455-8650 to update location on the Aetna directory, location addition will allow for approval of all individual providers tasks as it is an urgent-care contract. ', NULL, NULL, '2021-03-25 15:33:49', '2021-03-25 15:33:49'),
(22195, 3040, 22024, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Location added in Aetna provider directory. Since we have an ancillary contract we don\'t need to enroll the provider individually.   Please see group attachment. ', NULL, NULL, '2021-04-08 14:11:20', '2021-04-08 14:11:20'),
(22196, 3046, 22025, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:09:28', '2021-03-16 13:09:28'),
(22197, 1006, 22025, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted an LOI to Aetna @ (859) 455-8650 to update location on the Aetna directory, location addition will allow for approval of all individual providers tasks as it is an urgent-care contract. ', NULL, NULL, '2021-03-25 15:33:53', '2021-03-25 15:33:53'),
(22198, 3040, 22025, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Location added in Aetna provider directory. Since we have an ancillary contract we don\'t need to enroll the provider individually.   Please see group attachment. ', NULL, NULL, '2021-04-08 14:11:26', '2021-04-08 14:11:26'),
(22199, 3046, 22026, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:09:34', '2021-03-16 13:09:34'),
(22200, 1006, 22026, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted an LOI to Aetna @ (859) 455-8650 to update location on the Aetna directory, location addition will allow for approval of all individual providers tasks as it is an urgent-care contract. ', NULL, NULL, '2021-03-25 15:33:58', '2021-03-25 15:33:58'),
(22201, 3040, 22026, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Location added in Aetna provider directory. Since we have an ancillary contract we don\'t need to enroll the provider individually.   Please see group attachment. ', NULL, NULL, '2021-04-08 14:11:35', '2021-04-08 14:11:35'),
(22202, 3046, 22027, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:09:36', '2021-03-16 13:09:36'),
(22203, 1006, 22027, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted an LOI to Aetna @ (859) 455-8650 to update location on the Aetna directory, location addition will allow for approval of all individual providers tasks as it is an urgent-care contract. ', NULL, NULL, '2021-03-25 15:34:02', '2021-03-25 15:34:02'),
(22204, 3040, 22027, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Location added in Aetna provider directory. Since we have an ancillary contract we don\'t need to enroll the provider individually.   Please see group attachment. ', NULL, NULL, '2021-04-08 14:11:39', '2021-04-08 14:11:39'),
(22205, 3046, 22028, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:09:38', '2021-03-16 13:09:38'),
(22206, 1006, 22028, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted an LOI to Aetna @ (859) 455-8650 to update location on the Aetna directory, location addition will allow for approval of all individual providers tasks as it is an urgent-care contract. ', NULL, NULL, '2021-03-25 15:34:06', '2021-03-25 15:34:06'),
(22207, 3040, 22028, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Location added in Aetna provider directory. Since we have an ancillary contract we don\'t need to enroll the provider individually.   Please see group attachment. ', NULL, NULL, '2021-04-08 14:11:44', '2021-04-08 14:11:44'),
(22208, 3046, 22029, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:09:40', '2021-03-16 13:09:40'),
(22209, 1006, 22029, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted an LOI to Aetna @ (859) 455-8650 to update location on the Aetna directory, location addition will allow for approval of all individual providers tasks as it is an urgent-care contract. ', NULL, NULL, '2021-03-25 15:34:10', '2021-03-25 15:34:10'),
(22210, 3040, 22029, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Location added in Aetna provider directory. Since we have an ancillary contract we don\'t need to enroll the provider individually.   Please see group attachment. ', NULL, NULL, '2021-04-08 14:11:48', '2021-04-08 14:11:48'),
(22211, 3046, 22030, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:09:43', '2021-03-16 13:09:43'),
(22212, 1006, 22030, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted an LOI to Aetna @ (859) 455-8650 to update location on the Aetna directory, location addition will allow for approval of all individual providers tasks as it is an urgent-care contract. ', NULL, NULL, '2021-03-25 15:34:14', '2021-03-25 15:34:14'),
(22213, 3040, 22030, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Location added in Aetna provider directory. Since we have an ancillary contract we don\'t need to enroll the provider individually.   Please see group attachment. ', NULL, NULL, '2021-04-08 14:11:53', '2021-04-08 14:11:53'),
(22214, 3046, 22031, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:12:30', '2021-03-16 13:12:30'),
(22215, 1005, 22031, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-S got ancillary contract. No need to credential individual provider. Ref Task link: http://app.emrbs.com/Credentials/Details/8032', NULL, NULL, '2021-03-25 14:10:54', '2021-03-25 14:10:54'),
(22216, 3046, 22032, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:12:36', '2021-03-16 13:12:36'),
(22217, 1005, 22032, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-S got ancillary contract. No need to credential individual provider. Ref Task link: http://app.emrbs.com/Credentials/Details/8032', NULL, NULL, '2021-03-25 14:11:06', '2021-03-25 14:11:06'),
(22218, 3046, 22033, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:12:37', '2021-03-16 13:12:37'),
(22219, 1005, 22033, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-S got ancillary contract. No need to credential individual provider. Ref Task link: http://app.emrbs.com/Credentials/Details/8032', NULL, NULL, '2021-03-25 14:11:08', '2021-03-25 14:11:08'),
(22220, 3046, 22034, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:12:39', '2021-03-16 13:12:39'),
(22221, 1005, 22034, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-S got ancillary contract. No need to credential individual provider. Ref Task link: http://app.emrbs.com/Credentials/Details/8032', NULL, NULL, '2021-03-25 14:11:11', '2021-03-25 14:11:11'),
(22222, 3046, 22035, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:12:41', '2021-03-16 13:12:41'),
(22223, 1005, 22035, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-S got ancillary contract. No need to credential individual provider. Ref Task link: http://app.emrbs.com/Credentials/Details/8032', NULL, NULL, '2021-03-25 14:11:14', '2021-03-25 14:11:14'),
(22224, 3046, 22036, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:12:43', '2021-03-16 13:12:43'),
(22225, 1005, 22036, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-S got ancillary contract. No need to credential individual provider. Ref Task link: http://app.emrbs.com/Credentials/Details/8032', NULL, NULL, '2021-03-25 14:12:40', '2021-03-25 14:12:40'),
(22226, 3046, 22037, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:12:44', '2021-03-16 13:12:44'),
(22227, 1005, 22037, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-S got ancillary contract. No need to credential individual provider. Ref Task link: http://app.emrbs.com/Credentials/Details/8032', NULL, NULL, '2021-03-25 14:12:34', '2021-03-25 14:12:34'),
(22228, 3046, 22038, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:12:46', '2021-03-16 13:12:46'),
(22229, 1005, 22038, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-S got ancillary contract. No need to credential individual provider. Ref Task link: http://app.emrbs.com/Credentials/Details/8032', NULL, NULL, '2021-03-25 14:12:41', '2021-03-25 14:12:41'),
(22230, 3046, 22039, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:12:48', '2021-03-16 13:12:48'),
(22231, 1005, 22039, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-S got ancillary contract. No need to credential individual provider. Ref Task link: http://app.emrbs.com/Credentials/Details/8032', NULL, NULL, '2021-03-25 14:12:41', '2021-03-25 14:12:41'),
(22232, 3046, 22040, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:12:51', '2021-03-16 13:12:51'),
(22233, 1005, 22040, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-S got ancillary contract. No need to credential individual provider. Ref Task link: http://app.emrbs.com/Credentials/Details/8032', NULL, NULL, '2021-03-25 14:12:41', '2021-03-25 14:12:41'),
(22234, 3046, 22041, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:23:17', '2021-03-16 13:23:17'),
(22235, 3040, 22041, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject:  Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||   Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 13:05:13', '2021-03-29 13:05:13');
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
(22236, 3040, 22041, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com, Provider_Relations_South_Texas@bcbstx.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 08:37:21', '2021-03-30 08:37:21'),
(22237, 1006, 22041, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Received following email from Valerie_Martinez@bcbstx.com  Sub: BCBSTX PROVIDER UPDATE JUAN CAPUPUS APN  Good afternoon,   The following provider is showing to be in network.   Thank you,  Valerie Martinez | Internal Network Support Rep II – Southwest Region ', NULL, NULL, '2021-04-27 07:47:20', '2021-04-27 07:47:20'),
(22238, 3046, 22042, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:23:21', '2021-03-16 13:23:21'),
(22239, 3040, 22042, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider enrolled with BCBS. ', NULL, NULL, '2021-03-29 12:28:16', '2021-03-29 12:28:16'),
(22240, 3046, 22043, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:23:22', '2021-03-16 13:23:22'),
(22241, 3040, 22043, NULL, '2021-04-05 00:00:00.000', 'Approved', 'The provider is now in network effective 12/04/2020', NULL, NULL, '2021-03-29 12:32:37', '2021-03-29 12:32:37'),
(22242, 3046, 22044, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:23:27', '2021-03-16 13:23:27'),
(22243, 3040, 22044, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider Contracted with RHC\'s. ', NULL, NULL, '2021-03-29 12:43:53', '2021-03-29 12:43:53'),
(22244, 3046, 22045, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:23:29', '2021-03-16 13:23:29'),
(22245, 3040, 22045, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider enrolled in BCBS.', NULL, NULL, '2021-03-29 12:48:52', '2021-03-29 12:48:52'),
(22246, 3046, 22046, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:23:31', '2021-03-16 13:23:31'),
(22247, 3040, 22046, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject:  Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||   Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 13:04:31', '2021-03-29 13:04:31'),
(22248, 3040, 22046, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com, Provider_Relations_South_Texas@bcbstx.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 08:40:46', '2021-03-30 08:40:46'),
(22249, 1006, 22046, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Received an email from Bel Villarreal (Bel_Villarreal@bcbstx.com  \"RE: Credentialing Status - Petina Rogers- STATCARE MINOR EMERGENCY CLINIC  Good Afternoon Ahmed,   The providers effective network date is 11/19/2019, for the following networks: Blue Choice PPO, Blue Essentials HMO/Health select, Blue Advantage HMO, Chip, and Medicare Advantage PPO. \"  The provider has been added to the location, location confirmation is attached for reference.', NULL, NULL, '2021-04-27 07:22:47', '2021-04-27 07:22:47'),
(22250, 3046, 22047, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:23:33', '2021-03-16 13:23:33'),
(22251, 3040, 22047, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider Participating with BCBS ', NULL, NULL, '2021-03-29 12:57:15', '2021-03-29 12:57:15'),
(22252, 3046, 22048, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:24:23', '2021-03-16 13:24:23'),
(22253, 3040, 22048, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group contracted with BCBS.   Please see attachment. ', NULL, NULL, '2021-03-29 10:47:50', '2021-03-29 10:47:50'),
(22254, 3046, 22049, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:26:58', '2021-03-16 13:26:58'),
(22255, 1006, 22049, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Dear PATRICK AYARZAGOITIA,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 02/05/2021. Your provider identification number is‍ ‌6223529. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com). ', NULL, NULL, '2021-03-29 11:19:33', '2021-03-29 11:19:33'),
(22256, 3046, 22050, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:26:59', '2021-03-16 13:26:59'),
(22257, 1006, 22050, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Received the following update from Cigna rep, waiing on copy of welcome letter that we should be receiving in 10~15 business days;  Juan - Provider ID# 3642374 Eff: 05/01/2020  Ref: Lynette 03/29/2021 ', NULL, NULL, '2021-03-29 10:11:23', '2021-03-29 10:11:23'),
(22258, 3046, 22051, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:27:04', '2021-03-16 13:27:04'),
(22259, 1006, 22051, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Dear MARI KATRINA CAPUPUS, PA,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Julie A. Vayer  Vice President  Total Health & Network  Julie Vayer	 Let’s get started Your effective date is 05/01/2020. Your provider identification number is‍ ‌3986834. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-03-29 11:30:12', '2021-03-29 11:30:12'),
(22260, 3046, 22052, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:27:11', '2021-03-16 13:27:11'),
(22261, 1006, 22052, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Dear MARY GONZALEZ,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 02/05/2021. Your provider identification number is‍ ‌0964158. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  ', NULL, NULL, '2021-03-29 11:36:12', '2021-03-29 11:36:12'),
(22262, 3046, 22053, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:27:13', '2021-03-16 13:27:13'),
(22263, 1006, 22053, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Dear TRACI MASON, MSN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Julie A. Vayer  Vice President  Total Health & Network  Julie Vayer	 Let’s get started Your effective date is 04/27/2020. Your provider identification number is‍ ‌4863679. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  ', NULL, NULL, '2021-03-29 11:43:47', '2021-03-29 11:43:47'),
(22264, 3046, 22054, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:27:16', '2021-03-16 13:27:16'),
(22265, 1006, 22054, NULL, '2021-04-05 00:00:00.000', 'Approved', 'As per my discussion with Cigna provider rep:   Katherine - Provider ID# 3353951 Eff: 02/18/2013  Ref: Lynette 03/29/2021 ', NULL, NULL, '2021-03-29 10:06:32', '2021-03-29 10:06:32'),
(22266, 3046, 22055, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:27:18', '2021-03-16 13:27:18'),
(22267, 1006, 22055, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Dear PETINA ROGERS, APRN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Julie A. Vayer  Vice President  Total Health & Network  Julie Vayer	 Let’s get started Your effective date is 05/01/2020. Your provider identification number is‍ ‌0355344. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  ', NULL, NULL, '2021-03-29 11:47:44', '2021-03-29 11:47:44'),
(22268, 3046, 22056, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:27:20', '2021-03-16 13:27:20'),
(22269, 1006, 22056, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Dear MAEGAN SVATEK, APRN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Julie A. Vayer  Vice President  Total Health & Network  Julie Vayer	 Let’s get started Your effective date is 05/01/2020. Your provider identification number is‍ ‌6115934. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  ', NULL, NULL, '2021-03-29 11:53:00', '2021-03-29 11:53:00'),
(22270, 3046, 22057, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:27:35', '2021-03-16 13:27:35'),
(22271, 1006, 22057, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Welcome letter attached for reference as well as Plans/Network & Location.   Provider ID# 3642734 Eff: 05/01/2020 ', NULL, NULL, '2021-03-29 11:02:44', '2021-03-29 11:02:44'),
(22272, 1006, 22058, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:27:59', '2021-03-16 13:27:59'),
(22273, 1019, 22058, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex', NULL, NULL, '2021-04-19 15:28:13', '2021-04-19 15:28:13'),
(22274, 1019, 22058, 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 13:00:25', '2021-06-05 13:00:25'),
(22275, 1019, 22058, 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 09:36:09', '2021-06-23 09:36:09'),
(22276, 1019, 22058, NULL, '2021-07-14 00:00:00.000', 'Not Eligible', 'Received the following message from Tufts: Allison_Morris@tufts-health.com Hello,  I’m writing in response to the provider application we received for LCSW. Unfortunately we cannot proceed with contracting this provider as we are only able to credential and contract LICSW providers, not LCSWs.        Thank you,  _____________________________________  Allison Morris  Associate Contract Specialist, Behavioral Health Services  Allied Health Contracting  Tufts Health Plan', NULL, NULL, '2021-07-07 12:10:08', '2021-07-07 12:10:08'),
(22277, 1006, 22059, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:28:01', '2021-03-16 13:28:01'),
(22278, 1019, 22059, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex', NULL, NULL, '2021-04-19 15:29:25', '2021-04-19 15:29:25'),
(22279, 1019, 22059, 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 13:00:17', '2021-06-05 13:00:17'),
(22280, 1019, 22059, 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 09:36:01', '2021-06-23 09:36:01'),
(22281, 1019, 22059, 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 02/10/2020 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 12:04:15', '2021-07-07 12:04:15'),
(22282, 1006, 22060, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:28:03', '2021-03-16 13:28:03'),
(22283, 1019, 22060, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'To: Tufts_Health_Plan_Credentialing_Department@tufts-health.com Cc: Spectrum Neuro Behavioral Health snbc@claimsmedinc.com Hello,  Please find the attached request to initiate the credentialing/contracting for our provider Kerry Smith. Do let me know if anything else is required. ', NULL, NULL, '2021-03-31 08:20:26', '2021-03-31 08:20:26'),
(22284, 1019, 22060, NULL, '2021-05-21 00:00:00.000', 'In Process', 'Received the following email from Tufts_Health_Plan_Credentialing_Department@tufts-health.com SUB: PPO0100584 - Re: Allied Health Provider Agreement for Kerry Smith, LICSW  incident number - PPO0100584   Hello,  The contract has been received and is being reviewed by a credentialing specialist. We will contact you if any other information is needed. Please allow at least 30 business days for us to complete credentialing. Thank you and have a wonderful day.   Ref:MSG6923033', NULL, NULL, '2021-05-14 13:10:30', '2021-05-14 13:10:30'),
(22285, 1019, 22060, 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 13:01:48', '2021-06-05 13:01:48'),
(22286, 1019, 22060, 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 09:35:53', '2021-06-23 09:35:53'),
(22287, 1019, 22060, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from AHCBehavioralHealth@tufts-health.com  Dear Provider, Welcome to Tufts Health Plan! We are pleased to have you as part of our provider network.  Please find a copy of your fully executed Allied Health Services Provider Agreement attached.  Your in-network effective date is: 06/10/2021', NULL, NULL, '2021-07-07 12:08:43', '2021-07-07 12:08:43'),
(22288, 1006, 22061, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:28:04', '2021-03-16 13:28:04'),
(22289, 1019, 22061, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex Rathore, Uzair New	 ', NULL, NULL, '2021-04-19 15:30:08', '2021-04-19 15:30:08'),
(22290, 1019, 22061, 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 13:00:11', '2021-06-05 13:00:11'),
(22291, 1019, 22061, NULL, '2021-06-30 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 09:35:44', '2021-06-23 09:35:44'),
(22292, 1019, 22061, NULL, '2021-07-14 00:00:00.000', 'Not Eligible', 'Received the following message from Tufts: Allison_Morris@tufts-health.com Hello,  I’m writing in response to the provider application we received for LCSW. Unfortunately we cannot proceed with contracting this provider as we are only able to credential and contract LICSW providers, not LCSWs.        Thank you,  _____________________________________  Allison Morris  Associate Contract Specialist, Behavioral Health Services  Allied Health Contracting  Tufts Health Plan', NULL, NULL, '2021-07-07 12:09:54', '2021-07-07 12:09:54'),
(22293, 1019, 22061, NULL, '2021-10-06 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com, - provider_data_request@tufts-health.com  Good Morning, Attached is the application for our provider as he is LICSW now, please expedite this application as we were waiting on it for several months now.', NULL, NULL, '2021-09-29 07:56:25', '2021-09-29 07:56:25'),
(22294, 1019, 22061, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Received the following email from Tufts. Hello ,  We are in receipt of your request regarding Enrollment Application || Jonathan Schubert || SNBCARE || Tufts Health/ Tufts Public Plans that was submitted on 2021-09-29 08:57:52 EDT.  Please reference ticket number PRO0150549 for further communications about this request.  Thank you,  Tufts Health Public Plans, Provider Information Management Team    Ref:MSG7645241', NULL, NULL, '2021-10-19 08:22:19', '2021-10-19 08:22:19'),
(22295, 11056, 22061, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:52:26', '2021-12-03 14:52:26'),
(22296, 19067, 22061, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   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 Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:40:59', '2021-12-15 17:40:59');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(22297, 19067, 22061, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location 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 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:05:55', '2021-12-29 10:05:55'),
(22298, 19067, 22061, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:45:05', '2022-01-10 14:45:05'),
(22299, 19067, 22061, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:39:33', '2022-02-11 11:39:33'),
(22300, 22077, 22061, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Fwd: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:09:13', '2022-04-05 10:09:13'),
(22301, 1006, 22062, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:28:07', '2021-03-16 13:28:07'),
(22302, 1019, 22062, NULL, '2021-04-26 00:00:00.000', 'New/Not Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex', NULL, NULL, '2021-04-19 15:31:10', '2021-04-19 15:31:10'),
(22303, 1019, 22062, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex', NULL, NULL, '2021-04-19 15:31:16', '2021-04-19 15:31:16'),
(22304, 1019, 22062, 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 13:00:04', '2021-06-05 13:00:04'),
(22305, 1019, 22062, 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 09:35:36', '2021-06-23 09:35:36'),
(22306, 1019, 22062, 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 01/22/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 12:02:27', '2021-07-07 12:02:27'),
(22307, 1006, 22063, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:28:08', '2021-03-16 13:28:08'),
(22308, 1019, 22063, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex', NULL, NULL, '2021-04-19 15:32:13', '2021-04-19 15:32:13'),
(22309, 1019, 22063, 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 12:59:58', '2021-06-05 12:59:58'),
(22310, 1019, 22063, 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 09:35:29', '2021-06-23 09:35:29'),
(22311, 1019, 22063, 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 12/09/2019 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 11:59:39', '2021-07-07 11:59:39'),
(22312, 1006, 22064, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:28:11', '2021-03-16 13:28:11'),
(22313, 1019, 22064, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex', NULL, NULL, '2021-04-19 15:33:06', '2021-04-19 15:33:06'),
(22314, 1019, 22064, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Received the following email from  Tufts_Health_Plan_Credentialing_Department@tufts-health.com   Hello,    Attached please find your Allied Health Provider Agreement with Tufts Associated Health Maintenance Organization, Inc., Total Health Plan, Inc.     Complete the signature page (signature, printed name, title, and date) and return to us so that we may countersign it.     If you make any changes to the contract document we will not be able to process your contract for you.      You may return the completed signature page via email to:  Tufts_Health_Plan_Credentialing_Department@tufts-health.com or fax it to 617-972-9591      Once we are in receipt of your completed contract, the credentialing process will begin.         Thank you    Tufts Health Plan    ', NULL, NULL, '2021-05-10 09:52:55', '2021-05-10 09:52:55'),
(22315, 1019, 22064, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com    Hello,  Find the attached signed document, let us know if anything else is needed.       Thank you, ', NULL, NULL, '2021-05-10 09:53:22', '2021-05-10 09:53:22'),
(22316, 1019, 22064, 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 13:01:39', '2021-06-05 13:01:39'),
(22317, 1019, 22064, 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 09:35:21', '2021-06-23 09:35:21'),
(22318, 1019, 22064, 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 05/04/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 11:57:21', '2021-07-07 11:57:21'),
(22319, 1006, 22065, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:28:13', '2021-03-16 13:28:13'),
(22320, 1019, 22065, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex', NULL, NULL, '2021-04-19 15:33:53', '2021-04-19 15:33:53'),
(22321, 1019, 22065, 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 12:59:52', '2021-06-05 12:59:52'),
(22322, 1019, 22065, 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 09:35:14', '2021-06-23 09:35:14'),
(22323, 11056, 22065, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:52:14', '2021-12-03 14:52:14'),
(22324, 19067, 22065, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   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 Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:40:12', '2021-12-15 17:40:12'),
(22325, 19067, 22065, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location 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 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:06:15', '2021-12-29 10:06:15'),
(22326, 19067, 22065, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location 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 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:09:17', '2021-12-29 10:09:17'),
(22327, 19067, 22065, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:44:58', '2022-01-10 14:44:58'),
(22328, 19067, 22065, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:39:48', '2022-02-11 11:39:48'),
(22329, 1006, 22066, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:28:14', '2021-03-16 13:28:14'),
(22330, 1019, 22066, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex', NULL, NULL, '2021-04-19 15:34:37', '2021-04-19 15:34:37'),
(22331, 1019, 22066, 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 12:59:46', '2021-06-05 12:59:46'),
(22332, 1019, 22066, 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 09:35:07', '2021-06-23 09:35:07'),
(22333, 1019, 22066, 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 05/09/2019 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 11:50:52', '2021-07-07 11:50:52'),
(22334, 1006, 22067, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:28:16', '2021-03-16 13:28:16'),
(22335, 1019, 22067, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex', NULL, NULL, '2021-04-19 15:35:19', '2021-04-19 15:35:19'),
(22336, 1019, 22067, 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 12:59:20', '2021-06-05 12:59:20');
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
(22337, 1019, 22067, 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 09:34:59', '2021-06-23 09:34:59'),
(22338, 1019, 22067, 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 01/07/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 11:48:47', '2021-07-07 11:48:47'),
(22339, 1006, 22068, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:28:18', '2021-03-16 13:28:18'),
(22340, 1019, 22068, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex', NULL, NULL, '2021-04-19 15:36:34', '2021-04-19 15:36:34'),
(22341, 1019, 22068, 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 12:59:13', '2021-06-05 12:59:13'),
(22342, 1019, 22068, 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 09:34:49', '2021-06-23 09:34:49'),
(22343, 1019, 22068, 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 04/08/2020 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-07-07 09:34:09', '2021-07-07 09:34:09'),
(22344, 1006, 22069, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:28:20', '2021-03-16 13:28:20'),
(22345, 1019, 22069, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'To: Tufts_Health_Plan_Credentialing_Department@tufts-health.com Cc: Spectrum Neuro Behavioral Health snbc@claimsmedinc.com Hello,  Please find the attached request to initiate the credentialing/contracting for our provider Rodesia Edmundson. Do let me know if anything else is required. ', NULL, NULL, '2021-04-07 16:42:59', '2021-04-07 16:42:59'),
(22346, 1019, 22069, 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 12:59:02', '2021-06-05 12:59:02'),
(22347, 1019, 22069, 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 09:34:42', '2021-06-23 09:34:42'),
(22348, 1019, 22069, NULL, '2021-07-08 00:00:00.000', 'Approved', 'Received the following email from AHCBehavioralHealth@tufts-health.com  Dear Provider, Welcome to Tufts Health Plan! We are pleased to have you as part of our provider network.  Please find a copy of your fully executed Allied Health Services Provider Agreement attached. Your in-network effective date is: 06/29/2021  Please check member eligibility, benefits, and authorization requirements prior to rendering services by contacting the Tufts Health Plan Behavioral Health Department at (800) 208-9565 or via the Secure Provider Website.  Please refer to the following links for additional resources:  - Behavioral Health Provider Resource Guide   - Registration Instructions for Secure Provider Websites - All Products - Product Overview and Member ID Card Guide - Electronic Data Interchange (EDI) Overview - Electronic Claim Submission Frequently Asked Questions - Provider Contact Information - Provider Information Change Form  We look forward to working with you! thpwatsmr1.tufts-health.com made the following annotations', NULL, NULL, '2021-07-01 13:27:54', '2021-07-01 13:27:54'),
(22349, 1006, 22070, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:28:22', '2021-03-16 13:28:22'),
(22350, 1019, 22070, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex', NULL, NULL, '2021-04-19 15:38:07', '2021-04-19 15:38:07'),
(22351, 1019, 22070, 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 12:58:47', '2021-06-05 12:58:47'),
(22352, 1019, 22070, 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 09:34:34', '2021-06-23 09:34:34'),
(22353, 11056, 22070, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:52:05', '2021-12-03 14:52:05'),
(22354, 19067, 22070, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location 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 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:06:59', '2021-12-29 10:06:59'),
(22355, 19067, 22070, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location 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 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:10:05', '2021-12-29 10:10:05'),
(22356, 19067, 22070, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location 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 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:10:20', '2021-12-29 10:10:20'),
(22357, 19067, 22070, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:44:53', '2022-01-10 14:44:53'),
(22358, 19067, 22070, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:40:05', '2022-02-11 11:40:05'),
(22359, 19067, 22070, NULL, '2022-03-04 00:00:00.000', 'In Process', 'Email sent to: Padrick_Shaughnessey@tufts-health.com  Subject: Enrollment Request || SNBCARE || TMS || Tufts Health Plans ||   To Whom It May Concern,    I am writing to formally request that the following CPT codes be amended to our existing contract.     90867 – Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Initial, Including Cortical Mapping, Motor Threshold Determination, Delivery and Management     90868 –  Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Subsequent Delivery and Management, Per Session     90869 – Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Subsequent Motor Threshold Re-Determination with Delivery and Management     Kindly advise when the addition of the codes listed above is complete and include an amended fee schedule with contracted rates for our reference.    Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Tertiary Address	63 Eddie Dowling Hwy, Suite 8, North Smithfield, RI 02896 Provider Name	NPI Fauzia Wali Khan	1699761965 Katie Tawakol	1609222116 Mahreen Rashid	1396393146 Prisca Hefti	1508133182 Peggy Pionke	1699307322 Barbara Arnold	1922432053 Lauren Powell	1285304980 Eliza Rodrigues	1821751405 Dina Filoteo-Nichols	1770021099 Allie DiCostanzo	1669045738 Helena Halterman	1801473749 Jessica Hartman	1326665472 Barbara Hignite	1982617262 Lynnetta Loveland	1598163602 Jonathan Schubert	1235755505 Kerry Smith	1275083230 Erin Oliva	1407349632      Thank you,', NULL, NULL, '2022-02-25 18:03:40', '2022-02-25 18:03:40'),
(22360, 19067, 22070, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: Padrick.Shaughnessey@point32health.org  Subject: RE: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hi Hammad & Alex     See attached TMS exhibit that need signature.  I have included the rates.  We will need both the group contract and exhibit signed before they are implemented.     We are awaiting on both.     Thanks,  Padrick', NULL, NULL, '2022-03-01 13:03:29', '2022-03-01 13:03:29'),
(22361, 19067, 22070, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: padrick.shaughnessey@point32health.org  Subject: RE: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hi Padrick,  Kindly see the attached as per you requested and don\'t hesitate to reach me if you need any document or information.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-03-01 13:19:42', '2022-03-01 13:19:42'),
(22362, 19067, 22070, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email received from: Padrick.Shaughnessey@point32health.org  Subject: RE: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hi Hammad,     Do you have signing authority for Spectrum Neuro Behavioral Care LLC?     Normal it would be a VP or higher that signs and exhibit or the contract.  Plus we need back the signed group contract that was sent to Alex.     We still do not have it.     Thanks,  Padrick', NULL, NULL, '2022-03-02 09:25:52', '2022-03-02 09:25:52'),
(22363, 19067, 22070, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: Padrick.Shaughnessey@point32health.org  Subject: Re: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hello Padrick,   Attached is the Signed TMS exhibit, also I\'m still waiting for you to sent me that group contract as I never received that, also I have sent you several email to you with no reponse on them. Please share the group contract again here,    Regards, Alex', NULL, NULL, '2022-03-02 09:26:57', '2022-03-02 09:26:57'),
(22364, 22077, 22070, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Fwd: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:04:21', '2022-04-05 10:04:21'),
(22365, 3046, 22071, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:29:28', '2021-03-16 13:29:28'),
(22366, 1006, 22071, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:58:38', '2021-04-06 14:58:38'),
(22367, 3046, 22072, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:29:30', '2021-03-16 13:29:30'),
(22368, 1006, 22072, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:58:44', '2021-04-06 14:58:44'),
(22369, 3046, 22073, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:29:31', '2021-03-16 13:29:31'),
(22370, 1006, 22073, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:58:48', '2021-04-06 14:58:48'),
(22371, 3046, 22074, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:29:33', '2021-03-16 13:29:33'),
(22372, 1006, 22074, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:58:53', '2021-04-06 14:58:53'),
(22373, 3046, 22075, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:29:35', '2021-03-16 13:29:35'),
(22374, 1006, 22075, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:58:58', '2021-04-06 14:58:58'),
(22375, 3046, 22076, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:29:38', '2021-03-16 13:29:38'),
(22376, 1006, 22076, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:59:03', '2021-04-06 14:59:03'),
(22377, 3046, 22077, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:29:44', '2021-03-16 13:29:44'),
(22378, 1006, 22077, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:59:11', '2021-04-06 14:59:11'),
(22379, 3046, 22078, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:29:46', '2021-03-16 13:29:46'),
(22380, 1006, 22078, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:59:31', '2021-04-06 14:59:31'),
(22381, 3046, 22079, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:29:49', '2021-03-16 13:29:49'),
(22382, 1006, 22079, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 14:59:49', '2021-04-06 14:59:49'),
(22383, 3046, 22080, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:38:15', '2021-03-16 13:38:15'),
(22384, 3040, 22080, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Email sent to: SWHPRegion4@bswhealth.org  Subject: Contract Information Request || Statcare Minor Emergency Clinic || Group & Providers || Scott & White ||  Greetings,   Hope you are doing well. Can you please advise me the type of contract for the below mentioned practice and I wanted to verify the locations that all of the four locations are updated under the contract.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quantetry Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  --', NULL, NULL, '2021-03-31 14:00:49', '2021-03-31 14:00:49'),
(22385, 1006, 22080, NULL, '2021-04-14 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals.  ', NULL, NULL, '2021-04-07 15:53:37', '2021-04-07 15:53:37'),
(22386, 3046, 22081, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:38:18', '2021-03-16 13:38:18'),
(22387, 1006, 22081, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 08:58:27', '2021-04-08 08:58:27'),
(22388, 3046, 22082, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:38:19', '2021-03-16 13:38:19'),
(22389, 1006, 22082, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 08:58:49', '2021-04-08 08:58:49'),
(22390, 3046, 22083, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:38:21', '2021-03-16 13:38:21'),
(22391, 1006, 22083, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 08:59:01', '2021-04-08 08:59:01'),
(22392, 3046, 22084, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:38:23', '2021-03-16 13:38:23'),
(22393, 1006, 22084, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 08:59:09', '2021-04-08 08:59:09'),
(22394, 3046, 22085, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:38:24', '2021-03-16 13:38:24'),
(22395, 1006, 22085, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 08:59:17', '2021-04-08 08:59:17'),
(22396, 3046, 22086, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:38:26', '2021-03-16 13:38:26'),
(22397, 1006, 22086, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 08:59:25', '2021-04-08 08:59:25'),
(22398, 3046, 22087, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:38:28', '2021-03-16 13:38:28'),
(22399, 1006, 22087, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 08:59:32', '2021-04-08 08:59:32'),
(22400, 3046, 22088, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:38:29', '2021-03-16 13:38:29'),
(22401, 1006, 22088, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 08:59:41', '2021-04-08 08:59:41'),
(22402, 3046, 22089, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:38:31', '2021-03-16 13:38:31'),
(22403, 1006, 22089, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 08:59:49', '2021-04-08 08:59:49'),
(22404, 3046, 22090, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:38:34', '2021-03-16 13:38:34'),
(22405, 1006, 22090, NULL, '2021-04-15 00:00:00.000', 'Approved', 'We have a facility contract with S&WHP and I\'ve attached the references for both the locations & approvals on the respective group task.  ', NULL, NULL, '2021-04-08 08:59:57', '2021-04-08 08:59:57'),
(22406, 3046, 22091, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:43:10', '2021-03-16 13:43:10'),
(22407, 1006, 22091, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 17:08:47', '2021-03-25 17:08:47'),
(22408, 3046, 22092, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:43:11', '2021-03-16 13:43:11'),
(22409, 1006, 22092, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 17:08:54', '2021-03-25 17:08:54'),
(22410, 3046, 22093, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:43:13', '2021-03-16 13:43:13'),
(22411, 1006, 22093, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 17:08:58', '2021-03-25 17:08:58'),
(22412, 3046, 22094, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:43:15', '2021-03-16 13:43:15'),
(22413, 1006, 22094, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 17:09:01', '2021-03-25 17:09:01'),
(22414, 3046, 22095, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:43:16', '2021-03-16 13:43:16'),
(22415, 1006, 22095, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 17:09:05', '2021-03-25 17:09:05'),
(22416, 3046, 22096, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:43:18', '2021-03-16 13:43:18'),
(22417, 1006, 22096, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 17:09:09', '2021-03-25 17:09:09'),
(22418, 3046, 22097, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:43:19', '2021-03-16 13:43:19'),
(22419, 1006, 22097, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 17:09:13', '2021-03-25 17:09:13'),
(22420, 3046, 22098, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:43:22', '2021-03-16 13:43:22'),
(22421, 1006, 22098, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 17:09:18', '2021-03-25 17:09:18'),
(22422, 3046, 22099, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:43:24', '2021-03-16 13:43:24'),
(22423, 1006, 22099, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 17:09:21', '2021-03-25 17:09:21');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(22424, 3046, 22100, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:43:26', '2021-03-16 13:43:26'),
(22425, 1006, 22100, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 17:09:28', '2021-03-25 17:09:28'),
(22426, 3046, 22101, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:43:28', '2021-03-16 13:43:28'),
(22427, 1006, 22101, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 17:09:34', '2021-03-25 17:09:34'),
(22428, 3046, 22102, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:46:09', '2021-03-16 13:46:09'),
(22429, 3040, 22102, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Received following email: dmarley@ghn-mci.com  This location has been input effective 6-24-19.   Thanks, for your time and consideration in this matter,   Daniel M. Contract Specialist Galaxy Health Network (P) 800-975-3322 X 1124  (F) 817-633-5729', NULL, NULL, '2021-03-29 16:19:20', '2021-03-29 16:19:20'),
(22430, 3046, 22103, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:46:28', '2021-03-16 13:46:28'),
(22431, 3040, 22103, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:17:08', '2021-03-29 16:17:08'),
(22432, 3046, 22104, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:46:30', '2021-03-16 13:46:30'),
(22433, 3040, 22104, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:22:31', '2021-03-29 16:22:31'),
(22434, 3046, 22105, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:46:31', '2021-03-16 13:46:31'),
(22435, 3040, 22105, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:26:04', '2021-03-29 16:26:04'),
(22436, 3046, 22106, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:46:38', '2021-03-16 13:46:38'),
(22437, 3040, 22106, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:34:03', '2021-03-29 16:34:03'),
(22438, 3046, 22107, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:46:40', '2021-03-16 13:46:40'),
(22439, 3040, 22107, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:38:40', '2021-03-29 16:38:40'),
(22440, 3046, 22108, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:46:42', '2021-03-16 13:46:42'),
(22441, 3040, 22108, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:42:26', '2021-03-29 16:42:26'),
(22442, 3046, 22109, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:46:44', '2021-03-16 13:46:44'),
(22443, 3040, 22109, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:45:25', '2021-03-29 16:45:25'),
(22444, 3046, 22110, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:46:46', '2021-03-16 13:46:46'),
(22445, 3040, 22110, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:47:55', '2021-03-29 16:47:55'),
(22446, 3046, 22111, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:52:07', '2021-03-16 13:52:07'),
(22447, 3040, 22111, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider enrolled with Health Smart.   Effective date: 11/01/2019 ', NULL, NULL, '2021-03-29 14:01:45', '2021-03-29 14:01:45'),
(22448, 3046, 22112, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:52:10', '2021-03-16 13:52:10'),
(22449, 3040, 22112, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Received following email from: pr.south@healthsmart.com  Sub: Provider Credentialing Status Request  Hi,  Provider \" Juan Miguel Capupus, NP \" is effective \" 03/01/2019 \".  ', NULL, NULL, '2021-03-29 14:06:05', '2021-03-29 14:06:05'),
(22450, 3046, 22113, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:52:12', '2021-03-16 13:52:12'),
(22451, 3040, 22113, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Received following email from: pr.south@healthsmart.com  Sub: Provider Network Status Request  Hi,  Please see the below providers effective date.  Providers Name       Effective Date Mari Capupus     03/01/2019 ', NULL, NULL, '2021-03-29 14:12:21', '2021-03-29 14:12:21'),
(22452, 3046, 22114, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:52:14', '2021-03-16 13:52:14'),
(22453, 3040, 22114, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Health smart for our group Statcare Minor Emergency Clinic under the below mentioned locations.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 15:48:27', '2021-03-29 15:48:27'),
(22454, 3040, 22114, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,   Please find the attached CAQH access form for the providers that were requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-16 07:31:50', '2021-04-16 07:31:50'),
(22455, 9057, 22114, NULL, '2021-06-02 00:00:00.000', 'In Process', ' Provider Id: Effective Date: Approved On:  Current Status: Inprocess  Initiated On: 2021-03-29  Expected: 2021-06-27  Last FollowUp: 2021-05-26  Next FollowUp: 2021-04-23 Statcare Minor Emergency Clinic (Kingsville) Tax Id: 46-0575924  Main Address: 500 E CAESAR  NPI: 1689924904 Trevino, Rose  NPI: 1437174794  Health Smart    Status Notes Attachments Activity Log   New/Not Initiated2021-03-16Javed,Humair  Initiated2021-03-29Abbas,Adil Email sent to: pr.south@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Health smart for our group Statcare Minor Emergency Clinic under the below mentioned locations.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   In Process2021-04-16Abbas,Adil Email sent to: mdiprsupport@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,   Please find the attached CAQH access form for the providers that were requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   In Process2021-05-26Saim,Muhammad We Sent an email to mdiprsupport@healthsmart.com Sub: Enrollment request status - RHC - Health Smart  Hello, We submitted a request for the enrollment of providers under the following group.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  Kindly let us know what is the current status regarding our request as soon as possible.  Thanks   ', NULL, NULL, '2021-05-26 10:32:14', '2021-05-26 10:32:14'),
(22456, 9057, 22114, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to mdiprsupport@healthsmart.com Sub: Enrollment request status - RHC - Health Smart  Hello, We submitted a request for the enrollment of providers under the following group.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  Kindly let us know what is the current status regarding our request as soon as possible.  Thanks  ', NULL, NULL, '2021-05-26 10:33:22', '2021-05-26 10:33:22'),
(22457, 9057, 22114, NULL, '2021-06-04 00:00:00.000', 'In Process', 'We Received an email from mdiprsupport@healthsmart.com  They asked for the submission of form for this provider, now we have submitted it. Attached is reference', NULL, NULL, '2021-05-28 09:24:15', '2021-05-28 09:24:15'),
(22458, 1006, 22114, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hello,  I hope you\'re doing well, I needed to get an update regarding the enrollment and location update status for the following providers under our group, their info is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415 Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-15 16:44:19', '2021-06-15 16:44:19'),
(22459, 1006, 22114, NULL, '2021-06-24 00:00:00.000', 'Approved', 'William Francis - Eff: 01/01/2021 Ref# 2046862  Location addition has been completed, it has been attached for reference. ', NULL, NULL, '2021-06-17 13:56:51', '2021-06-17 13:56:51'),
(22460, 3046, 22115, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:52:15', '2021-03-16 13:52:15'),
(22461, 3040, 22115, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Health smart for our group Statcare Minor Emergency Clinic under the below mentioned locations.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 15:48:52', '2021-03-29 15:48:52'),
(22462, 3040, 22115, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,   Please find the attached CAQH access form for the providers that were requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-16 07:35:05', '2021-04-16 07:35:05'),
(22463, 1006, 22115, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following email from Leslie.Perez@healthsmart.com:  Sub: Fwd: Mary Gonzalez NPI 1952713083  \"Hello,  I need the following information on Mary Gonzalez NPI 1952713083.  Once, I\'ve obtained this information I will continue to credential this provider.    Copy of current board of specialty --   American Academy of Nurse Practitioners   Thank you,  Leslie Perez Credentialing Specialist 222 W. Las Colinas Blvd., Suite 500N Irving, TX 75039 PH:  214-574-1152   FAX 214-574-2368 Leslie.Perez@HealthSmart.com www.HealthSmart.com\"  We submitted the reply and attached the provider\'s AANP.', NULL, NULL, '2021-04-28 07:31:56', '2021-04-28 07:31:56'),
(22464, 9057, 22115, NULL, '2021-06-02 00:00:00.000', 'In Process', ' Provider Id: Effective Date: Approved On:  Current Status: Inprocess  Initiated On: 2021-03-29  Expected: 2021-06-27  Last FollowUp: 2021-05-26  Next FollowUp: 2021-04-23 Statcare Minor Emergency Clinic (Kingsville) Tax Id: 46-0575924  Main Address: 500 E CAESAR  NPI: 1689924904 Trevino, Rose  NPI: 1437174794  Health Smart    Status Notes Attachments Activity Log   New/Not Initiated2021-03-16Javed,Humair  Initiated2021-03-29Abbas,Adil Email sent to: pr.south@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Health smart for our group Statcare Minor Emergency Clinic under the below mentioned locations.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   In Process2021-04-16Abbas,Adil Email sent to: mdiprsupport@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,   Please find the attached CAQH access form for the providers that were requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   In Process2021-05-26Saim,Muhammad We Sent an email to mdiprsupport@healthsmart.com Sub: Enrollment request status - RHC - Health Smart  Hello, We submitted a request for the enrollment of providers under the following group.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  Kindly let us know what is the current status regarding our request as soon as possible.  Thanks   ', NULL, NULL, '2021-05-26 10:32:26', '2021-05-26 10:32:26'),
(22465, 9057, 22115, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to mdiprsupport@healthsmart.com Sub: Enrollment request status - RHC - Health Smart  Hello, We submitted a request for the enrollment of providers under the following group.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  Kindly let us know what is the current status regarding our request as soon as possible.  Thanks  ', NULL, NULL, '2021-05-26 10:33:38', '2021-05-26 10:33:38'),
(22466, 1006, 22115, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hello,  I hope you\'re doing well, I needed to get an update regarding the enrollment and location update status for the following providers under our group, their info is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415 Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-15 16:44:16', '2021-06-15 16:44:16'),
(22467, 1006, 22115, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Submitted demographic update request @ Provider Relations - South pr.south@healthsmart.com:  Sub: Demographic Update - RHC - HealthSmart  \"Hello,   Please find the attached demographic update request form for our providers, please let me know if anything else is required.  Thank you!\"', NULL, NULL, '2021-06-17 17:15:59', '2021-06-17 17:15:59'),
(22468, 1006, 22115, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following reply from MDI PR Support mdiprsupport@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hi,  Our system has been updated as requested.  * The locations below have been added.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 77954)  Thanks Healthsmart Provider Relations.\"  Sent f/u email:  \"Hello,   When will these be updated on the provider directory?  Thank you!\" ', NULL, NULL, '2021-06-21 09:05:17', '2021-06-21 09:05:17'),
(22469, 1006, 22115, NULL, '2021-07-12 00:00:00.000', 'Approved', 'The location has been added, location confirmation is attached for reference.   Eff: 06/01/2021', NULL, NULL, '2021-07-05 16:07:35', '2021-07-05 16:07:35'),
(22470, 3046, 22116, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:52:17', '2021-03-16 13:52:17'),
(22471, 3040, 22116, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Received following email from: pr.south@healthsmart.com  Hello,   Traci S Mason PID: 13658699 is currently loaded in the system with the following addresses: 500 E  CESAR AVE KINGSVILLE, TX 78363 4042 RIVER HILL DR CORPUS CHRISTI, TX 78410 6646 S STAPLES ST #122 CORPUS CHRISTI, TX 78413   Thank you kindly, Heather W.  Provider Relations Healthsmart Network Solutions 6303 Commerce Drive, Suite 180 Irving, Texas 75063 Ph: 800.687.0500 Fax: 214.574.2368', NULL, NULL, '2021-03-29 14:17:27', '2021-03-29 14:17:27'),
(22472, 3046, 22117, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:52:19', '2021-03-16 13:52:19'),
(22473, 3040, 22117, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider Participating Effective Date: 06/01/2019 ', NULL, NULL, '2021-03-29 14:31:14', '2021-03-29 14:31:14'),
(22474, 3046, 22118, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:52:21', '2021-03-16 13:52:21'),
(22475, 3040, 22118, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || Health Smart ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 15:34:19', '2021-03-29 15:34:19'),
(22476, 1006, 22118, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Sent a f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment Status - RHC - Health Smart  \"Hello,   I wanted to get an update regarding the enrollment status for the following provider under our group:   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Petina Rogers NPI# 1801443916  Please get back to me as soon as you\'re able regarding the status.   Thank you. \"', NULL, NULL, '2021-06-03 14:03:35', '2021-06-03 14:03:35'),
(22477, 1006, 22118, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent another f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment Status - RHC - Health Smart  \"Hello,   Thank you for the information regarding the effective date, could you please verify if the locations listed are added under the given provider?  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-06-09 08:26:51', '2021-06-09 08:26:51'),
(22478, 1006, 22118, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hello,  I hope you\'re doing well, I needed to get an update regarding the enrollment and location update status for the following providers under our group, their info is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415 Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-15 16:44:13', '2021-06-15 16:44:13'),
(22479, 1006, 22118, NULL, '2021-06-24 00:00:00.000', 'Approved', 'The location has been added for the provider. Location confirmation is attached for reference.   Eff: 01/01/2020', NULL, NULL, '2021-06-17 13:20:55', '2021-06-17 13:20:55'),
(22480, 3046, 22119, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:52:23', '2021-03-16 13:52:23'),
(22481, 3040, 22119, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Provider enrolled with Health smart   Eff: 03/01/2019', NULL, NULL, '2021-03-29 14:42:42', '2021-03-29 14:42:42'),
(22482, 3046, 22120, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:52:25', '2021-03-16 13:52:25'),
(22483, 3040, 22120, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Health smart for our group Statcare Minor Emergency Clinic under the below mentioned locations.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 15:49:16', '2021-03-29 15:49:16'),
(22484, 3040, 22120, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,   Please find the attached CAQH access form for the providers that were requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-16 07:37:06', '2021-04-16 07:37:06'),
(22485, 9057, 22120, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to mdiprsupport@healthsmart.com Sub: Enrollment request status - RHC - Health Smart  Hello, We submitted a request for the enrollment of providers under the following group.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  Kindly let us know what is the current status regarding our request as soon as possible.  Thanks  ', NULL, NULL, '2021-05-26 10:33:48', '2021-05-26 10:33:48'),
(22486, 1006, 22120, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hello,  I hope you\'re doing well, I needed to get an update regarding the enrollment and location update status for the following providers under our group, their info is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415 Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-15 16:44:07', '2021-06-15 16:44:07'),
(22487, 1006, 22120, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Submitted demographic update request @ Provider Relations - South pr.south@healthsmart.com:  Sub: Demographic Update - RHC - HealthSmart  \"Hello,   Please find the attached demographic update request form for our providers, please let me know if anything else is required.  Thank you!\"', NULL, NULL, '2021-06-17 17:15:55', '2021-06-17 17:15:55'),
(22488, 1006, 22120, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following reply from MDI PR Support mdiprsupport@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hi,  Our system has been updated as requested.  * The locations below have been added.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 77954)  Thanks Healthsmart Provider Relations.\"  Sent f/u email:  \"Hello,   When will these be updated on the provider directory?  Thank you!\" ', NULL, NULL, '2021-06-21 09:05:14', '2021-06-21 09:05:14'),
(22489, 1006, 22120, NULL, '2021-07-12 00:00:00.000', 'Approved', 'The location has been added, location confirmation is attached for reference.   Eff: 06/01/2021', NULL, NULL, '2021-07-05 16:06:37', '2021-07-05 16:06:37'),
(22490, 3046, 22121, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 13:55:32', '2021-03-16 13:55:32'),
(22491, 1006, 22121, NULL, '2021-04-05 00:00:00.000', 'Approved', 'The Group has an Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.  All Three Locations Added. ', NULL, NULL, '2021-03-29 16:15:00', '2021-03-29 16:15:00'),
(22492, 3046, 22122, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:02:59', '2021-03-16 14:02:59'),
(22493, 1006, 22122, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Submitted a location addition email @ facilityinfo@usamco.com: \"Hello,   I hope you\'re doing well, we wish to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required to complete this request.   Thank you.\"  Once the location is added, the task will be approved as it is an ancillary contract with no need to add individual providers. ', NULL, NULL, '2021-03-26 17:20:39', '2021-03-26 17:20:39'),
(22494, 9057, 22122, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to facilityinfo@usamco.com Sub: Enrollment status request - RHC - Managed Care Organization  Hello,   we requested to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you. ', NULL, NULL, '2021-05-26 14:01:48', '2021-05-26 14:01:48'),
(22495, 1006, 22122, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Received the following response from Jackie Hipolito HIPOLITJ@usamco.com:  Sub: USA Provider# 1177750 - Location Addition  \"Thank you Brad , the locations have been added effective 03/26/2021 per update recv’d.  A confirmation for your records.  Kindly USA MCO rising star Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:  P: 512.306.0201 F: 512.306.1921\"  Location addition confirmation is attached as well as executed facility contract in main group task for reference. ', NULL, NULL, '2021-06-11 14:55:38', '2021-06-11 14:55:38'),
(22496, 3046, 22123, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:03:02', '2021-03-16 14:03:02'),
(22497, 1006, 22123, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Submitted a location addition email @ facilityinfo@usamco.com: \"Hello,   I hope you\'re doing well, we wish to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required to complete this request.   Thank you.\"  Once the location is added, the task will be approved as it is an ancillary contract with no need to add individual providers. ', NULL, NULL, '2021-03-26 17:20:58', '2021-03-26 17:20:58'),
(22498, 9057, 22123, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to facilityinfo@usamco.com Sub: Enrollment status request - RHC - Managed Care Organization  Hello,   we requested to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you. ', NULL, NULL, '2021-05-26 14:02:08', '2021-05-26 14:02:08'),
(22499, 1006, 22123, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Received the following response from Jackie Hipolito HIPOLITJ@usamco.com:  Sub: USA Provider# 1177750 - Location Addition  \"Thank you Brad , the locations have been added effective 03/26/2021 per update recv’d.  A confirmation for your records.  Kindly USA MCO rising star Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:  P: 512.306.0201 F: 512.306.1921\"  Location addition confirmation is attached as well as executed facility contract in main group task for reference.  ', NULL, NULL, '2021-06-11 15:11:15', '2021-06-11 15:11:15'),
(22500, 3046, 22124, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:03:04', '2021-03-16 14:03:04'),
(22501, 1006, 22124, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Submitted a location addition email @ facilityinfo@usamco.com: \"Hello,   I hope you\'re doing well, we wish to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required to complete this request.   Thank you.\"  Once the location is added, the task will be approved as it is an ancillary contract with no need to add individual providers. ', NULL, NULL, '2021-03-26 17:20:54', '2021-03-26 17:20:54'),
(22502, 9057, 22124, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to facilityinfo@usamco.com Sub: Enrollment status request - RHC - Managed Care Organization  Hello,   we requested to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you. ', NULL, NULL, '2021-05-26 14:02:18', '2021-05-26 14:02:18'),
(22503, 1006, 22124, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Received the following response from Jackie Hipolito HIPOLITJ@usamco.com:  Sub: USA Provider# 1177750 - Location Addition  \"Thank you Brad , the locations have been added effective 03/26/2021 per update recv’d.  A confirmation for your records.  Kindly USA MCO rising star Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:  P: 512.306.0201 F: 512.306.1921\"  Location addition confirmation is attached as well as executed facility contract in main group task for reference.  ', NULL, NULL, '2021-06-11 15:11:09', '2021-06-11 15:11:09'),
(22504, 3046, 22125, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:03:06', '2021-03-16 14:03:06'),
(22505, 1006, 22125, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Submitted a location addition email @ facilityinfo@usamco.com: \"Hello,   I hope you\'re doing well, we wish to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required to complete this request.   Thank you.\"  Once the location is added, the task will be approved as it is an ancillary contract with no need to add individual providers. ', NULL, NULL, '2021-03-26 17:20:50', '2021-03-26 17:20:50'),
(22506, 9057, 22125, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to facilityinfo@usamco.com Sub: Enrollment status request - RHC - Managed Care Organization  Hello,   we requested to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you. ', NULL, NULL, '2021-05-26 14:02:25', '2021-05-26 14:02:25'),
(22507, 1006, 22125, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Received the following response from Jackie Hipolito HIPOLITJ@usamco.com:  Sub: USA Provider# 1177750 - Location Addition  \"Thank you Brad , the locations have been added effective 03/26/2021 per update recv’d.  A confirmation for your records.  Kindly USA MCO rising star Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:  P: 512.306.0201 F: 512.306.1921\"  Location addition confirmation is attached as well as executed facility contract in main group task for reference.  ', NULL, NULL, '2021-06-11 15:10:59', '2021-06-11 15:10:59'),
(22508, 3046, 22126, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:03:07', '2021-03-16 14:03:07'),
(22509, 1006, 22126, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Submitted a location addition email @ facilityinfo@usamco.com: \"Hello,   I hope you\'re doing well, we wish to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required to complete this request.   Thank you.\"  Once the location is added, the task will be approved as it is an ancillary contract with no need to add individual providers. ', NULL, NULL, '2021-03-26 17:20:47', '2021-03-26 17:20:47'),
(22510, 9057, 22126, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to facilityinfo@usamco.com Sub: Enrollment status request - RHC - Managed Care Organization  Hello,   we requested to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you. ', NULL, NULL, '2021-05-26 14:02:32', '2021-05-26 14:02:32'),
(22511, 1006, 22126, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Received the following response from Jackie Hipolito HIPOLITJ@usamco.com:  Sub: USA Provider# 1177750 - Location Addition  \"Thank you Brad , the locations have been added effective 03/26/2021 per update recv’d.  A confirmation for your records.  Kindly USA MCO rising star Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:  P: 512.306.0201 F: 512.306.1921\"  Location addition confirmation is attached as well as executed facility contract in main group task for reference.  ', NULL, NULL, '2021-06-11 15:10:53', '2021-06-11 15:10:53'),
(22512, 3046, 22127, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:03:10', '2021-03-16 14:03:10');
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
(22513, 1006, 22127, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Submitted a location addition email @ facilityinfo@usamco.com: \"Hello,   I hope you\'re doing well, we wish to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required to complete this request.   Thank you.\"  Once the location is added, the task will be approved as it is an ancillary contract with no need to add individual providers. ', NULL, NULL, '2021-03-26 17:20:43', '2021-03-26 17:20:43'),
(22514, 9057, 22127, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to facilityinfo@usamco.com Sub: Enrollment status request - RHC - Managed Care Organization  Hello,   we requested to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you. ', NULL, NULL, '2021-05-26 14:02:43', '2021-05-26 14:02:43'),
(22515, 1006, 22127, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Received the following response from Jackie Hipolito HIPOLITJ@usamco.com:  Sub: USA Provider# 1177750 - Location Addition  \"Thank you Brad , the locations have been added effective 03/26/2021 per update recv’d.  A confirmation for your records.  Kindly USA MCO rising star Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:  P: 512.306.0201 F: 512.306.1921\"  Location addition confirmation is attached as well as executed facility contract in main group task for reference.  ', NULL, NULL, '2021-06-11 15:10:46', '2021-06-11 15:10:46'),
(22516, 3046, 22128, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:03:11', '2021-03-16 14:03:11'),
(22517, 1006, 22128, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Submitted a location addition email @ facilityinfo@usamco.com: \"Hello,   I hope you\'re doing well, we wish to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required to complete this request.   Thank you.\"  Once the location is added, the task will be approved as it is an ancillary contract with no need to add individual providers. ', NULL, NULL, '2021-03-26 17:20:36', '2021-03-26 17:20:36'),
(22518, 9057, 22128, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to facilityinfo@usamco.com Sub: Enrollment status request - RHC - Managed Care Organization  Hello,   we requested to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you. ', NULL, NULL, '2021-05-26 14:02:50', '2021-05-26 14:02:50'),
(22519, 1006, 22128, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Received the following response from Jackie Hipolito HIPOLITJ@usamco.com:  Sub: USA Provider# 1177750 - Location Addition  \"Thank you Brad , the locations have been added effective 03/26/2021 per update recv’d.  A confirmation for your records.  Kindly USA MCO rising star Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:  P: 512.306.0201 F: 512.306.1921\"  Location addition confirmation is attached as well as executed facility contract in main group task for reference.  ', NULL, NULL, '2021-06-11 15:10:39', '2021-06-11 15:10:39'),
(22520, 3046, 22129, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:03:14', '2021-03-16 14:03:14'),
(22521, 1006, 22129, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Submitted a location addition email @ facilityinfo@usamco.com: \"Hello,   I hope you\'re doing well, we wish to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required to complete this request.   Thank you.\"  Once the location is added, the task will be approved as it is an ancillary contract with no need to add individual providers. ', NULL, NULL, '2021-03-26 17:20:32', '2021-03-26 17:20:32'),
(22522, 9057, 22129, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to facilityinfo@usamco.com Sub: Enrollment status request - RHC - Managed Care Organization  Hello,   we requested to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you. ', NULL, NULL, '2021-05-26 14:02:56', '2021-05-26 14:02:56'),
(22523, 1006, 22129, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Received the following response from Jackie Hipolito HIPOLITJ@usamco.com:  Sub: USA Provider# 1177750 - Location Addition  \"Thank you Brad , the locations have been added effective 03/26/2021 per update recv’d.  A confirmation for your records.  Kindly USA MCO rising star Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:  P: 512.306.0201 F: 512.306.1921\"  Location addition confirmation is attached as well as executed facility contract in main group task for reference.  ', NULL, NULL, '2021-06-11 15:10:32', '2021-06-11 15:10:32'),
(22524, 3046, 22130, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:03:15', '2021-03-16 14:03:15'),
(22525, 1006, 22130, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Submitted a location addition email @ facilityinfo@usamco.com: \"Hello,   I hope you\'re doing well, we wish to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required to complete this request.   Thank you.\"  Once the location is added, the task will be approved as it is an ancillary contract with no need to add individual providers. ', NULL, NULL, '2021-03-26 17:20:28', '2021-03-26 17:20:28'),
(22526, 9057, 22130, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to facilityinfo@usamco.com Sub: Enrollment status request - RHC - Managed Care Organization  Hello,   we requested to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you. ', NULL, NULL, '2021-05-26 14:03:04', '2021-05-26 14:03:04'),
(22527, 1006, 22130, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Received the following response from Jackie Hipolito HIPOLITJ@usamco.com:  Sub: USA Provider# 1177750 - Location Addition  \"Thank you Brad , the locations have been added effective 03/26/2021 per update recv’d.  A confirmation for your records.  Kindly USA MCO rising star Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:  P: 512.306.0201 F: 512.306.1921\"  Location addition confirmation is attached as well as executed facility contract in main group task for reference.  ', NULL, NULL, '2021-06-11 15:10:23', '2021-06-11 15:10:23'),
(22528, 3046, 22131, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:03:18', '2021-03-16 14:03:18'),
(22529, 1006, 22131, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Submitted a location addition email @ facilityinfo@usamco.com: \"Hello,   I hope you\'re doing well, we wish to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required to complete this request.   Thank you.\"  Once the location is added, the task will be approved as it is an ancillary contract with no need to add individual providers. ', NULL, NULL, '2021-03-26 17:20:24', '2021-03-26 17:20:24'),
(22530, 9057, 22131, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to facilityinfo@usamco.com Sub: Enrollment status request - RHC - Managed Care Organization  Hello,   we requested to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you. ', NULL, NULL, '2021-05-26 14:03:11', '2021-05-26 14:03:11'),
(22531, 1006, 22131, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Received the following response from Jackie Hipolito HIPOLITJ@usamco.com:  Sub: USA Provider# 1177750 - Location Addition  \"Thank you Brad , the locations have been added effective 03/26/2021 per update recv’d.  A confirmation for your records.  Kindly USA MCO rising star Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:  P: 512.306.0201 F: 512.306.1921\"  Location addition confirmation is attached as well as executed facility contract in main group task for reference.  ', NULL, NULL, '2021-06-11 15:10:14', '2021-06-11 15:10:14'),
(22532, 3046, 22132, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:03:21', '2021-03-16 14:03:21'),
(22533, 1006, 22132, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Submitted a location addition email @ facilityinfo@usamco.com: \"Hello,   I hope you\'re doing well, we wish to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required to complete this request.   Thank you.\"  Once the location is added, the task will be approved as it is an ancillary contract with no need to add individual providers. ', NULL, NULL, '2021-03-26 17:20:20', '2021-03-26 17:20:20'),
(22534, 9057, 22132, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to facilityinfo@usamco.com Sub: Enrollment status request - RHC - Managed Care Organization  Hello,   we requested to add the following locations to our facility contract, group information and the addresses are as follows:   Group name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E Caesar Avenue, Kingsville, TX 78363  Secondary Address: 4042 River Hill, Corpus Christi, TX 78410  Tertiary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone# 361-334-2035 Fax# 361-334-2038  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you. ', NULL, NULL, '2021-05-26 14:03:18', '2021-05-26 14:03:18'),
(22535, 1006, 22132, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Received the following response from Jackie Hipolito HIPOLITJ@usamco.com:  Sub: USA Provider# 1177750 - Location Addition  \"Thank you Brad , the locations have been added effective 03/26/2021 per update recv’d.  A confirmation for your records.  Kindly USA MCO rising star Jackie Hipolito, Provider Relations USA Managed Care Organization usamco.com Austin:  P: 512.306.0201 F: 512.306.1921\"  Location addition confirmation is attached as well as executed facility contract in main group task for reference.  ', NULL, NULL, '2021-06-11 15:10:06', '2021-06-11 15:10:06'),
(22536, 1006, 22133, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:04:23', '2021-03-16 14:04:23'),
(22537, 1019, 22133, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex Same attachment as in Tufts Health Plan', NULL, NULL, '2021-04-19 15:44:20', '2021-04-19 15:44:20'),
(22538, 1019, 22133, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following email from provider_data_request@tufts-health.com Hello ,  We are in receipt of your request regarding New Location Addition || Group & Providers || SNBCARE || Tufts Health that was submitted on 2021-04-19 16:14:45 EDT. Please reference ticket number PRO0134438 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team   Ref:MSG6844383', NULL, NULL, '2021-04-27 07:09:12', '2021-04-27 07:09:12'),
(22539, 1019, 22133, 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 07:57:14', '2021-06-07 07:57:14'),
(22540, 1019, 22133, 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 09:39:10', '2021-06-23 09:39:10'),
(22541, 11056, 22133, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:55:21', '2021-12-03 14:55:21'),
(22542, 19067, 22133, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location 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 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:07:15', '2021-12-29 10:07:15'),
(22543, 19067, 22133, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:43:50', '2022-01-10 14:43:50'),
(22544, 19067, 22133, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:40:21', '2022-02-11 11:40:21'),
(22545, 19067, 22133, NULL, '2022-03-04 00:00:00.000', 'In Process', 'Email sent to: Padrick_Shaughnessey@tufts-health.com  Subject: Enrollment Request || SNBCARE || TMS || Tufts Health Plans ||   To Whom It May Concern,    I am writing to formally request that the following CPT codes be amended to our existing contract.     90867 – Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Initial, Including Cortical Mapping, Motor Threshold Determination, Delivery and Management     90868 –  Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Subsequent Delivery and Management, Per Session     90869 – Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) Treatment; Subsequent Motor Threshold Re-Determination with Delivery and Management     Kindly advise when the addition of the codes listed above is complete and include an amended fee schedule with contracted rates for our reference.    Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	834482753 Group NPI	1356906572 Primary & Billing Address	61 Lincoln St, Ste 203, Framingham, MA 01702 Secondary Address	100 New State Highway, Raynham, MA 02767 Tertiary Address	63 Eddie Dowling Hwy, Suite 8, North Smithfield, RI 02896 Provider Name	NPI Fauzia Wali Khan	1699761965 Katie Tawakol	1609222116 Mahreen Rashid	1396393146 Prisca Hefti	1508133182 Peggy Pionke	1699307322 Barbara Arnold	1922432053 Lauren Powell	1285304980 Eliza Rodrigues	1821751405 Dina Filoteo-Nichols	1770021099 Allie DiCostanzo	1669045738 Helena Halterman	1801473749 Jessica Hartman	1326665472 Barbara Hignite	1982617262 Lynnetta Loveland	1598163602 Jonathan Schubert	1235755505 Kerry Smith	1275083230 Erin Oliva	1407349632      Thank you,', NULL, NULL, '2022-02-25 18:04:07', '2022-02-25 18:04:07'),
(22546, 19067, 22133, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: Padrick.Shaughnessey@point32health.org  Subject: RE: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hi Hammad & Alex     See attached TMS exhibit that need signature.  I have included the rates.  We will need both the group contract and exhibit signed before they are implemented.     We are awaiting on both.     Thanks,  Padrick', NULL, NULL, '2022-03-01 13:03:49', '2022-03-01 13:03:49'),
(22547, 19067, 22133, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: padrick.shaughnessey@point32health.org  Subject: RE: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hi Padrick,  Kindly see the attached as per you requested and don\'t hesitate to reach me if you need any document or information.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-03-01 13:19:59', '2022-03-01 13:19:59'),
(22548, 19067, 22133, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email received from: Padrick.Shaughnessey@point32health.org  Subject: RE: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hi Hammad,     Do you have signing authority for Spectrum Neuro Behavioral Care LLC?     Normal it would be a VP or higher that signs and exhibit or the contract.  Plus we need back the signed group contract that was sent to Alex.     We still do not have it.     Thanks,  Padrick', NULL, NULL, '2022-03-02 09:25:59', '2022-03-02 09:25:59'),
(22549, 19067, 22133, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: Padrick.Shaughnessey@point32health.org  Subject: Re: Enrollment Request || SNBCARE || TMS || Tufts Health Plans || (Spectrum Neuro Behavioral Care LLC)    Hello Padrick,   Attached is the Signed TMS exhibit, also I\'m still waiting for you to sent me that group contract as I never received that, also I have sent you several email to you with no reponse on them. Please share the group contract again here,    Regards, Alex', NULL, NULL, '2022-03-02 09:27:03', '2022-03-02 09:27:03'),
(22550, 22077, 22133, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans |  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:33:12', '2022-04-05 10:33:12'),
(22551, 1006, 22134, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:04:25', '2021-03-16 14:04:25'),
(22552, 1019, 22134, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'To: Tufts_Health_Plan_Credentialing_Department@tufts-health.com Cc: Spectrum Neuro Behavioral Health snbc@claimsmedinc.com Hello,  Please find the attached request to initiate the credentialing/contracting for our provider Rodesia Edmundson. Do let me know if anything else is required. ', NULL, NULL, '2021-04-22 06:51:32', '2021-04-22 06:51:32'),
(22553, 1019, 22134, 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 07:53:28', '2021-06-07 07:53:28'),
(22554, 1019, 22134, 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 09:39:03', '2021-06-23 09:39:03'),
(22555, 1019, 22134, 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 06/29/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:34:22', '2021-08-10 23:34:22'),
(22556, 1006, 22135, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:04:26', '2021-03-16 14:04:26'),
(22557, 1019, 22135, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex Same attachment as in Tufts Health Plan', NULL, NULL, '2021-04-19 15:45:01', '2021-04-19 15:45:01'),
(22558, 1019, 22135, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following email from provider_data_request@tufts-health.com Hello ,  We are in receipt of your request regarding New Location Addition || Group & Providers || SNBCARE || Tufts Health that was submitted on 2021-04-19 16:14:45 EDT. Please reference ticket number PRO0134438 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team   Ref:MSG6844383', NULL, NULL, '2021-04-27 07:06:22', '2021-04-27 07:06:22'),
(22559, 1019, 22135, 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 07:57:05', '2021-06-07 07:57:05'),
(22560, 1019, 22135, 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 09:38:55', '2021-06-23 09:38:55'),
(22561, 1019, 22135, 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 03/08/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:32:19', '2021-08-10 23:32:19'),
(22562, 1006, 22136, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:04:27', '2021-03-16 14:04:27'),
(22563, 1019, 22136, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex Same attachment as in Tufts Health Plan', NULL, NULL, '2021-04-19 15:45:30', '2021-04-19 15:45:30'),
(22564, 1019, 22136, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following email from provider_data_request@tufts-health.com Hello ,  We are in receipt of your request regarding New Location Addition || Group & Providers || SNBCARE || Tufts Health that was submitted on 2021-04-19 16:14:45 EDT. Please reference ticket number PRO0134438 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team   Ref:MSG6844383', NULL, NULL, '2021-04-27 07:08:52', '2021-04-27 07:08:52'),
(22565, 1019, 22136, 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 07:56:56', '2021-06-07 07:56:56');
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
(22566, 1019, 22136, 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 09:38:48', '2021-06-23 09:38:48'),
(22567, 1019, 22136, NULL, '2021-08-17 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 04/19/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:05:19', '2021-08-10 23:05:19'),
(22568, 1006, 22137, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:04:28', '2021-03-16 14:04:28'),
(22569, 1019, 22137, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex Same attachment as in Tufts Health Plan', NULL, NULL, '2021-04-19 15:45:47', '2021-04-19 15:45:47'),
(22570, 1019, 22137, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following email from provider_data_request@tufts-health.com Hello ,  We are in receipt of your request regarding New Location Addition || Group & Providers || SNBCARE || Tufts Health that was submitted on 2021-04-19 16:14:45 EDT. Please reference ticket number PRO0134438 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team   Ref:MSG6844383', NULL, NULL, '2021-04-27 07:08:27', '2021-04-27 07:08:27'),
(22571, 1019, 22137, 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 07:56:48', '2021-06-07 07:56:48'),
(22572, 1019, 22137, 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 09:38:42', '2021-06-23 09:38:42'),
(22573, 1019, 22137, 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 04/19/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:06:30', '2021-08-10 23:06:30'),
(22574, 1006, 22138, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:04:29', '2021-03-16 14:04:29'),
(22575, 1019, 22138, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex Same attachment as in Tufts Health Plan', NULL, NULL, '2021-04-19 15:45:59', '2021-04-19 15:45:59'),
(22576, 1019, 22138, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following email from provider_data_request@tufts-health.com Hello ,  We are in receipt of your request regarding New Location Addition || Group & Providers || SNBCARE || Tufts Health that was submitted on 2021-04-19 16:14:45 EDT. Please reference ticket number PRO0134438 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team   Ref:MSG6844383', NULL, NULL, '2021-04-27 07:08:01', '2021-04-27 07:08:01'),
(22577, 1019, 22138, 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 07:56:40', '2021-06-07 07:56:40'),
(22578, 1019, 22138, 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 09:38:35', '2021-06-23 09:38:35'),
(22579, 11056, 22138, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:54:08', '2021-12-03 14:54:08'),
(22580, 11056, 22138, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:55:09', '2021-12-03 14:55:09'),
(22581, 19067, 22138, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   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 Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:40:18', '2021-12-15 17:40:18'),
(22582, 19067, 22138, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location 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 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:06:20', '2021-12-29 10:06:20'),
(22583, 19067, 22138, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:46:20', '2022-01-10 14:46:20'),
(22584, 19067, 22138, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:39:38', '2022-02-11 11:39:38'),
(22585, 1006, 22139, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:04:31', '2021-03-16 14:04:31'),
(22586, 1019, 22139, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex Same attachment as in Tufts Health Plan', NULL, NULL, '2021-04-19 15:46:10', '2021-04-19 15:46:10'),
(22587, 1019, 22139, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following email from provider_data_request@tufts-health.com Hello ,  We are in receipt of your request regarding New Location Addition || Group & Providers || SNBCARE || Tufts Health that was submitted on 2021-04-19 16:14:45 EDT. Please reference ticket number PRO0134438 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team   Ref:MSG6844383', NULL, NULL, '2021-04-27 07:05:55', '2021-04-27 07:05:55'),
(22588, 1019, 22139, 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 07:56:30', '2021-06-07 07:56:30'),
(22589, 1019, 22139, 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 09:38:27', '2021-06-23 09:38:27'),
(22590, 1019, 22139, 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 03/09/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:29:17', '2021-08-10 23:29:17'),
(22591, 1006, 22140, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:04:32', '2021-03-16 14:04:32'),
(22592, 1019, 22140, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex Same attachment as in Tufts Health Plan', NULL, NULL, '2021-04-19 15:46:23', '2021-04-19 15:46:23'),
(22593, 1019, 22140, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following email from provider_data_request@tufts-health.com Hello ,  We are in receipt of your request regarding New Location Addition || Group & Providers || SNBCARE || Tufts Health that was submitted on 2021-04-19 16:14:45 EDT. Please reference ticket number PRO0134438 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team   Ref:MSG6844383', NULL, NULL, '2021-04-27 07:07:35', '2021-04-27 07:07:35'),
(22594, 1019, 22140, 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 07:56:21', '2021-06-07 07:56:21'),
(22595, 1019, 22140, 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 09:38:20', '2021-06-23 09:38:20'),
(22596, 1019, 22140, 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 03/10/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:19:33', '2021-08-10 23:19:33'),
(22597, 1006, 22141, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:04:33', '2021-03-16 14:04:33'),
(22598, 1019, 22141, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex Same attachment as in Tufts Health Plan', NULL, NULL, '2021-04-19 15:46:33', '2021-04-19 15:46:33'),
(22599, 1019, 22141, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following email from provider_data_request@tufts-health.com Hello ,  We are in receipt of your request regarding New Location Addition || Group & Providers || SNBCARE || Tufts Health that was submitted on 2021-04-19 16:14:45 EDT. Please reference ticket number PRO0134438 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team   Ref:MSG6844383', NULL, NULL, '2021-04-27 07:07:11', '2021-04-27 07:07:11'),
(22600, 1019, 22141, 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 07:56:14', '2021-06-07 07:56:14'),
(22601, 1019, 22141, 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 09:38:12', '2021-06-23 09:38:12'),
(22602, 1019, 22141, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer with SNBCARE.', NULL, NULL, '2021-11-09 10:33:23', '2021-11-09 10:33:23'),
(22603, 1006, 22142, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:04:35', '2021-03-16 14:04:35'),
(22604, 1019, 22142, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex Same attachment as in Tufts Health Plan', NULL, NULL, '2021-04-19 15:46:44', '2021-04-19 15:46:44'),
(22605, 1019, 22142, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following email from provider_data_request@tufts-health.com Hello ,  We are in receipt of your request regarding New Location Addition || Group & Providers || SNBCARE || Tufts Health that was submitted on 2021-04-19 16:14:45 EDT. Please reference ticket number PRO0134438 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team   Ref:MSG6844383', NULL, NULL, '2021-04-27 07:05:35', '2021-04-27 07:05:35');
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
(22606, 1019, 22142, 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 07:56:06', '2021-06-07 07:56:06'),
(22607, 1019, 22142, 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 09:38:05', '2021-06-23 09:38:05'),
(22608, 1019, 22142, NULL, '2021-08-18 00:00:00.000', 'Not Eligible', 'Received the following message from Tufts: Allison_Morris@tufts-health.com Hello,  I’m writing in response to the provider application we received for LCSW. Unfortunately we cannot proceed with contracting this provider as we are only able to credential and contract LICSW providers, not LCSWs.        Thank you,  _____________________________________  Allison Morris  Associate Contract Specialist, Behavioral Health Services  Allied Health Contracting  Tufts Health Plan', NULL, NULL, '2021-08-10 23:38:11', '2021-08-10 23:38:11'),
(22609, 1019, 22142, NULL, '2021-10-06 00:00:00.000', 'Initiated', 'Sent the following email to Tufts_Health_Plan_Credentialing_Department@tufts-health.com, - provider_data_request@tufts-health.com  Good Morning, Attached is the application for our provider as he is LICSW now, please expedite this application as we were waiting on it for several months now.', NULL, NULL, '2021-09-29 07:57:37', '2021-09-29 07:57:37'),
(22610, 1019, 22142, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Received the following email from Tufts. Hello ,  We are in receipt of your request regarding Enrollment Application || Jonathan Schubert || SNBCARE || Tufts Health/ Tufts Public Plans that was submitted on 2021-09-29 08:57:52 EDT.  Please reference ticket number PRO0150549 for further communications about this request.  Thank you,  Tufts Health Public Plans, Provider Information Management Team    Ref:MSG7645241', NULL, NULL, '2021-10-19 08:22:56', '2021-10-19 08:22:56'),
(22611, 11056, 22142, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to: Denise_Rysinger@tufts-health.com  Sub: Fwd: Enrollment Issue with Tufts Health Plan  Hello,  We are facing issues getting our provider credentialed with Tufts as your process has been too long, due to which we are having issues seeing our patients. We have submitted the signed agreement for the following back in March and the rest others we have sent an enrollment application to Tufts but still didn\'t hear anything.     Group:  Spectrum Neuro Behavioral Care LLC. NPI: 1356906572     Providers  Loveland, Lynnetta -  NPI: 1598163602  Schubert, Jonathan –  NPI: 1235755505  Filoteo-Nichols, Dina - NPI: 1770021099  Halterman, Helena –  NPI: 1801473749', NULL, NULL, '2021-12-03 14:55:02', '2021-12-03 14:55:02'),
(22612, 19067, 22142, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   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 Dina, Filoteo-Nichols	1770021099	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Dina, Filoteo-Nichols	1770021099	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	100 New State Highway, Raynham, MA, 02767. Loveland, Lynnetta	1598163602	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Schubert, Jonathan	1235755505	61 Lincoln Street, Suite 203, Framingham, MA, 01702. Schubert, Jonathan	1235755505	100 New State Highway, Raynham, MA, 02767.  Kindly respond to me in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-15 17:41:10', '2021-12-15 17:41:10'),
(22613, 19067, 22142, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Provider_Data_Request@tufts-health.com, tufts_health_plan_credentialing_department@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Good Morning!  Hope you are doing well and having a productive day.  I would like to know the enrollment status of the following Providers and Groups.   Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location 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 Helena Halterman	1801473749	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Helena Halterman	1801473749	100 New State HWY, Raynham, MA 02767-5423 Jonathan Schubert	1235755505	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Jonathan Schubert	1235755505	100 New State HWY, Raynham, MA 02767-5423 Lynnetta Loveland	1598163602	61 Lincoln St. Suite 203, Framingham, MA 01702-8264 Lynnetta Loveland	1598163602	100 New State HWY, Raynham, MA 02767-5423 Erin Oliva	1407349632	63 Eddie Dowling HWY, Suite 8, North Smithfield, RI 02896-7322   Kindly respond to us in a timely manner.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 10:06:06', '2021-12-29 10:06:06'),
(22614, 19067, 22142, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||  Greetings!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:46:15', '2022-01-10 14:46:15'),
(22615, 19067, 22142, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com, Provider_Data_Request@tufts-health.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans ||   Hello!  This is my SECOND REMINDER on the previously mentioned request.  Kindly respond as per your convenience.  Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-11 11:39:24', '2022-02-11 11:39:24'),
(22616, 22077, 22142, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: tufts_health_plan_credentialing_department@tufts-health.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tufts Health & Tufts Public Plans |  Hello,  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-05 10:40:44', '2022-04-05 10:40:44'),
(22617, 1006, 22143, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:04:37', '2021-03-16 14:04:37'),
(22618, 1019, 22143, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'To: Tufts_Health_Plan_Credentialing_Department@tufts-health.com Cc: Spectrum Neuro Behavioral Health snbc@claimsmedinc.com Hello,  Please find the attached request to initiate the credentialing/contracting for our provider Kerry Smith. Do let me know if anything else is required. ', NULL, NULL, '2021-04-02 15:09:50', '2021-04-02 15:09:50'),
(22619, 1019, 22143, 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 07:53:20', '2021-06-07 07:53:20'),
(22620, 1019, 22143, 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 09:37:58', '2021-06-23 09:37:58'),
(22621, 1019, 22143, NULL, '2021-11-16 00:00:00.000', 'Approved', 'Effective Date 06/10/2021, attached is the Location Confirmation & Accepted Plans list.', NULL, NULL, '2021-11-09 11:00:48', '2021-11-09 11:00:48'),
(22622, 1006, 22144, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:04:38', '2021-03-16 14:04:38'),
(22623, 1019, 22144, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex Same attachment as in Tufts Health Plan', NULL, NULL, '2021-04-19 15:47:11', '2021-04-19 15:47:11'),
(22624, 1019, 22144, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following email from provider_data_request@tufts-health.com Hello ,  We are in receipt of your request regarding New Location Addition || Group & Providers || SNBCARE || Tufts Health that was submitted on 2021-04-19 16:14:45 EDT. Please reference ticket number PRO0134438 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team   Ref:MSG6844383', NULL, NULL, '2021-04-27 07:06:41', '2021-04-27 07:06:41'),
(22625, 1019, 22144, 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 07:55:56', '2021-06-07 07:55:56'),
(22626, 1019, 22144, 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 09:36:54', '2021-06-23 09:36:54'),
(22627, 1019, 22144, 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 04/19/2021 Attached are the Location Addition and Provider Roster of Tufts', NULL, NULL, '2021-08-10 23:15:46', '2021-08-10 23:15:46'),
(22628, 1006, 22145, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:04:40', '2021-03-16 14:04:40'),
(22629, 1019, 22145, NULL, '2021-04-26 00:00:00.000', 'Initiated', 'Sent the following email to : provider_information_dept@tufts-health.com  Sub: New Location Addition || Group & Providers || SNBCARE || Tufts Health Hello, Attached are the Provider Information Forms to add a new location under our Group and providers. Please let me know if you need further assistance     Regards, Alex Same attachment as in Tufts Health Plan', NULL, NULL, '2021-04-19 15:47:29', '2021-04-19 15:47:29'),
(22630, 1019, 22145, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following email from provider_data_request@tufts-health.com Hello ,  We are in receipt of your request regarding New Location Addition || Group & Providers || SNBCARE || Tufts Health that was submitted on 2021-04-19 16:14:45 EDT. Please reference ticket number PRO0134438 for further communications about this request.  Thank you, Tufts Health Public Plans, Provider Information Management Team   Ref:MSG6844383', NULL, NULL, '2021-04-27 07:05:04', '2021-04-27 07:05:04'),
(22631, 1019, 22145, 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 07:55:48', '2021-06-07 07:55:48'),
(22632, 1019, 22145, 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 09:36:46', '2021-06-23 09:36:46'),
(22633, 1019, 22145, NULL, '2021-08-18 00:00:00.000', 'Not Eligible', 'Received the following message from Tufts: Allison_Morris@tufts-health.com Hello,  I’m writing in response to the provider application we received for LCSW. Unfortunately we cannot proceed with contracting this provider as we are only able to credential and contract LICSW providers, not LCSWs.        Thank you,  _____________________________________  Allison Morris  Associate Contract Specialist, Behavioral Health Services  Allied Health Contracting  Tufts Health Plan', NULL, NULL, '2021-08-10 23:37:56', '2021-08-10 23:37:56'),
(22634, 3046, 22146, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:06:44', '2021-03-16 14:06:44'),
(22635, 1006, 22146, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The provider is enrolled with TMHP and the location is updated for the provider, attached for reference.  ', NULL, NULL, '2021-03-26 16:05:19', '2021-03-26 16:05:19'),
(22636, 3046, 22147, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:07:01', '2021-03-16 14:07:01'),
(22637, 1006, 22147, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Request submitted via TMHP website:  Enrollment Application Status  Application Status PEP Ticket Number Submitted		17675965 ', NULL, NULL, '2021-03-26 15:27:57', '2021-03-26 15:27:57'),
(22638, 1006, 22147, NULL, '2021-05-25 00:00:00.000', 'Approved', 'The provider has been enrolled in Medicaid, approval and location confirmation are attached: Eff: 01/01/2021 TPI# 372072404', NULL, NULL, '2021-05-18 11:54:15', '2021-05-18 11:54:15'),
(22639, 3046, 22148, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:13', '2021-03-16 14:08:13'),
(22640, 1005, 22148, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Location has been added. Task approved.', NULL, NULL, '2021-03-25 14:31:52', '2021-03-25 14:31:52'),
(22641, 1006, 22149, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:19', '2021-03-16 14:08:19'),
(22642, 1019, 22149, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Called Provider Express and requested to add new location under our group and linked all providers. As per the rep it will take up to 24 to 72 hours to loaded in their systems. Ref# : Marisa 04/15/2020', NULL, NULL, '2021-04-22 10:22:27', '2021-04-22 10:22:27'),
(22643, 1019, 22149, NULL, '2021-06-16 00:00:00.000', 'Approved', 'Spoken to Rep Ian, the Location has been added eff 03/01/2020. Also I have attached a copy of Location Confirmation for Reference Call Ref: IAN I- 06/09/2021 - (877) 614-0484', NULL, NULL, '2021-06-09 10:49:20', '2021-06-09 10:49:20'),
(22644, 19067, 22149, NULL, '2022-04-12 00:00:00.000', 'Approved', 'Email sent to: andria_prado@optum.com  Subject: Enrollment Request || SNBCARE || TMS || UBH ||     Hello Andria,  Hope this email finds you well, has the CPT codes been added to our Fee Schedule yet?  Can a nurse practitioner associated with my existing contract prescribe transcranial magnetic stimulation? Can a nurse practitioner perform motor threshold mapping and oversee subsequent daily treatment sessions? What are the contracted amounts for each of the three CPT codes under a nurse practitioner (90867, 90868, 90869)?  Thanks, Hammad Ahmed', NULL, NULL, '2022-04-05 10:31:04', '2022-04-05 10:31:04'),
(22645, 1006, 22150, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:21', '2021-03-16 14:08:21'),
(22646, 1019, 22150, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Enrollment Request Initiated Thru Provider Express. See attached for Reference', NULL, NULL, '2021-04-21 16:08:58', '2021-04-21 16:08:58'),
(22647, 1019, 22150, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Received the following email from waltham_account_processing@optum.com Sub: Optum Provider Express – Network Participation Request has been Submitted  Dear Provider,  Thank you for your request to join the Optum behavioral health network! The Network Participation Request Form for Rodesia Edmundson has been received and will now proceed to Network Management for review. We will contact you if additional information is needed.  You can now easily track the status of your online submission using the new Credentialing Status Toolbar. To access the Toolbar, log into providerexpress.com using your Optum ID, click the Join our Network link in the upper right corner and then select Check Initial Credentialing Status. If you need assistance, please contact our Provider Express Support Center at 1-866-209-9320.  Regards,  Optum Network Services', NULL, NULL, '2021-04-22 06:28:50', '2021-04-22 06:28:50'),
(22648, 1019, 22150, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Received the following email from bhcredentialing@optum.com SUB: Optum Application to Aperture for Rodesia Edmundson   6/11/2021  Rodesia Edmundson Email:  snbc@claimsmedinc.com  Dear Rodesia Edmundson, 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, '2021-06-11 13:24:28', '2021-06-11 13:24:28'),
(22649, 1019, 22150, NULL, '2021-07-14 00:00:00.000', 'Approved', 'Received the following email from bhcredentialing@optum.com 6/25/2021  001064702  Rodesia Edmundson snbc@claimsmedinc.com snbc@claimsmedinc.com  Dear Rodesia Edmundson:  I am pleased to inform you that our Credentialing Committee approved your participation in our network effective 6/25/2021.  You are now a contracted provider eligible to receive Member referrals from Optum and brands covered by other Payors, in accordance with your Agreement', NULL, NULL, '2021-07-07 14:18:24', '2021-07-07 14:18:24'),
(22650, 1006, 22151, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:24', '2021-03-16 14:08:24'),
(22651, 1019, 22151, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Called Provider Express and requested to add new location under our group and linked all providers. As per the rep it will take up to 24 to 72 hours to loaded in their systems. Ref# : Marisa 04/15/2020', NULL, NULL, '2021-04-22 10:22:14', '2021-04-22 10:22:14'),
(22652, 1019, 22151, NULL, '2021-06-16 00:00:00.000', 'Approved', 'Spoken to Rep Ian, the Location has been added eff 01/29/2020. Also I have attached a copy of Location Confirmation for Reference Call Ref: IAN I- 06/09/2021 - (877) 614-0484', NULL, NULL, '2021-06-09 10:52:11', '2021-06-09 10:52:11'),
(22653, 1006, 22152, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:26', '2021-03-16 14:08:26'),
(22654, 1019, 22152, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Called Provider Express and requested to add new location under our group and linked all providers. As per the rep it will take up to 24 to 72 hours to loaded in their systems. Ref# : Marisa 04/15/2020', NULL, NULL, '2021-04-22 10:22:04', '2021-04-22 10:22:04'),
(22655, 1019, 22152, NULL, '2021-06-16 00:00:00.000', 'Approved', 'Spoken to Rep Ian, the Location has been added eff 02/10/2021. Also I have attached a copy of Location Confirmation for Reference Call Ref: IAN I- 06/09/2021 - (877) 614-0484', NULL, NULL, '2021-06-09 10:55:04', '2021-06-09 10:55:04'),
(22656, 1006, 22153, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:28', '2021-03-16 14:08:28'),
(22657, 1006, 22153, NULL, '2021-04-23 00:00:00.000', 'Approved', 'The provider is approved with UBH and the location is also updated, proof of enrollment and location addition is attached for reference. ', NULL, NULL, '2021-04-16 15:46:54', '2021-04-16 15:46:54'),
(22658, 1006, 22154, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:30', '2021-03-16 14:08:30'),
(22659, 1019, 22154, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Called Provider Express and requested to add new location under our group and linked all providers. As per the rep it will take up to 24 to 72 hours to loaded in their systems. Ref# : Marisa 04/15/2020', NULL, NULL, '2021-04-22 10:21:22', '2021-04-22 10:21:22'),
(22660, 1019, 22154, NULL, '2021-06-16 00:00:00.000', 'Approved', 'Spoken to Rep Ian, the Location has been added eff 01/01/2021. Also I have attached a copy of Location Confirmation for Reference Call Ref: IAN I- 06/09/2021 - (877) 614-0484', NULL, NULL, '2021-06-09 10:57:16', '2021-06-09 10:57:16'),
(22661, 1006, 22155, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:31', '2021-03-16 14:08:31'),
(22662, 1019, 22155, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Called Provider Express and requested to add new location under our group and linked all providers. As per the rep it will take up to 24 to 72 hours to loaded in their systems. Ref# : Marisa 04/15/2020', NULL, NULL, '2021-04-22 10:21:12', '2021-04-22 10:21:12'),
(22663, 1019, 22155, NULL, '2021-06-21 00:00:00.000', 'Not Eligible', 'Spoken to Rep Ian, the provider is linked to our group under supervisory protocol. So we can billed under Supervisory protocol. Call Ref: IAN I- 06/09/2021 - (877) 614-0484', NULL, NULL, '2021-06-14 07:24:05', '2021-06-14 07:24:05'),
(22664, 1006, 22156, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:33', '2021-03-16 14:08:33'),
(22665, 1019, 22156, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Called Provider Express and requested to add new location under our group and linked all providers. As per the rep it will take up to 24 to 72 hours to loaded in their systems. Ref# : Marisa 04/15/2020', NULL, NULL, '2021-04-22 10:21:01', '2021-04-22 10:21:01'),
(22666, 1019, 22156, NULL, '2021-06-16 00:00:00.000', 'Approved', 'Spoken to Rep Ian, the Location has been added eff 12/19/2019. Also I have attached a copy of Location Confirmation for Reference Call Ref: IAN I- 06/09/2021 - (877) 614-0484', NULL, NULL, '2021-06-09 10:59:21', '2021-06-09 10:59:21'),
(22667, 1006, 22157, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:34', '2021-03-16 14:08:34'),
(22668, 1019, 22157, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Called Provider Express and requested to add new location under our group and linked all providers. As per the rep it will take up to 24 to 72 hours to loaded in their systems. Ref# : Marisa 04/15/2020', NULL, NULL, '2021-04-22 10:20:47', '2021-04-22 10:20:47'),
(22669, 1019, 22157, NULL, '2021-06-16 00:00:00.000', 'Approved', 'Spoken to Rep Ian, the Location has been added eff 01/22/2021. Also I have attached a copy of Location Confirmation for Reference Call Ref: IAN I- 06/09/2021 - (877) 614-0484', NULL, NULL, '2021-06-09 11:02:04', '2021-06-09 11:02:04'),
(22670, 1006, 22158, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:36', '2021-03-16 14:08:36'),
(22671, 1019, 22158, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Called Provider Express and requested to add new location under our group and linked all providers. As per the rep it will take up to 24 to 72 hours to loaded in their systems. Ref# : Marisa 04/15/2020', NULL, NULL, '2021-04-22 10:20:36', '2021-04-22 10:20:36'),
(22672, 1019, 22158, NULL, '2021-06-21 00:00:00.000', 'Not Eligible', 'Spoken to Rep Ian, the provider is linked to our group under supervisory protocol. So we can billed under Supervisory protocol. Call Ref: IAN I- 06/09/2021 - (877) 614-0484', NULL, NULL, '2021-06-14 07:25:10', '2021-06-14 07:25:10'),
(22673, 1019, 22158, NULL, '2021-10-05 00:00:00.000', 'Initiated', 'Application submitted thru Provider Portal as a LICSW. ', NULL, NULL, '2021-09-28 08:36:10', '2021-09-28 08:36:10'),
(22674, 1019, 22158, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Received the following email from UBH, attached is the location confirmation  10/7/2021    001002248    Jonathan Schubert  credentialing@happierliving.com  snbc@claimsmedinc.com    Dear Jonathan Schubert:    I am pleased to inform you that our Credentialing Committee approved your participation in our network effective 10/6/2021.  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.', NULL, NULL, '2021-11-30 17:10:42', '2021-11-30 17:10:42'),
(22675, 1006, 22159, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:38', '2021-03-16 14:08:38'),
(22676, 1019, 22159, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Initiated thru Provider Express ', NULL, NULL, '2021-04-02 14:32:24', '2021-04-02 14:32:24'),
(22677, 3040, 22159, NULL, '2021-04-26 00:00:00.000', 'In Process', 'I had a word with (Hydae) UBH representative and she said the application received and its in initial review process and it will take 30-45 business days. Regarding the addresses she said after the completion the form she can able to verify the addresses.   Ref: 04/19/2021', NULL, NULL, '2021-04-19 07:29:11', '2021-04-19 07:29:11'),
(22678, 1019, 22159, NULL, '2021-06-21 00:00:00.000', 'Not Eligible', 'Spoken to Rep Ian, the provider is linked to our group under supervisory protocol. So we can billed under Supervisory protocol. Call Ref: IAN I- 06/09/2021 - (877) 614-0484 ', NULL, NULL, '2021-06-14 07:23:41', '2021-06-14 07:23:41'),
(22679, 1006, 22160, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:39', '2021-03-16 14:08:39'),
(22680, 1019, 22160, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Called Provider Express and requested to add new location under our group. As per the rep it will take up to 24 to 72 hours to loaded in their systems. Ref# : Marisa 04/15/2020', NULL, NULL, '2021-04-22 10:20:03', '2021-04-22 10:20:03'),
(22681, 1019, 22160, NULL, '2021-06-16 00:00:00.000', 'Approved', 'Spoken to Rep Ian, the Location has been added eff 03/01/2020. Also I have attached a copy of Location Confirmation for Reference Call Ref: IAN I- 06/09/2021 - (877) 614-0484', NULL, NULL, '2021-06-09 11:08:25', '2021-06-09 11:08:25'),
(22682, 1006, 22161, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:08:42', '2021-03-16 14:08:42'),
(22683, 1019, 22161, NULL, '2021-04-29 00:00:00.000', 'Initiated', 'Called Provider Express and requested to add new location under our group. As per the rep it will take up to 24 to 72 hours to loaded in their systems. Ref# : Marisa 04/15/2020', NULL, NULL, '2021-04-22 10:19:44', '2021-04-22 10:19:44');
