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
(29209, 3040, 23069, NULL, '2021-05-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-21 14:11:52', '2021-05-21 14:11:52'),
(29210, 3040, 23069, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 2:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-10 09:25:22', '2021-06-10 09:25:22'),
(29211, 3040, 23069, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings,   Hope you are doing well. Please find the attached Individual Provider Contracting form as per above requested email for the below mentioned providers for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider 1: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 2:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:   Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-06-28 17:09:16', '2021-06-28 17:09:16'),
(29212, 3040, 23069, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:32', '2021-07-16 17:05:32'),
(29213, 11056, 23069, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:56:06', '2021-08-12 08:56:06'),
(29214, 3040, 23069, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings Brittney,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thank you   ', NULL, NULL, '2021-08-27 11:53:15', '2021-08-27 11:53:15'),
(29215, 10057, 23069, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings for the day!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-10-18 09:54:10', '2021-10-18 09:54:10'),
(29216, 10057, 23069, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello Veronica,  Hope this email finds you in good health. Can you please check the below mentioned remaining providers status along with the facility group contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Joseph, Molly - NUCC - IVUC - LPMC	1396380077 PAUL, SIGI - IVUC - LPMC	1033623616 Jacob, Jaya - IVUC - LPMC	1194336149  Kindly get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-22 11:41:03', '2021-11-22 11:41:03'),
(29217, 10057, 23069, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #69503 for Normandy Urgent Care Center and #69505 for Longpoint Medical Center.   Thank you,  Lionel Negrete Provider Account Manager', NULL, NULL, '2021-11-23 10:06:53', '2021-11-23 10:06:53'),
(29218, 10057, 23069, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : RE: Ref # 69635 Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good afternoon,  I hope all is well.   In review of NPI#1033623616 for provider Sigi Paul, I was not able to find them in our system.   As of today’s date, I don’t see an application received for your provider.   Below I will be attaching a link where you can submit an application on line.  Once you submit the application, our Network Development team with reach out to you within 5 business days acknowledging receipt of your request.    I hope this helps.  Have a great day.   https://www.superiorhealthplan.com/providers/become-a-provider.html     On the left hand side, select Add a Provider to an Existing Group Practice.   Thank you, Lionel Negrete', NULL, NULL, '2021-12-03 09:46:57', '2021-12-03 09:46:57'),
(29219, 10057, 23069, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Called to check the status: 800-656-4817. Still in the process.  Need to check after 10 days.  Call Reference - 71689 - TIM', NULL, NULL, '2021-12-10 14:55:15', '2021-12-10 14:55:15'),
(29220, 10057, 23069, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Will Follow-up in Next Week.  Please see previous Call Comments. Thank you', NULL, NULL, '2021-12-17 10:58:50', '2021-12-17 10:58:50'),
(29221, 10057, 23069, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello Steve,  I hope this message finds you well.  Please find below the information requested.  Group Name:  NORMANDY URGENT CARE CENTER PA  TIN:  270796429  Provider(s):   MOLLY JOSEPH, NPI:  1396380077, contract status- pending completion.  Tentative effective date:  01/01/2022 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  09/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  10/01/2021  Group Name:  LONG POINT MEDICAL CENTER  TIN:  760612416  MOLLY JOSEPH, NPI:  1396380077, contract complete.  Effective date:  07/01/2021 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  07/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  07/01/2021.  Happy Holidays.  Thank you, Yvette Hernandez', NULL, NULL, '2021-12-23 10:54:16', '2021-12-23 10:54:16'),
(29222, 10057, 23069, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Thank you for your response Yvette. Is there any way that I can get welcome letters for all of them?  I really appreciate your kind assistance. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:17:19', '2021-12-30 13:17:19'),
(29223, 19067, 23069, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505     Good afternoon Steve,     Thank you for your email. Unfortunately, our department does not disperses Welcome Letters for providers.     I have sent our ECM team with your request to have welcome letters be issued out to you. Please await on a response from them with letters requested.    Thank you,   Yesenia Prado  Provider Account Manager  Nueces, Harris & Jefferson SDA', NULL, NULL, '2022-01-03 17:47:59', '2022-01-03 17:47:59'),
(29224, 20067, 23069, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@SuperiorHealthPlan.com  Sub: Fwd: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Hope this email finds you well.Any update on the previously mentioned request.  Thanks and regards Syed Ahad. ', NULL, NULL, '2022-01-12 15:22:34', '2022-01-12 15:22:34'),
(29225, 20067, 23069, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Sub:  [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505   Good afternoon,      This issue was resolved and Welcome Letters were sent out to provider on 1/7/2022. See attached email.        Thank you,', NULL, NULL, '2022-01-18 18:01:23', '2022-01-18 18:01:23'),
(29226, 20067, 23069, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good Morning!  I would like to know the effective date of the below mentioned Groups and Providers. Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jaya Jacob	1194336149 SIGI PAUL	1033623616  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-28 11:27:59', '2022-01-28 11:27:59'),
(29227, 20067, 23069, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: ${SECURE}{secure} RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good Afternoon!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-mentioned providers. Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Sigi Paul	1033623616 Jeny John	1073019493  Thank you,', NULL, NULL, '2022-03-02 12:10:49', '2022-03-02 12:10:49'),
(29228, 20067, 23069, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505   Good Afternoon!  Hope this email finds you well. I would like to know the status of the Listed providers with mentioned locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jeny John	1073019493	779 Normandy St Ste 114 Houston , TX 77015-3441 Sigi Paul	1033623616	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Thank you, Syed.', NULL, NULL, '2022-03-18 15:21:35', '2022-03-18 15:21:35'),
(29229, 20067, 23069, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email received from: txps-coord@superiorhealthplan.com  Sub: RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello,     Thank you for contacting Superior Health Plan. Your reference# is R-16163706.     Below is the requested credentialing status under Tax ID  270796429.     Provider Name:  Jeny John  Provider NPI: 1073019493  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Effective date: 04/01/2022  We do show this address on file for this provider. Please allow up to  30 days to receive a welcome letter.     Provider Name:  Jeny John  Provider NPI: Jeny John  Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Effective date: 04/01/2022  We do show this address on file for this provider. Please allow up to  30 days to receive a welcome letter.     Provider Name:  Sigi Paul  Provider NPI: 1033623616  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  We do not show this address on file for this provider. Should you  have additional questions or concerns, please contact your regional  account manager at AM.Houston@superiorhealthplan.com.     Provider Name:  Jaya Jacob  Provider NPI: 1194336149  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 7706  We do not show this address on file for this provider. Should you  have additional questions or concerns, please contact your regional  account manager at AM.Houston@superiorhealthplan.com.', NULL, NULL, '2022-03-22 13:07:29', '2022-03-22 13:07:29'),
(29230, 20067, 23069, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Demographic Update || Providers || NUCC & IVUC || SHP  Good Afternoon!  I would like to add the secondary location for the below-listed providers. Attached is the W9 of the location.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Sigi Paul	1033623616   Thank you,', NULL, NULL, '2022-03-22 13:12:48', '2022-03-22 13:12:48'),
(29231, 22077, 23069, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject:  Demographic Update || Providers || NUCC & IVUC || SHP #87031  Hello,        The W9 that was sent in is outdated. Per the cred team, it must be dated within the last six months. Please send in an updated w9 so that we can have this completed.     Adriano Garcia; CPhT', NULL, NULL, '2022-04-07 14:22:04', '2022-04-07 14:22:04'),
(29232, 22077, 23069, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: 	Re: Demographic Update || Providers || NUCC & IVUC || SHP #87031  Hi,  Attached is the updated W9 as requested.  Thanks', NULL, NULL, '2022-04-07 14:24:12', '2022-04-07 14:24:12'),
(29233, 22077, 23069, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: 	Re: Demographic Update || Providers || NUCC & IVUC || SHP #87031  Hi,  Attached is the updated W9 as requested.  Thanks', NULL, NULL, '2022-04-07 14:24:14', '2022-04-07 14:24:14'),
(29234, 22077, 23069, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: 	Re: Demographic Update || Providers || NUCC & IVUC || SHP #87031  Hi,  Attached is the updated W9 as requested.  Thanks', NULL, NULL, '2022-04-07 14:24:16', '2022-04-07 14:24:16'),
(29235, 22077, 23069, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: RE: Demographic Update || Providers || NUCC & IVUC || SHP #87031  Thank you. this has been forwarded to the team for review.', NULL, NULL, '2022-04-08 07:39:03', '2022-04-08 07:39:03'),
(29236, 3046, 23070, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:56:04', '2021-03-18 08:56:04'),
(29237, 3040, 23070, NULL, '2021-05-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-21 14:12:30', '2021-05-21 14:12:30'),
(29238, 3040, 23070, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Good morning,              I am able to locate the following information for the providers below:  1134525868-The re-credential date for the provider will be 10/31/2021.  1841755956- Provider is currently undergoing validation and has not been received by the credentialing team at this time.  1033623616- Provider is currently undergoing validation and has not been received by the credentialing team at this time.  1194336149-Provider is currently undergoing validation and has not been received by the credentialing team at this time.  1356321509- Application has not been received for this provider. The process to inquire about a new contract/adding provider or service to your existing contract begins by completing a Network Participation Inquiry through our website.   http://www.superiorhealthplan.com/for-providers/join-our-network/  1497726202-Application has not been received for this provider. The process to inquire about a new contract/adding provider or service to your existing contract begins by completing a Network Participation Inquiry through our website.   http://www.superiorhealthplan.com/for-providers/join-our-network/  1588959118-Provider is currently undergoing validation and has not been received by the credentialing team at this time.  1134777238-Provider is currently undergoing validation and has not been received by the credentialing team at this time.  Please contact our network development team for assistance with validation at: SHP.NetworkDevelopment@superiorhealthplan.com  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com', NULL, NULL, '2021-06-10 08:54:11', '2021-06-10 08:54:11'),
(29239, 3040, 23070, NULL, '2021-06-17 00:00:00.000', 'In Process', 'As per above email we submitted the request online. Please see attachment.   Thank You For Your Request! Important to Note:  Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs.  Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation.  If additional information is required to process your request, a Superior representative will contact you soon.', NULL, NULL, '2021-06-10 08:55:57', '2021-06-10 08:55:57'),
(29240, 3040, 23070, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings,   Hope you are doing well. Please find the attached Individual Provider Contracting form as per above requested email for the below mentioned providers for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider 1: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 2:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:   Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-06-28 17:09:06', '2021-06-28 17:09:06'),
(29241, 3040, 23070, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:28', '2021-07-16 17:05:28'),
(29242, 11056, 23070, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:56:01', '2021-08-12 08:56:01'),
(29243, 3040, 23070, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings Brittney,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thank you   ', NULL, NULL, '2021-08-27 11:53:10', '2021-08-27 11:53:10'),
(29244, 10057, 23070, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings for the day!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-10-18 09:53:58', '2021-10-18 09:53:58'),
(29245, 10057, 23070, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Good morning Steve  Hope all is well this Friday morning  Here is the information on the following Providers  ·        MINI PHILIP CHENNEMKARA  NPI#1841755956  under TID#270796429--- application completed with eff date of 8/1/2021  ·        SIGI PAUL NPI# under TID#270796429---- application completed with eff date of 9/1/2021  ·        JAYA JACOB NPI#1194336149  under TID#270796429 – application completed with eff date of 10/1/2021  ·        ABDUR RAUF NPI#1497726202 under TID#270796429--- application completed with eff date of 8/1/2021  ·        JAMES PICCIONE JR NPI#1356321509 under TID#270796429 – application completed with eff date of 10/1/2021  ·        CINI THOMAS NPI# 1134777238  under TID#270796429--- application completed with eff date of 8/1/2021  Veronica Botello Rocha Provider Relations Coord', NULL, NULL, '2021-11-22 11:16:45', '2021-11-22 11:16:45'),
(29246, 3046, 23071, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:56:06', '2021-03-18 08:56:06'),
(29247, 3040, 23071, NULL, '2021-05-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-21 14:12:55', '2021-05-21 14:12:55'),
(29248, 3040, 23071, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Good morning,              I am able to locate the following information for the providers below:  1134525868-The re-credential date for the provider will be 10/31/2021.  1841755956- Provider is currently undergoing validation and has not been received by the credentialing team at this time.  1033623616- Provider is currently undergoing validation and has not been received by the credentialing team at this time.  1194336149-Provider is currently undergoing validation and has not been received by the credentialing team at this time.  1356321509- Application has not been received for this provider. The process to inquire about a new contract/adding provider or service to your existing contract begins by completing a Network Participation Inquiry through our website.   http://www.superiorhealthplan.com/for-providers/join-our-network/  1497726202-Application has not been received for this provider. The process to inquire about a new contract/adding provider or service to your existing contract begins by completing a Network Participation Inquiry through our website.   http://www.superiorhealthplan.com/for-providers/join-our-network/  1588959118-Provider is currently undergoing validation and has not been received by the credentialing team at this time.  1134777238-Provider is currently undergoing validation and has not been received by the credentialing team at this time.  Please contact our network development team for assistance with validation at: SHP.NetworkDevelopment@superiorhealthplan.com  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com', NULL, NULL, '2021-06-10 09:00:05', '2021-06-10 09:00:05'),
(29249, 3040, 23071, NULL, '2021-06-17 00:00:00.000', 'In Process', 'As per above email we submitted the request online. Please see attachment.   Thank You For Your Request! Important to Note:  Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs.  Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation.  If additional information is required to process your request, a Superior representative will contact you soon.', NULL, NULL, '2021-06-10 09:00:40', '2021-06-10 09:00:40'),
(29250, 3040, 23071, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings,   Hope you are doing well. Please find the attached Individual Provider Contracting form as per above requested email for the below mentioned providers for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider 1: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 2:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:   Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-06-28 17:08:52', '2021-06-28 17:08:52'),
(29251, 3040, 23071, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:20', '2021-07-16 17:05:20'),
(29252, 11056, 23071, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:55:53', '2021-08-12 08:55:53'),
(29253, 3040, 23071, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings Brittney,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thank you   ', NULL, NULL, '2021-08-27 11:53:08', '2021-08-27 11:53:08'),
(29254, 10057, 23071, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings for the day!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-10-18 09:53:43', '2021-10-18 09:53:43'),
(29255, 10057, 23071, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Good morning Steve  Hope all is well this Friday morning  Here is the information on the following Providers  ·        MINI PHILIP CHENNEMKARA  NPI#1841755956  under TID#270796429--- application completed with eff date of 8/1/2021  ·        SIGI PAUL NPI# under TID#270796429---- application completed with eff date of 9/1/2021  ·        JAYA JACOB NPI#1194336149  under TID#270796429 – application completed with eff date of 10/1/2021  ·        ABDUR RAUF NPI#1497726202 under TID#270796429--- application completed with eff date of 8/1/2021  ·        JAMES PICCIONE JR NPI#1356321509 under TID#270796429 – application completed with eff date of 10/1/2021  ·        CINI THOMAS NPI# 1134777238  under TID#270796429--- application completed with eff date of 8/1/2021  Veronica Botello Rocha Provider Relations Coord', NULL, NULL, '2021-11-22 11:15:43', '2021-11-22 11:15:43'),
(29256, 3046, 23072, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:56:07', '2021-03-18 08:56:07'),
(29257, 3040, 23072, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 14:27:46', '2021-05-31 14:27:46'),
(29258, 3040, 23072, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 2:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-10 09:25:17', '2021-06-10 09:25:17'),
(29259, 3040, 23072, NULL, '2021-07-05 00:00:00.000', 'Approved', 'Provider is participating with Superior Healthplan. Please see attachment. ', NULL, NULL, '2021-06-28 15:36:02', '2021-06-28 15:36:02'),
(29260, 3046, 23073, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:56:09', '2021-03-18 08:56:09'),
(29261, 3040, 23073, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 14:27:50', '2021-05-31 14:27:50'),
(29262, 3040, 23073, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:  Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 2:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 5: Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-10 09:25:09', '2021-06-10 09:25:09');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(29263, 3040, 23073, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings,   Hope you are doing well. Please find the attached Individual Provider Contracting form as per above requested email for the below mentioned providers for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider 1: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 2:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:   Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-06-28 17:08:57', '2021-06-28 17:08:57'),
(29264, 3040, 23073, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:23', '2021-07-16 17:05:23'),
(29265, 11056, 23073, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:55:46', '2021-08-12 08:55:46'),
(29266, 3040, 23073, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings Brittney,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thank you   ', NULL, NULL, '2021-08-27 11:53:05', '2021-08-27 11:53:05'),
(29267, 3040, 23073, NULL, '2021-09-16 00:00:00.000', 'Approved', 'Email rcvd from: ECMExecutionTeam@superiorhealthplan.com  Subject: Fwd: CINI THOMAS WELCOME LETTER  CINI THOMAS  NORMANDY URGENT CARE CENTER PA  ASK@CLAIMSMEDINC.COM        Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:  08/01/2021                                                    C/ 53559', NULL, NULL, '2021-09-09 14:15:30', '2021-09-09 14:15:30'),
(29268, 3046, 23074, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:59:57', '2021-03-18 08:59:57'),
(29269, 1006, 23074, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Group is showing linked with medicare railroad and effective date is 01/06/2015. Screenshot is attached   ', NULL, NULL, '2021-05-17 12:00:47', '2021-05-17 12:00:47'),
(29270, 3046, 23075, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:59:58', '2021-03-18 08:59:58'),
(29271, 1006, 23075, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Provider is showing linked with medicare railroad and effective date is 05/01/2019 ', NULL, NULL, '2021-05-17 12:04:12', '2021-05-17 12:04:12'),
(29272, 3046, 23076, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 08:59:59', '2021-03-18 08:59:59'),
(29273, 1006, 23076, NULL, '2021-05-24 00:00:00.000', 'Approved', 'PROVIDER NAME	JEENA ABRAHAM PROVIDER PTAN	P02531430 PROVIDER NPI	1467901587 EFFECTIVE DATE	04/22/2017 END DATE	 ', NULL, NULL, '2021-05-17 13:08:31', '2021-05-17 13:08:31'),
(29274, 3046, 23077, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 09:00:00', '2021-03-18 09:00:00'),
(29275, 1006, 23077, NULL, '2021-05-24 00:00:00.000', 'Approved', 'PTAN: P02442337 Eff: 01/29/2020 ', NULL, NULL, '2021-05-17 13:10:31', '2021-05-17 13:10:31'),
(29276, 3046, 23078, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 09:00:02', '2021-03-18 09:00:02'),
(29277, 1006, 23078, NULL, '2021-05-24 00:00:00.000', 'Approved', 'PROVIDER NAME	MINI P CHENNEMKARA NP PROVIDER PTAN	P02530830 PROVIDER NPI	1841755956 EFFECTIVE DATE	03/06/2020 END DATE	 ', NULL, NULL, '2021-05-17 13:12:38', '2021-05-17 13:12:38'),
(29278, 3046, 23079, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 09:00:04', '2021-03-18 09:00:04'),
(29279, 1006, 23079, NULL, '2021-05-24 00:00:00.000', 'Initiated', 'Enrollment request submitted via the online portal.   Reference Number :	21137001297 ', NULL, NULL, '2021-05-17 15:32:37', '2021-05-17 15:32:37'),
(29280, 3040, 23079, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare Railroad.', NULL, NULL, '2021-06-07 17:43:18', '2021-06-07 17:43:18'),
(29281, 3046, 23080, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 09:00:05', '2021-03-18 09:00:05'),
(29282, 1006, 23080, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Provider is approved, confirmation attached for reference.  Eff: 03/01/2020', NULL, NULL, '2021-05-17 13:18:25', '2021-05-17 13:18:25'),
(29283, 3046, 23081, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 09:00:06', '2021-03-18 09:00:06'),
(29284, 1006, 23081, NULL, '2021-05-24 00:00:00.000', 'Initiated', 'Enrollment request submitted via the online portal.   Reference Number :	21137001290 ', NULL, NULL, '2021-05-17 15:29:45', '2021-05-17 15:29:45'),
(29285, 3040, 23081, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare Railroad.', NULL, NULL, '2021-06-07 17:43:14', '2021-06-07 17:43:14'),
(29286, 3046, 23082, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 09:00:08', '2021-03-18 09:00:08'),
(29287, 1006, 23082, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Provider is approved with Railroad, approval confirmation is attached for reference.  Eff: 03/01/2020 ', NULL, NULL, '2021-05-17 14:00:53', '2021-05-17 14:00:53'),
(29288, 3046, 23083, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 09:00:10', '2021-03-18 09:00:10'),
(29289, 1006, 23083, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is enrolled with the insurance, approval is attached for reference. Eff: 01/22/2020', NULL, NULL, '2021-05-17 14:16:31', '2021-05-17 14:16:31'),
(29290, 3046, 23084, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 09:00:12', '2021-03-18 09:00:12'),
(29291, 1006, 23084, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Provider is showing linked with medicare railroad and effective date is 08/13/2018 ', NULL, NULL, '2021-05-17 14:18:23', '2021-05-17 14:18:23'),
(29292, 3046, 23085, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 09:00:13', '2021-03-18 09:00:13'),
(29293, 1006, 23085, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Provider is showing linked with medicare railroad and effective date is 01/06/2015. Screenshot is attached   ', NULL, NULL, '2021-05-17 12:02:22', '2021-05-17 12:02:22'),
(29294, 3046, 23086, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 09:00:16', '2021-03-18 09:00:16'),
(29295, 1006, 23086, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Effective date: 03/19/2020 Rail Road PTAN: P02442476 ', NULL, NULL, '2021-05-17 14:24:27', '2021-05-17 14:24:27'),
(29296, 3046, 23087, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 09:00:19', '2021-03-18 09:00:19'),
(29297, 1006, 23087, NULL, '2021-05-24 00:00:00.000', 'Approved', 'PROVIDER NAME	ANI STEPHEN NP PROVIDER PTAN	P02531565 PROVIDER NPI	1588959118 EFFECTIVE DATE	02/07/2020 END DATE	 ', NULL, NULL, '2021-05-17 14:26:46', '2021-05-17 14:26:46'),
(29298, 3046, 23088, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 12:26:10', '2021-03-18 12:26:10'),
(29299, 3040, 23088, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:48:04', '2021-05-31 15:48:04'),
(29300, 3040, 23088, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:20:30', '2021-06-17 12:20:30'),
(29301, 3040, 23088, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:29', '2021-07-06 13:38:29'),
(29302, 3040, 23088, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:27', '2021-07-06 13:42:27'),
(29303, 3040, 23088, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:02', '2021-07-26 16:39:02'),
(29304, 11056, 23088, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:22:01', '2021-08-13 15:22:01'),
(29305, 3040, 23088, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:38', '2021-08-26 08:45:38'),
(29306, 10057, 23088, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:50:52', '2021-10-08 13:50:52'),
(29307, 10057, 23088, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:06:36', '2021-10-21 11:06:36'),
(29308, 10057, 23088, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:50:22', '2021-10-29 09:50:22'),
(29309, 10057, 23088, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:36:16', '2021-11-22 13:36:16'),
(29310, 10057, 23088, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:26:14', '2021-12-02 14:26:14'),
(29311, 10057, 23088, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:52:57', '2021-12-09 11:52:57'),
(29312, 10057, 23088, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:55:47', '2021-12-16 14:55:47'),
(29313, 10057, 23088, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:49:07', '2021-12-22 13:49:07'),
(29314, 10057, 23088, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:03:50', '2021-12-29 12:03:50'),
(29315, 20067, 23088, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:58:58', '2022-01-12 14:58:58'),
(29316, 20067, 23088, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:56:41', '2022-01-19 09:56:41'),
(29317, 20067, 23088, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:24:40', '2022-01-28 10:24:40'),
(29318, 20067, 23088, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061  Thanks & Regards, Syed Ahad ', NULL, NULL, '2022-03-01 15:27:12', '2022-03-01 15:27:12'),
(29319, 22077, 23088, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response!  Thanks & Regards.', NULL, NULL, '2022-04-18 11:57:37', '2022-04-18 11:57:37'),
(29320, 3046, 23089, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 12:26:12', '2021-03-18 12:26:12'),
(29321, 3040, 23089, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:48:07', '2021-05-31 15:48:07'),
(29322, 3040, 23089, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:20:27', '2021-06-17 12:20:27'),
(29323, 3040, 23089, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:26', '2021-07-06 13:38:26'),
(29324, 3040, 23089, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:26', '2021-07-06 13:42:26'),
(29325, 3040, 23089, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:01', '2021-07-26 16:39:01'),
(29326, 11056, 23089, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:21:53', '2021-08-13 15:21:53'),
(29327, 3040, 23089, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:38', '2021-08-26 08:45:38'),
(29328, 10057, 23089, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:48:38', '2021-10-08 13:48:38'),
(29329, 10057, 23089, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:06:30', '2021-10-21 11:06:30'),
(29330, 10057, 23089, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:50:16', '2021-10-29 09:50:16'),
(29331, 10057, 23089, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:36:09', '2021-11-22 13:36:09'),
(29332, 10057, 23089, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:26:08', '2021-12-02 14:26:08'),
(29333, 10057, 23089, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:52:50', '2021-12-09 11:52:50'),
(29334, 10057, 23089, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:55:41', '2021-12-16 14:55:41'),
(29335, 10057, 23089, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:49:00', '2021-12-22 13:49:00'),
(29336, 10057, 23089, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:03:45', '2021-12-29 12:03:45'),
(29337, 20067, 23089, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:58:48', '2022-01-12 14:58:48'),
(29338, 20067, 23089, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:56:35', '2022-01-19 09:56:35'),
(29339, 20067, 23089, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:24:45', '2022-01-28 10:24:45'),
(29340, 20067, 23089, NULL, '2022-03-03 00:00:00.000', 'Approved', 'Received an attached roster,  Effective Date: 02/01/2022 Provider ID: PR00002350903 ', NULL, NULL, '2022-02-24 12:26:19', '2022-02-24 12:26:19'),
(29341, 3046, 23090, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 12:26:14', '2021-03-18 12:26:14'),
(29342, 3040, 23090, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:48:10', '2021-05-31 15:48:10');
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
(29343, 3040, 23090, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:20:23', '2021-06-17 12:20:23'),
(29344, 3040, 23090, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:23', '2021-07-06 13:38:23'),
(29345, 3040, 23090, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:25', '2021-07-06 13:42:25'),
(29346, 3040, 23090, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:01', '2021-07-26 16:39:01'),
(29347, 11056, 23090, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:21:46', '2021-08-13 15:21:46'),
(29348, 3040, 23090, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:37', '2021-08-26 08:45:37'),
(29349, 10057, 23090, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:48:21', '2021-10-08 13:48:21'),
(29350, 10057, 23090, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:06:23', '2021-10-21 11:06:23'),
(29351, 10057, 23090, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:50:10', '2021-10-29 09:50:10'),
(29352, 10057, 23090, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:36:03', '2021-11-22 13:36:03'),
(29353, 10057, 23090, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:26:02', '2021-12-02 14:26:02'),
(29354, 10057, 23090, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:52:42', '2021-12-09 11:52:42'),
(29355, 10057, 23090, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:55:35', '2021-12-16 14:55:35'),
(29356, 10057, 23090, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:48:53', '2021-12-22 13:48:53'),
(29357, 10057, 23090, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:03:40', '2021-12-29 12:03:40'),
(29358, 20067, 23090, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:58:41', '2022-01-12 14:58:41'),
(29359, 20067, 23090, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:56:30', '2022-01-19 09:56:30'),
(29360, 20067, 23090, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:24:52', '2022-01-28 10:24:52'),
(29361, 20067, 23090, NULL, '2022-03-03 00:00:00.000', 'Approved', 'Received an attached roster.  Effective Date:02/01/2022 Provider ID: PR00002350906 ', NULL, NULL, '2022-02-24 12:24:40', '2022-02-24 12:24:40'),
(29362, 3046, 23091, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 12:26:16', '2021-03-18 12:26:16'),
(29363, 3040, 23091, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:48:15', '2021-05-31 15:48:15'),
(29364, 3040, 23091, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:20:20', '2021-06-17 12:20:20'),
(29365, 3040, 23091, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:20', '2021-07-06 13:38:20'),
(29366, 3040, 23091, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:25', '2021-07-06 13:42:25'),
(29367, 3040, 23091, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:00', '2021-07-26 16:39:00'),
(29368, 11056, 23091, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:21:35', '2021-08-13 15:21:35'),
(29369, 3040, 23091, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:37', '2021-08-26 08:45:37'),
(29370, 10057, 23091, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:48:01', '2021-10-08 13:48:01'),
(29371, 10057, 23091, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:06:18', '2021-10-21 11:06:18'),
(29372, 10057, 23091, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:50:04', '2021-10-29 09:50:04'),
(29373, 10057, 23091, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:35:57', '2021-11-22 13:35:57'),
(29374, 10057, 23091, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:25:54', '2021-12-02 14:25:54'),
(29375, 10057, 23091, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:52:36', '2021-12-09 11:52:36'),
(29376, 10057, 23091, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:55:29', '2021-12-16 14:55:29'),
(29377, 10057, 23091, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:48:46', '2021-12-22 13:48:46'),
(29378, 10057, 23091, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:03:33', '2021-12-29 12:03:33'),
(29379, 20067, 23091, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:58:34', '2022-01-12 14:58:34'),
(29380, 20067, 23091, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:56:23', '2022-01-19 09:56:23'),
(29381, 20067, 23091, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:24:59', '2022-01-28 10:24:59'),
(29382, 20067, 23091, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061  Thanks & Regards, Syed Ahad ', NULL, NULL, '2022-03-01 15:27:05', '2022-03-01 15:27:05'),
(29383, 22077, 23091, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response!  Thanks & Regards.', NULL, NULL, '2022-04-18 12:00:49', '2022-04-18 12:00:49'),
(29384, 3046, 23092, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 12:26:18', '2021-03-18 12:26:18'),
(29385, 3040, 23092, NULL, '2021-06-07 00:00:00.000', 'In Process', NULL, NULL, NULL, '2021-05-31 15:48:18', '2021-05-31 15:48:18'),
(29386, 3040, 23092, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:48:22', '2021-05-31 15:48:22'),
(29387, 3040, 23092, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:20:17', '2021-06-17 12:20:17'),
(29388, 3040, 23092, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:17', '2021-07-06 13:38:17'),
(29389, 3040, 23092, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:24', '2021-07-06 13:42:24'),
(29390, 3040, 23092, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:00', '2021-07-26 16:39:00'),
(29391, 11056, 23092, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:21:27', '2021-08-13 15:21:27'),
(29392, 3040, 23092, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:36', '2021-08-26 08:45:36'),
(29393, 10057, 23092, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:47:34', '2021-10-08 13:47:34'),
(29394, 10057, 23092, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:06:10', '2021-10-21 11:06:10'),
(29395, 10057, 23092, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:49:58', '2021-10-29 09:49:58'),
(29396, 10057, 23092, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:35:51', '2021-11-22 13:35:51'),
(29397, 10057, 23092, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:25:47', '2021-12-02 14:25:47'),
(29398, 10057, 23092, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:52:29', '2021-12-09 11:52:29'),
(29399, 10057, 23092, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:55:23', '2021-12-16 14:55:23'),
(29400, 10057, 23092, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:48:40', '2021-12-22 13:48:40'),
(29401, 10057, 23092, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:03:26', '2021-12-29 12:03:26'),
(29402, 20067, 23092, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:58:26', '2022-01-12 14:58:26'),
(29403, 20067, 23092, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:56:16', '2022-01-19 09:56:16'),
(29404, 20067, 23092, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:25:04', '2022-01-28 10:25:04'),
(29405, 20067, 23092, NULL, '2022-03-03 00:00:00.000', 'Approved', 'Received an attached roster.  Effective Date: 02/01/2022 Provider ID: PR00002350904 ', NULL, NULL, '2022-02-24 12:22:00', '2022-02-24 12:22:00'),
(29406, 3046, 23093, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 12:26:19', '2021-03-18 12:26:19');
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
(29407, 3040, 23093, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: axhartma@texaschildrens.org  Subject: TCHP Welcome Letter - Mini P. Chennemkara, FNP-C - Normandy Urgent Care Center PA - 3 Houston Addresses  Good Evening,  Welcome to TCHP. Mini P. Chennemkara, FNP-C is now participating with Texas Children’s Health Plan under Normandy Urgent Care Center PA at Normandy St, Imperial Valley Dr., and Long Pointe Rd . Attached you will find a welcome letter with an effective date for all contracted products as well as the contact information for your Provider Relations Representative.  Please reach out to your PR Rep or the main Contracting Department phone line at (832) 828-1063 with any questions.  Thank you,', NULL, NULL, '2021-05-04 08:35:48', '2021-05-04 08:35:48'),
(29408, 20067, 23093, NULL, '2022-03-03 00:00:00.000', 'Approved', 'Received an attached roster  Effective Date: 05/01/2021 Provider ID: PR00002344284 ', NULL, NULL, '2022-02-24 12:19:47', '2022-02-24 12:19:47'),
(29409, 3046, 23094, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 12:26:20', '2021-03-18 12:26:20'),
(29410, 3040, 23094, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Location Addition || Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Vibitha || TCHP  Greetings,  Hope you are doing well. Please find the attached PIF form along with W9 to add the below provider in the locations.   Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-19 12:19:44', '2021-03-19 12:19:44'),
(29411, 3040, 23094, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:48:28', '2021-05-31 15:48:28'),
(29412, 3040, 23094, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:20:15', '2021-06-17 12:20:15'),
(29413, 3040, 23094, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:13', '2021-07-06 13:38:13'),
(29414, 3040, 23094, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:19', '2021-07-06 13:42:19'),
(29415, 3040, 23094, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:38:59', '2021-07-26 16:38:59'),
(29416, 11056, 23094, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:21:19', '2021-08-13 15:21:19'),
(29417, 3040, 23094, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:36', '2021-08-26 08:45:36'),
(29418, 10057, 23094, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:47:04', '2021-10-08 13:47:04'),
(29419, 10057, 23094, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:06:04', '2021-10-21 11:06:04'),
(29420, 10057, 23094, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:49:52', '2021-10-29 09:49:52'),
(29421, 10057, 23094, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:35:45', '2021-11-22 13:35:45'),
(29422, 10057, 23094, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:25:40', '2021-12-02 14:25:40'),
(29423, 10057, 23094, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:52:23', '2021-12-09 11:52:23'),
(29424, 10057, 23094, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:55:17', '2021-12-16 14:55:17'),
(29425, 10057, 23094, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:48:34', '2021-12-22 13:48:34'),
(29426, 10057, 23094, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:03:21', '2021-12-29 12:03:21'),
(29427, 20067, 23094, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:58:18', '2022-01-12 14:58:18'),
(29428, 20067, 23094, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:56:08', '2022-01-19 09:56:08'),
(29429, 20067, 23094, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:25:12', '2022-01-28 10:25:12'),
(29430, 20067, 23094, NULL, '2022-03-03 00:00:00.000', 'Approved', 'Received an attached roster.  Effective Date: 10/14/2020 Provider ID: PR00002341625 ', NULL, NULL, '2022-02-24 12:17:45', '2022-02-24 12:17:45'),
(29431, 3046, 23095, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 12:26:21', '2021-03-18 12:26:21'),
(29432, 3040, 23095, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:48:31', '2021-05-31 15:48:31'),
(29433, 3040, 23095, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:20:11', '2021-06-17 12:20:11'),
(29434, 3040, 23095, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:10', '2021-07-06 13:38:10'),
(29435, 3040, 23095, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:18', '2021-07-06 13:42:18'),
(29436, 3040, 23095, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:38:58', '2021-07-26 16:38:58'),
(29437, 11056, 23095, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:21:12', '2021-08-13 15:21:12'),
(29438, 3040, 23095, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:36', '2021-08-26 08:45:36'),
(29439, 10057, 23095, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:45:15', '2021-10-08 13:45:15'),
(29440, 10057, 23095, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:05:58', '2021-10-21 11:05:58'),
(29441, 10057, 23095, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:49:46', '2021-10-29 09:49:46'),
(29442, 10057, 23095, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:35:20', '2021-11-22 13:35:20'),
(29443, 10057, 23095, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:35:38', '2021-11-22 13:35:38'),
(29444, 10057, 23095, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:25:33', '2021-12-02 14:25:33'),
(29445, 10057, 23095, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:52:16', '2021-12-09 11:52:16'),
(29446, 10057, 23095, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:55:10', '2021-12-16 14:55:10'),
(29447, 10057, 23095, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:48:28', '2021-12-22 13:48:28'),
(29448, 10057, 23095, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:03:16', '2021-12-29 12:03:16'),
(29449, 20067, 23095, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:58:06', '2022-01-12 14:58:06'),
(29450, 20067, 23095, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:56:02', '2022-01-19 09:56:02'),
(29451, 20067, 23095, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:25:18', '2022-01-28 10:25:18'),
(29452, 20067, 23095, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061  Thanks & Regards, Syed Ahad ', NULL, NULL, '2022-03-01 15:26:59', '2022-03-01 15:26:59'),
(29453, 22077, 23095, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response!  Thanks & Regards.', NULL, NULL, '2022-04-18 12:00:29', '2022-04-18 12:00:29'),
(29454, 3046, 23096, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 12:26:23', '2021-03-18 12:26:23'),
(29455, 3040, 23096, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:48:36', '2021-05-31 15:48:36'),
(29456, 3040, 23096, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:20:08', '2021-06-17 12:20:08'),
(29457, 3040, 23096, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:08', '2021-07-06 13:38:08'),
(29458, 3040, 23096, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:18', '2021-07-06 13:42:18'),
(29459, 3040, 23096, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:38:58', '2021-07-26 16:38:58'),
(29460, 11056, 23096, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:21:05', '2021-08-13 15:21:05'),
(29461, 3040, 23096, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:35', '2021-08-26 08:45:35'),
(29462, 10057, 23096, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:44:58', '2021-10-08 13:44:58'),
(29463, 10057, 23096, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:05:52', '2021-10-21 11:05:52'),
(29464, 10057, 23096, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:49:40', '2021-10-29 09:49:40'),
(29465, 10057, 23096, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:35:13', '2021-11-22 13:35:13');
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
(29466, 10057, 23096, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:25:28', '2021-12-02 14:25:28'),
(29467, 10057, 23096, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:52:10', '2021-12-09 11:52:10'),
(29468, 10057, 23096, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:55:04', '2021-12-16 14:55:04'),
(29469, 10057, 23096, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:48:21', '2021-12-22 13:48:21'),
(29470, 10057, 23096, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:03:11', '2021-12-29 12:03:11'),
(29471, 20067, 23096, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:57:54', '2022-01-12 14:57:54'),
(29472, 20067, 23096, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:55:56', '2022-01-19 09:55:56'),
(29473, 20067, 23096, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:25:23', '2022-01-28 10:25:23'),
(29474, 20067, 23096, NULL, '2022-03-03 00:00:00.000', 'Approved', 'Received an attached roster.  Effective Date: 12/08/2021 Provider ID: PR00002265158 ', NULL, NULL, '2022-02-24 12:13:47', '2022-02-24 12:13:47'),
(29475, 3046, 23097, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 12:26:27', '2021-03-18 12:26:27'),
(29476, 3040, 23097, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:48:39', '2021-05-31 15:48:39'),
(29477, 3040, 23097, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:20:05', '2021-06-17 12:20:05'),
(29478, 3040, 23097, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:06', '2021-07-06 13:38:06'),
(29479, 3040, 23097, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:17', '2021-07-06 13:42:17'),
(29480, 3040, 23097, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:38:57', '2021-07-26 16:38:57'),
(29481, 11056, 23097, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:20:58', '2021-08-13 15:20:58'),
(29482, 3040, 23097, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:35', '2021-08-26 08:45:35'),
(29483, 10057, 23097, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:44:17', '2021-10-08 13:44:17'),
(29484, 10057, 23097, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:05:45', '2021-10-21 11:05:45'),
(29485, 10057, 23097, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:49:34', '2021-10-29 09:49:34'),
(29486, 10057, 23097, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:35:06', '2021-11-22 13:35:06'),
(29487, 10057, 23097, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:25:18', '2021-12-02 14:25:18'),
(29488, 10057, 23097, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:51:52', '2021-12-09 11:51:52'),
(29489, 10057, 23097, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:54:58', '2021-12-16 14:54:58'),
(29490, 10057, 23097, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:48:14', '2021-12-22 13:48:14'),
(29491, 10057, 23097, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:03:05', '2021-12-29 12:03:05'),
(29492, 20067, 23097, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:57:46', '2022-01-12 14:57:46'),
(29493, 20067, 23097, NULL, '2022-01-26 00:00:00.000', 'In Process', '', NULL, NULL, '2022-01-19 09:55:43', '2022-01-19 09:55:43'),
(29494, 20067, 23097, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:25:30', '2022-01-28 10:25:30'),
(29495, 20067, 23097, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061  Thanks & Regards, Syed Ahad ', NULL, NULL, '2022-03-01 15:26:53', '2022-03-01 15:26:53'),
(29496, 22077, 23097, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response!  Thanks & Regards.', NULL, NULL, '2022-04-18 12:00:16', '2022-04-18 12:00:16'),
(29497, 3040, 23098, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:25:24', '2021-03-18 14:25:24'),
(29498, 3040, 23098, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'The insurance is not listed on the new structure sheet by billing team, hence it is not eligible for enrollment. ', NULL, NULL, '2021-06-01 16:43:47', '2021-06-01 16:43:47'),
(29499, 3040, 23099, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:25:52', '2021-03-18 14:25:52'),
(29500, 3040, 23099, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'The insurance is not listed on the new structure sheet by billing team, hence it is not eligible for enrollment. ', NULL, NULL, '2021-06-01 16:43:56', '2021-06-01 16:43:56'),
(29501, 1006, 23102, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:28:26', '2021-03-18 14:28:26'),
(29502, 1019, 23102, NULL, NULL, 'Not Eligible', 'Duplicate task as this plan comes under Beacon Health. ', NULL, NULL, '2021-04-30 10:08:14', '2021-04-30 10:08:14'),
(29503, 1006, 23103, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:28:27', '2021-03-18 14:28:27'),
(29504, 1019, 23103, NULL, NULL, 'Not Eligible', 'Duplicate task as this plan comes under Beacon Health. ', NULL, NULL, '2021-04-30 10:08:26', '2021-04-30 10:08:26'),
(29505, 1006, 23104, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:28:51', '2021-03-18 14:28:51'),
(29506, 1006, 23104, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'This is a redundant task, Tufts Health already covers the Commercial plan.  ', NULL, NULL, '2021-04-21 12:23:04', '2021-04-21 12:23:04'),
(29507, 1006, 23105, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:28:52', '2021-03-18 14:28:52'),
(29508, 1006, 23105, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'This is a redundant task, Tufts Health already covers the Commercial plan.  ', NULL, NULL, '2021-04-21 12:25:51', '2021-04-21 12:25:51'),
(29509, 1006, 23106, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:28:53', '2021-03-18 14:28:53'),
(29510, 1006, 23106, NULL, '2021-04-26 00:00:00.000', 'Not Eligible', 'The redundant task, Tufts Health already covers the Commercial plan. ', NULL, NULL, '2021-04-19 15:51:03', '2021-04-19 15:51:03'),
(29511, 3040, 23107, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:29:45', '2021-03-18 14:29:45'),
(29512, 1005, 23107, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Not receiving the claims on this Insurance as per Billing.', NULL, NULL, '2021-06-07 17:28:44', '2021-06-07 17:28:44'),
(29513, 1006, 23110, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:30:19', '2021-03-18 14:30:19'),
(29514, 1006, 23110, NULL, '2021-04-09 00:00:00.000', 'On Hold', 'Cigna Healthspring is a Medicare Advantage Plan and is pending enrollment with Cigna and Medicare.   ', NULL, NULL, '2021-04-02 20:05:27', '2021-04-02 20:05:27'),
(29515, 1006, 23110, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Left VM @ 800-668-3813 for followup. ', NULL, NULL, '2021-05-26 17:14:54', '2021-05-26 17:14:54'),
(29516, 1006, 23110, NULL, '2021-06-04 00:00:00.000', 'Initiated', 'Sent following email @ TXMAContracting@cigna.com:  Sub: Enrollment Request - RSM - Cigna Healthspring  \"Hello,   Please find the attached enrollment requests for our group and providers, please let me know if you have any questions or if anything else is required.  Thank you.\"', NULL, NULL, '2021-05-28 11:50:50', '2021-05-28 11:50:50'),
(29517, 1006, 23110, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com & txgqproviderrelations@healthspring.com:  Sub: Enrollment Status - RSM - Cigna Healthspring  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers, we submitted an enrollment application for them back in May:  Group Name: Right Step Medical Center LLC NPI# 1063008084TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me on the status of these as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-16 15:18:32', '2021-06-16 15:18:32'),
(29518, 1006, 23110, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following email from \"PEREZ, JENNIFER (JEN) 866\" JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status - BAQC - Cigna Healthspring  \"HI Brad,  I have not seen it come through. I noticed you sent another inquiry for Right Step Medical Center, if you send me both letter of interest forms I can place it on file\"  Sent following reply to her:   \"Hello Jennifer, Here are the facility interest forms for both groups. Please let me know if anything else is required. Thank you!\"', NULL, NULL, '2021-06-21 13:36:54', '2021-06-21 13:36:54'),
(29519, 1006, 23110, NULL, '2021-07-15 00:00:00.000', 'In Process', 'We received the following reply from PEREZ, JENNIFER (JEN) 866 JENNIFER.PEREZ@cigna.com:  Sub: Enrollment Status - BAQC - Cigna Healthspring  \"Thank you Brad! I will provide these to the Network committee, where they will review at our next meeting. Once reviewed, I will get back in touch with you to inform you of their decision.\"  Sent f/u email:  \"Hello Jennifer,   I hope you\'re doing well, I wanted to get an update regarding the enrollment request for both of our groups, could you please get back to me as soon as possible?  Thank you.\"', NULL, NULL, '2021-07-08 13:06:19', '2021-07-08 13:06:19'),
(29520, 1006, 23110, NULL, '2021-07-19 00:00:00.000', 'Not Eligible', 'We received a denial letter, stating that there\'s no need for additional providers for the geographic location. The denial letter is attached in the main group task for reference. ', NULL, NULL, '2021-07-12 09:08:17', '2021-07-12 09:08:17'),
(29521, 3040, 23120, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:35:56', '2021-03-18 14:35:56'),
(29522, 3040, 23120, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'Already covered under Multiplan. No Need to add group and providers. ', NULL, NULL, '2021-06-02 15:44:56', '2021-06-02 15:44:56'),
(29523, 3040, 23121, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:36:21', '2021-03-18 14:36:21'),
(29524, 3040, 23121, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 13:58:14', '2021-05-31 13:58:14'),
(29525, 3040, 23121, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 14:43:48', '2021-06-17 14:43:48'),
(29526, 3040, 23121, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com cc:	catherine.chang@careallies.com, shannon.luke@careallies.com,  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 16:48:48', '2021-07-05 16:48:48'),
(29527, 3040, 23121, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Re: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Hello Alanis,   Hope you are doing well. Do you have any update regarding the enrollment for the below mentioned group and providers.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:43:51', '2021-07-26 12:43:51'),
(29528, 11056, 23121, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:23:49', '2021-08-11 16:23:49'),
(29529, 3040, 23121, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:08:45', '2021-08-18 13:08:45'),
(29530, 3046, 23122, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:37:24', '2021-03-18 14:37:24'),
(29531, 1006, 23122, NULL, '2021-05-20 00:00:00.000', 'Initiated', 'Submitted enrollment form for Group and Cynthia as main provider via Wellcare portal:  \"Become A Provider  Your form was submitted successfully.  Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in group task for reference.', NULL, NULL, '2021-05-04 10:19:07', '2021-05-04 10:19:07'),
(29532, 1006, 23122, NULL, '2021-06-17 00:00:00.000', 'In Process', 'I had a word with (John) with Wellcare representative and he advises their network development department will contact us.   Ref: 1012719812', NULL, NULL, '2021-06-10 12:21:13', '2021-06-10 12:21:13'),
(29533, 1006, 23122, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Sent f/u email @ \".ProspectiveProviderTX\" ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Status - BAQC - Wellcare  \"Hello,   I wanted to get an update regarding the enrollment status for our group and providers, we submitted the enrollment application via the website last month. The group and provider information is as follows:  Group Name: Bay Area Quick Care LLC NPI# 1437481421 TIN# 27-1702009 Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  Please get back to me on the updated status of the enrollment.  Thank you!\"', NULL, NULL, '2021-06-29 11:06:22', '2021-06-29 11:06:22'),
(29534, 1006, 23122, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ \".ProspectiveProviderTX\" ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Status - BAQC - Wellcare  \"Hello,   I hope you\'re doing well, please get back to me on the enrollment request for our group and providers.  Thank you!\"', NULL, NULL, '2021-07-23 16:47:57', '2021-07-23 16:47:57'),
(29535, 1006, 23122, NULL, '2021-08-05 00:00:00.000', 'In Process', 'Received response:  \"What is the TIN & NPI?  Thank you, Leslie Gilchrist Intake Coordinator Contract Management\"  Replied: \"Hello Melissa,   Sure thing, the information is as follows:  Group Name: Bay Area Quick Care PLLC NPI# 1437481421 TIN# 27-1702009  Provider Name: Melissa Ramsden NPI# 1194376228  Thank you. \"', NULL, NULL, '2021-07-29 13:00:16', '2021-07-29 13:00:16'),
(29536, 1006, 23122, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Sent f/u email @ SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello Lucy,   I just wanted to check with you if there had been any new updates, please let me know.   Thank you. \"', NULL, NULL, '2021-08-10 16:22:21', '2021-08-10 16:22:21'),
(29537, 11056, 23122, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good morning!  Hope this email finds you well. I wanted to get an latest updates regarding the enrollment status of the following providers and practice:  Practice Details: Practice Name: Bay Area Quick Care LLC Practice NPI# 1437481421 Practice TIN# 27-1702009 Practice Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Details:  Provider name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  If you have any questions or need documents please let me know. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-20 10:36:39', '2021-08-20 10:36:39'),
(29538, 11056, 23122, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com & cynthia.barnett@wellcare.com &  TERESA.Argueta@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good morning!  Hope this email finds you well. I wanted to get an latest updates regarding the enrollment status of the following providers and practice:  Practice Details: Practice Name: Bay Area Quick Care LLC Practice NPI# 1437481421 Practice TIN# 27-1702009 Practice Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Details:  Provider name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  If you have any questions or need documents please let me know. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-30 10:27:58', '2021-08-30 10:27:58'),
(29539, 11056, 23122, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email sent to : Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good morning Cynthia!  Hope this email finds you well. Please provide me with someone who can respond to my query for Wellcare, because no one hasn\'t responded to me since August. Kindly provide with the representative\'s email or contact no. for this address :Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148.  I will be grateful to you.   Thank you! Have a wonderful Weekend!', NULL, NULL, '2021-09-24 09:20:37', '2021-09-24 09:20:37'),
(29540, 11056, 23122, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good morning!  Hope you are doing great. I am still waiting for the representative details in the Corpus Christi area. Please assist me with that soon.  Eagerly, waiting to hear from you soon.  Thank you! Have a blessed day!  Contacted Miss Cynthia. She informed me that she gonna confirm if they provide services in Corpus christi area or  not.', NULL, NULL, '2021-10-11 10:37:21', '2021-10-11 10:37:21'),
(29541, 11056, 23122, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email received from : Schlonda.Ramee@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE  Good afternoon,     Ahmed, please excuse my tardiness.  The assigned Account Manager is Jetori Campbell. Jetori can be reached at Jetori.campbell@wellcare.com I have also included her in this email.     Jetori, can you please assist Ahmed?     Thanks,     Schlonda Ramee Jackson, Notary Public  Manager, Provider Network, G&A-Provider Relations     4888 Loop Central Drive, Suite 300  Houston, Texas 77081  Direct Mobile 713-409-6354  schlonda.rameejackson@wellcare.com | https://www.wellcare.com', NULL, NULL, '2021-10-18 09:22:37', '2021-10-18 09:22:37'),
(29542, 11056, 23122, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email received from : Jetori.Campbell@wellcare.com  Sub : Enrollment Status Updates - BAQC - WELCARE   Good Morning Ahmed,  Thank you for following up on your request to Join Our Network.  You should have received correspondence from Superior Health Plan/ WellCare in response to your request. Once all information is signed and received from both parties; please anticipate up to 90 days for credentialing to be completed.   Please let me know if you have any questions.  Thank You  Ms. JeTori Campbell Provider Account Manager 4888 Loop Central Drive, Suite 300  Houston, Texas 77081 Direct Mobile 972-795-8691 jetori.campbell@wellcare.com | https://www.wellcare.com', NULL, NULL, '2021-10-26 10:18:39', '2021-10-26 10:18:39'),
(29543, 11056, 23122, NULL, '2021-11-11 00:00:00.000', 'In Process', 'Email sent to: Jetori.Campbell@wellcare.com  Sub: Enrollment Status Updates - BAQC - WELCARE  Good morning!  Hope this email finds you well.  We haven\'t received any correspondence yet from the WellCare side. Please do provide the providers & facility enrollment status with WellCare. Please see below the case and emails from our side.  Please assist with the above at your earliest opportunity.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-04 14:46:38', '2021-11-04 14:46:38'),
(29544, 11056, 23122, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email received from: Jetori.Campbell@wellcare.com  Sub: Enrollment Status Updates - BAQC - WELCARE  Good Morning,  Ahmed, I am the account manager once the groups and providers have been loaded the contracting department is responsible for loads and updates on loads. They can be reached at ProspectiveProviderTX@wellcare.com.   Ms. JeTori Campbell Provider Account Manager 4888 Loop Central Drive, Suite 300  Houston, Texas 77081 Direct Mobile 972-795-8691 jetori.campbell@wellcare.com | https://www.wellcare.com', NULL, NULL, '2021-11-18 16:56:52', '2021-11-18 16:56:52');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(29545, 11056, 23122, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  Jetori.Campbell@wellcare.com  Sub:   Enrollment Status Updates - BAQC - WELCARE  Good morning!  Hope this email finds you well. Is Wellcare comes Under Medicare or Medicaid? And if both tell me with plans which come under Medicare only and enrolling process to enroll in them only.  Eagerly waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:11:37', '2021-12-01 12:11:37'),
(29546, 11056, 23122, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email sent to:  Jetori.Campbell@wellcare.com   Sub:  Enrollment Status Updates - BAQC - WELCARE    Good Morning,  WellCare is a Medicare Advantage plan only at this time.     Thank you', NULL, NULL, '2021-12-08 13:41:25', '2021-12-08 13:41:25'),
(29547, 11056, 23122, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  Jetori.Campbell@wellcare.com   Sub:  Enrollment Status Updates - BAQC - WELLCARE   Good afternoon!  Hope this email finds you well.  What do you mean by only at this time? Is it going to be changed in the future? If Yes, what are we going to do then?  Please elaborate on this and provide a detailed explanation about it.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 18:00:57', '2021-12-16 18:00:57'),
(29548, 11056, 23122, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Enrollment Status Updates - BAQC - WELLCARE   Dear Provider,   Superior Healthplan received the credentialing documents on 10/13/2021 for all the providers listed below. At this time they are all currently in credentialing which can take up to 90 days.  Sincerely,     Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-12-22 17:16:09', '2021-12-22 17:16:09'),
(29549, 19067, 23122, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Jetori.Campbell@wellcare.com  Subject: Enrollment Query || BAQC || Kynda, Cynthia & Group || Wellcare ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Providers and Group with Wellcare.   Group Name	Bay Area Quick Care Tax ID	27-1702009 Group NPI	1437481421 Provider Name	NPI	Location Kynda Orsak	1528553724	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148 Cynthia Malowitz	1336173244	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:23:48', '2021-12-30 14:23:48'),
(29550, 19067, 23122, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Query || BAQC || Kynda, Cynthia & Group || Wellcare |   Good Morning,    Happy New Year.     Both providers are still processing and are currently with the cred dept. Please keep in mind that it can take up to 90 days from the date Superior received the completed cred docs. Once they are credentialed by Superior then WellCare will get the files to load.     William Francis- NPI# 1457994436  cred docs were received on 10/13/2021     Kynda Orsak- NPI# 1528553724  cred docs were received on 10/13/2021', NULL, NULL, '2022-01-09 20:20:09', '2022-01-09 20:20:09'),
(29551, 19067, 23122, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Query || BAQC || Kynda, Cynthia & Group || Wellcare ||   Hello!  Hope this email finds you well.  Any updates on this?  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-14 10:41:45', '2022-01-14 10:41:45'),
(29552, 19067, 23122, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Jetori.Campbell@wellcare.com  Subject: Re: Enrollment Query || BAQC || Kynda, Cynthia & Group || Wellcare ||    Greetings!  Any updates on the request mentioned below?   Kindly respond promptly.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-20 20:10:03', '2022-01-20 20:10:03'),
(29553, 1019, 23122, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Received the following email from ProspectiveProviderTX@wellcare.com  Both providers are still processing and are currently with the cred dept. Please keep in mind that it can take up to 90 days from the date Superior received the completed cred docs.     William Francis- NPI# 1457994436  C58035- credentialing, cred docs were received on 10/13/2021     Kynda Orsak- NPI# 1528553724  C58036- credentialing, cred docs were received on 10/13/2021    Sincerely,     Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com  1634667499561', NULL, NULL, '2022-02-02 12:16:18', '2022-02-02 12:16:18'),
(29554, 19067, 23122, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Jetori.Campbell@wellcare.com  Subject: Re: Enrollment Query || BAQC || Kynda, Cynthia & Group || Wellcare ||   Hello!  Hope you are doing well. Kindly provide the enrollment status of the following providers with Wellcare.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary & Billing Location	9929 South Padre Island Drive Suite 10, Corpus Christi, TX 78418 Provider	NPI Cynthia Malowitz	1336173244 Kynda Orsak	1528553724  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-15 11:34:48', '2022-02-15 11:34:48'),
(29555, 19067, 23122, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Query || BAQC || Kynda, Cynthia & Group || Wellcare ||   Good Morning!  Any updates on the request below? Have the providers been credentialed?  Thanks, Hammad Ahmed.', NULL, NULL, '2022-03-09 11:22:38', '2022-03-09 11:22:38'),
(29556, 22077, 23122, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Query || BAQC || Kynda, Cynthia & Group || Wellcare ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 08:04:46', '2022-04-22 08:04:46'),
(29557, 3040, 23123, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:37:32', '2021-03-18 14:37:32'),
(29558, 3040, 23123, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - NUCC- TRPN  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 16:57:40', '2021-05-28 16:57:40'),
(29559, 3040, 23123, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067    Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-17 08:30:34', '2021-06-17 08:30:34'),
(29560, 3040, 23123, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group under the below mentioned locations. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429  Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:- Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067   Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI : 1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 15:25:54', '2021-07-05 15:25:54'),
(29561, 3040, 23123, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Mini Chennemkara is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 03/01/2016,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider James Piccione is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 05/29/2019,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/01/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Jeemol George is Active, effective date 06/09/2020,  Provider Julie Jose is Active, effective date 06/09/2020,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com', NULL, NULL, '2021-07-20 09:06:02', '2021-07-20 09:06:02'),
(29562, 3046, 23131, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:40:30', '2021-03-18 14:40:30'),
(29563, 9057, 23131, NULL, '2021-06-08 00:00:00.000', 'Initiated', 'We Sent an email to: CSHNproviderrelations@christushealth.org Sub: Requisition of Enrollment - BAQC - Christus Spohn  Hello, Hope you are doing well, We wish to enroll our group and providers, find details given below.   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Provider Name: Francis, William: NPI# 1457994436  If you need any more details, please let me know.  Thank you', NULL, NULL, '2021-06-01 09:58:51', '2021-06-01 09:58:51'),
(29564, 1006, 23131, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Sent f/u email @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Status - BAQC - Christus Spohn  \"Hello,   I wanted to get an update regarding the enrollment query we submitted for the following group and providers, their information is as follows:   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009  Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Provider Name: Francis, William: NPI# 1457994436  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-17 10:47:12', '2021-06-17 10:47:12'),
(29565, 11056, 23131, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to :   CSHNproviderrelations@christushealth.org  Sub : Enrollment Status - BAQC - Christus Spohn  Greetings,  Hope you are doing well. I wanted to get an update regarding the enrollment query we submitted for the following group and providers, their information is as follows:   Practice: Practice Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Providers: Provider name: Orsak, Kynda NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Provider Name: Francis, William: NPI# 1457994436  Please get back to me as soon as possible. Kindly Respond.  Thank you!', NULL, NULL, '2021-07-06 15:45:10', '2021-07-06 15:45:10'),
(29566, 1006, 23131, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ \"Guerra, Vicki A.\" vicki.guerra@christushealth.org ', NULL, NULL, '2021-07-27 16:33:41', '2021-07-27 16:33:41'),
(29567, 1006, 23131, NULL, '2021-08-12 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Enrollment Status - BAQC - Christus Spohn  \"Hi Brad,  Happy Thursday!  Does this provider group have hospital affiliations with a Christus facility? Or, is there a physician this group utilizes who does have hospital affiliations?  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Replied with:  \"Hello Vicki,   The group and provider do have a supervising physician David Gray (NPI# 1902814874) who has hospital affiliations. Please let me know if this works for you?  Thank you. \"', NULL, NULL, '2021-08-05 12:38:36', '2021-08-05 12:38:36'),
(29568, 1006, 23131, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'We received the following denial notification from vicki.guerra@christushealth.org:  Sub: Gray MD Affiliations Expired: Enrollment Status - BAQC - Christus Spohn  \"Hi Brad,  I reviewed Dr. Grays affiliations and they have expired with the hospital. Please see the attached. Dr. Gray will need to be credentialed again with the hospital in order for the group to be extended a contract. He may have missed his reappointment. Please see attached documentation.  Is this possible for Dr. Gray or yourself to reach out to medical staff administration and inquire?  Medical Staff Administration Tel: (361) 881-3151 Fax: (361) 881-3714  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"', NULL, NULL, '2021-08-18 10:57:17', '2021-08-18 10:57:17'),
(29569, 3040, 23137, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:42:58', '2021-03-18 14:42:58'),
(29570, 3040, 23137, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'Already covered under Multiplan. No Need to add group and providers. ', NULL, NULL, '2021-06-02 15:45:06', '2021-06-02 15:45:06'),
(29571, 3040, 23138, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:43:25', '2021-03-18 14:43:25'),
(29572, 3040, 23138, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 14:01:07', '2021-05-31 14:01:07'),
(29573, 3040, 23138, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 13:51:09', '2021-06-17 13:51:09'),
(29574, 11056, 23138, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to :  TXGQProviderRelations@healthspring.com  Sub:  ENROLLMENT INFORMATION OF PROVIDERS- LPMC - Renaissance Physicians   Greetings,  Hope you are doing well. Here is the information of the providers filled in the form which you asked for and kindly see the attachments under below.  Practice Details:  Practice Name:Longpoint Medical Center  Practice Tax ID# 76-0612416  Practice NPI# 1770763815  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 16:    Provider Name: Joseph, Molly  Provider NPI# 1396380077     If you need further more information please feel free to call or email me. Waiting to hear from you soon.      Thank you! ', NULL, NULL, '2021-06-22 13:15:40', '2021-06-22 13:15:40'),
(29575, 3040, 23138, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com, Chukwuma.Ezeokoli@careallies.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello Ezeokoli!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Renaissance Physicians in our group Longpoint Medical Center under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-05 16:42:52', '2021-07-05 16:42:52'),
(29576, 3040, 23138, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: Chukwuma.Ezeokoli@careallies.com  Subject: RE: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hi Adil,  Thank you for your interest in joining the Renaissance Physicians Organization (RPO) network! Attached you will find a Letter of Interest, which is required for all prospective providers. Upon completion of the LOI, the West Houston Board will review and determine whether or not Longpoint Medical Center will be added to the network.  Can you please complete the attached Letter of Interest and return it to me at your earliest convenience? Additionally, can you clarify whether you are looking to contract as PCPs in our network or are you looking to contract as an Urgent Care provider?  Feel free to reach out with any questions!  Best, Chuma  Chuma Ezeokoli Network Operations Senior Analyst  CareAllies 2800 North Loop West, Suite 600 Houston, Texas 77092 Email:          Chukwuma.Ezeokoli@CareAllies.com Cell:             +1.832.206.0656 Fax:             +1.832.553.3418   cid:image001.png@01D2E428.EC444E90', NULL, NULL, '2021-07-26 12:54:25', '2021-07-26 12:54:25'),
(29577, 3040, 23138, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com  Subject: Re: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello Chuma,   Please note that we already sent the forms at TXGQProviderRelations@healthspring.com on 06/22/2021.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:56:18', '2021-07-26 12:56:18'),
(29578, 11056, 23138, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to  :  Chukwuma.Ezeokoli@careallies.   & TXGQProviderRelations@healthspring.com  Sub : Fwd: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:43:59', '2021-08-11 16:43:59'),
(29579, 3040, 23138, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com  Subject: Re: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello, Ezeokoli,   I wanted to know the enrollment status for the below mentioned providers and practice in Renaissance Physician in our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-09-07 11:24:53', '2021-09-07 11:24:53'),
(29580, 10057, 23138, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : Chukwuma.Ezeokoli@careallies.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practice. Please get back to me as soon as you get a chance.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Thomas, Cini	1134777238 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 John, Jeny	1073019493 Joseph, Molly	1396380077  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 14:51:58', '2021-10-18 14:51:58'),
(29581, 10057, 23138, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : Chukwuma.Ezeokoli@careallies.com, providerservices@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello,  Hope all is well with you. Can I get the latest updates on below mentioned request.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 16:10:25', '2021-11-23 16:10:25'),
(29582, 10057, 23138, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : kjones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Thank you for the update. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-03 15:52:45', '2021-12-03 15:52:45'),
(29583, 10057, 23138, NULL, '2021-12-22 00:00:00.000', 'Not Eligible', 'Email Received From : KJones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good afternoon! We received your inquiry below. We do not deal with any kind of medical facility we are a dental insurance carrier only. This was sent to us in error. Thanks  *** After discuss with ALEX did it not eligible *** Steve Albert', NULL, NULL, '2021-12-15 13:13:14', '2021-12-15 13:13:14'),
(29584, 3040, 23140, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:45:01', '2021-03-18 14:45:01'),
(29585, 3040, 23140, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - NUCC- TRPN  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 17:04:13', '2021-05-28 17:04:13'),
(29586, 11056, 23140, NULL, '2021-06-24 00:00:00.000', 'In Process', 'EMAIL sent to : lpmc@claimsmedinc.com  Sub:  Provider Update Information Form- TRPN  Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI: 1770763815 Practice TIN: 76-0612416 Primary Address: 9504 LONG POINT RD STE EHouston , TX 77055-4226  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 8:  Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 9: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 10:  Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 11:  Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 12:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 13:  Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 14:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-17 13:52:06', '2021-06-17 13:52:06'),
(29587, 3040, 23140, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Longpoint Medical Center under the below location. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI: 1770763815 Practice TIN: 76-0612416 Primary Address: 9504 LONG POINT RD STE EHouston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 8:  Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 9: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 10:  Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 11:  Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 12:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 13:  Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 14:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-05 15:37:18', '2021-07-05 15:37:18'),
(29588, 3040, 23140, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject:  Provider Update Information Form- TRPN  Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 01/01/2021,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 01/01/2021,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/28/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Julie Jose is Active, effective date 01/01/2021,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com', NULL, NULL, '2021-07-20 08:04:32', '2021-07-20 08:04:32'),
(29589, 3040, 23143, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:48:33', '2021-03-18 14:48:33'),
(29590, 1006, 23143, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'The insurance is not listed on the new structure sheet by billing team, hence it is not eligible for enrollment. ', NULL, NULL, '2021-06-01 11:03:16', '2021-06-01 11:03:16'),
(29591, 3040, 23144, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:48:45', '2021-03-18 14:48:45'),
(29592, 1006, 23144, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'The insurance is not listed on the new structure sheet by billing team, hence it is not eligible for enrollment. ', NULL, NULL, '2021-06-01 11:03:21', '2021-06-01 11:03:21'),
(29593, 3046, 23155, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:51:39', '2021-03-18 14:51:39'),
(29594, 1006, 23155, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment initiation request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - BHUCC - Christus Spohn   \"Hello, We wish to enroll the following group and providers with Christus Spohn, their information is as follows:  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962 TIN# 84-4737737  Provider Name: Stephane Cyriaque NPI# 1780192633  Provider Name: Shametria Tann NPI# 1124615612  Please let me know what is required to proceed with this process.  Thank you. \"', NULL, NULL, '2021-06-07 10:47:38', '2021-06-07 10:47:38'),
(29595, 1006, 23155, NULL, '2021-07-01 00:00:00.000', 'Not Eligible', 'Christus Spohn service area does not cover Missouri City/Fort Bend County: https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area', NULL, NULL, '2021-06-24 13:43:31', '2021-06-24 13:43:31'),
(29596, 3040, 23160, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:52:18', '2021-03-18 14:52:18'),
(29597, 1006, 23160, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'The insurance is not listed on the new structure sheet by billing team, hence it is not eligible for enrollment. ', NULL, NULL, '2021-06-01 11:20:49', '2021-06-01 11:20:49'),
(29598, 3040, 23161, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:52:57', '2021-03-18 14:52:57'),
(29599, 3040, 23161, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:20:04', '2021-05-18 12:20:04'),
(29600, 3040, 23162, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:53:21', '2021-03-18 14:53:21'),
(29601, 3040, 23162, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 14:36:02', '2021-05-19 14:36:02'),
(29602, 3040, 23162, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:09:39', '2021-06-08 12:09:39'),
(29603, 3040, 23162, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:32:16', '2021-06-08 12:32:16'),
(29604, 3040, 23162, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:43:22', '2021-06-20 16:43:22'),
(29605, 3040, 23164, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:53:47', '2021-03-18 14:53:47'),
(29606, 3040, 23164, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.', NULL, NULL, '2021-05-20 09:33:43', '2021-05-20 09:33:43'),
(29607, 3040, 23164, NULL, '2021-06-16 00:00:00.000', 'In Process', 'I had a word with (Mary J) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: MXJINANG ', NULL, NULL, '2021-06-09 10:03:38', '2021-06-09 10:03:38'),
(29608, 3040, 23164, NULL, '2021-07-05 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-06-28 13:15:40', '2021-06-28 13:15:40'),
(29609, 3040, 23164, NULL, '2021-07-23 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-16 16:44:53', '2021-07-16 16:44:53');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(29610, 11056, 23164, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:45:02', '2021-08-05 13:45:02'),
(29611, 3040, 23164, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:32:14', '2021-09-03 14:32:14'),
(29612, 10057, 23164, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:43:22', '2021-10-18 11:43:22'),
(29613, 10057, 23164, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:39:47', '2021-11-23 17:39:47'),
(29614, 10057, 23164, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-06 13:36:22', '2021-12-06 13:36:22'),
(29615, 10057, 23164, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:05:35', '2021-12-13 13:05:35'),
(29616, 10057, 23164, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:30:57', '2021-12-20 13:30:57'),
(29617, 10057, 23164, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:48:32', '2021-12-27 12:48:32'),
(29618, 10057, 23164, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:10:01', '2021-12-30 14:10:01'),
(29619, 19067, 23164, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:38:18', '2022-01-10 09:38:18'),
(29620, 20067, 23164, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:29:04', '2022-01-19 12:29:04'),
(29621, 20067, 23164, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 06/24/2020 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:57:34', '2022-01-19 17:57:34'),
(29622, 3040, 23165, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:53:55', '2021-03-18 14:53:55'),
(29623, 1006, 23165, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'The insurance is not listed on the new structure sheet by billing team, hence it is not eligible for enrollment. ', NULL, NULL, '2021-06-01 11:21:33', '2021-06-01 11:21:33'),
(29624, 3046, 23177, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:56:18', '2021-03-18 14:56:18'),
(29625, 1006, 23177, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'We submitted a group enrollment request via the Wellcare website:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Enrollment form is attached in the group task for reference. ', NULL, NULL, '2021-06-08 16:30:58', '2021-06-08 16:30:58'),
(29626, 1006, 23177, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received the following reply from ProspectiveProviderTX ProspectiveProviderTX@wellcare.com:  Sub: RE: Become A Provider - Unsecured - Not Applicable - Texas  \"Dear Provider:  Thank you for your interest in joining our network, please allow 30 Calendar days for us to review your request.  Sincerely, Network Management – Texas | www.wellcare.com\"  Sent f/u email:   \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-25 10:19:31', '2021-06-25 10:19:31'),
(29627, 1006, 23177, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent another f/u email @ ProspectiveProviderTX@wellcare.com:  Sub: RE: Become A Provider - Unsecured - Not Applicable - Texas  \"Hello,   I hope you\'re doing well, I\'m still waiting on the status of this enrollment request.  Please get back to me as soon as you\'re able.  Thank you.\"', NULL, NULL, '2021-07-14 17:15:59', '2021-07-14 17:15:59'),
(29628, 1006, 23177, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Sent enrollment requests for providers @ shp.networkdevelopment@superiorhealthplan.com, information updated in their tasks.', NULL, NULL, '2021-07-26 10:07:49', '2021-07-26 10:07:49'),
(29629, 11056, 23177, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Sent enrollment requests for providers @ shp.networkdevelopment@superiorhealthplan.com, information updated in their tasks. ', NULL, NULL, '2021-08-18 16:59:01', '2021-08-18 16:59:01'),
(29630, 11056, 23177, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent enrollment requests for providers @ shp.networkdevelopment@superiorhealthplan.com, information updated in their tasks.', NULL, NULL, '2021-08-24 13:50:31', '2021-08-24 13:50:31'),
(29631, 11056, 23177, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Sent enrollment requests for providers @ shp.networkdevelopment@superiorhealthplan.com, information updated in their tasks.', NULL, NULL, '2021-09-01 14:38:53', '2021-09-01 14:38:53'),
(29632, 11056, 23177, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Rep : Rose S  Katherine Paterson in network 07/01/2021 participating with wellcare  Mercedita Flynn in network 07/01/2021 participating with wellcare  interaction code : 1296311845  application needed for the group.', NULL, NULL, '2021-09-17 17:12:36', '2021-09-17 17:12:36'),
(29633, 11056, 23177, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Rep : Rose S  Katherine Paterson in network 07/01/2021 participating with wellcare  Mercedita Flynn in network 07/01/2021 participating with wellcare  interaction code : 1296311845  application needed for the group.', NULL, NULL, '2021-09-17 17:12:36', '2021-09-17 17:12:36'),
(29634, 11056, 23177, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : TERESA.Argueta@wellcare.com & ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC   Good afternoon!  Hope all is well with you. I want to get the latest update regarding the enrollment status of the below mentioned providers under the facility TIN with Wellcare.   Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  If you have any questions or concerns feel free to reach out to me soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-29 13:25:14', '2021-09-29 13:25:14'),
(29635, 11056, 23177, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Approval Email received from : ProspectiveProviderTX@wellcare.com & cynthia.barnett@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC   New Providers for Costal Bend Urgent Care  Hello,   The providers below are PAR effective 7/1/2021.   Hi Ahmed,  Here is the spreadsheet on your providers for Coastal Bend Urgent Care.  Take care.  Cyn  Please see the attachment.', NULL, NULL, '2021-09-30 14:03:04', '2021-09-30 14:03:04'),
(29636, 11056, 23177, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Hello,   We are in process of loading the contract and provider.   We will let you know once complete.   Signed contract was sent to configuration to load to WellCare 9.10.2021.   Thanks  Network Development', NULL, NULL, '2021-10-07 14:55:54', '2021-10-07 14:55:54'),
(29637, 11056, 23177, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Good afternoon!  Hope this email finds you well. Yes, this request is to add an additional provider highlighted below. And add a secondary location for an already approved provider with the main address.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811 Mercedita Flynn ( Approved ) 1619166188 : Please list the secondary location below this provider.  If you have any questions or require additional information or documents please let me know.   Thank you! Have a great day!', NULL, NULL, '2021-10-14 16:49:14', '2021-10-14 16:49:14'),
(29638, 11056, 23177, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Good Afternoon,   To add an additional provider please submit all requests via our website. Also, this inbox is for contract change requests only. If you need to update demographic or location information, please reach out to your Account Manager.    https://www.wellcare.com/en/Texas/Become-a-Provider', NULL, NULL, '2021-10-22 09:21:24', '2021-10-22 09:21:24'),
(29639, 11056, 23177, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Thank you for the information.  We have already submitted an online application for the provider, Monica Gonzalez.  Please see the attachment.  Thank you!  Application has been submitted and attached.', NULL, NULL, '2021-11-09 16:45:15', '2021-11-09 16:45:15'),
(29640, 11056, 23177, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  ProspectiveProviderTX@wellcare.com  Sub: Add Provider- Katherine Paterson - CBUC & GWMC   Good morning!  Hope all is well with you. Please let us know the credentialing status of the below-mentioned providers with Wellcare.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811 Mercedita Flynn ( Approved ) 1619166188:  Please list the secondary location below this provider in your systems.  Please let us know the Account Manager of our area. And do provide his email & contact no. too.  Thank you! Have a great weekend!', NULL, NULL, '2021-11-24 14:08:20', '2021-11-24 14:08:20'),
(29641, 11056, 23177, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email received from:  ProspectiveProviderTX@wellcare.com  Sub: Add Provider- Katherine Paterson - CBUC & GWMC  Hello,   This provider is still being processed. You will be notified once completed.     Sincerely,     Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-12-06 17:43:12', '2021-12-06 17:43:12'),
(29642, 11056, 23177, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub:  Add Provider- Katherine Paterson - CBUC & GWMC  Good morning!  Hope all is well with you. Please do provide the welcome letter for the provider, Monica Gonzalez. And also confirm about the locations, Have both of the locations been mentioned and listed under the provider? Also, list the provider in the Wellcare provider directory as soon a possible.  Eagerly, waiting for your response.   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-21 17:17:51', '2021-12-21 17:17:51'),
(29643, 19067, 23177, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||    Good Morning!  Hope you are having a productive day.  I would like to know the enrollment status of the following Provider and Groups.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S Hillside DR STE 4, Beeville, TX 78102-5324 Provider Name	NPI	Location Mercedita Flynn	1619166188	504A Houston Street, Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663  Eagerly waiting for your response.    Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 10:23:37', '2022-01-04 10:23:37'),
(29644, 19067, 23177, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||   Greetings!  Any updates on the previously mentioned request?  Waiting to hear from you soon.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:33:18', '2022-01-09 22:33:18'),
(29645, 19067, 23177, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: 	Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||  Good Morning,   Here are the providers that are active and par for HMO and PPO lines of business   ACCEPT NEW PATIENTS	LINE OF BUSINESS	EFFECTIVE DATE	TERM DATE	PCP FLAG	MEMB COUNT	PROVIDER ID	LAST NAME	FIRST NAME	PROVIDER TYPE	SPECIALTY TYPE	PRIMARY SPECIALTY	IPA ID	IPA AFFIL	NATIONAL PROVIDER ID	PRIMARY NPI	DEFAULT VENDOR ADDR	VENDOR ID	VENDOR NAME	IRS TAX ID Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695112	PATERSON	KATHERINE	ALLIED	NURPRC	Y	 	TX15205	1164776548	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695112	PATERSON	KATHERINE	ALLIED	NURPRC	Y	 	TX15205	1164776548	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695133	FLYNN	MERCEDITA	ALLIED	NURPRC	Y	 	TX15205	1619166188	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695133	FLYNN	MERCEDITA	ALLIED	NURPRC	Y	 	TX15205	1619166188	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695406	TUDOR	JENNIFER	ALLIED	NURPRC	Y	 	TX15205	1720455835	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695406	TUDOR	JENNIFER	ALLIED	NURPRC	Y	 	TX15205	1720455835	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	NURPRC	Y	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	REGIST	N	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	NURPRC	Y	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	REGIST	N	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349  Sincerely,     Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com  1634667499561', NULL, NULL, '2022-01-20 23:49:27', '2022-01-20 23:49:27'),
(29646, 19067, 23177, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||   Hello,  Can I get the approval letter for the group? Kindly respond promptly.  Thanks, Hammad Ahmed', NULL, NULL, '2022-04-14 10:12:26', '2022-04-14 10:12:26'),
(29647, 19067, 23177, NULL, '2022-04-22 00:00:00.000', 'Approved', 'Email received from: Cynthia.Barnett@wellcare.com  Subject: RE: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||    Received the executed agreement. Effective date: 12/01/2017', NULL, NULL, '2022-04-15 15:19:40', '2022-04-15 15:19:40'),
(29648, 3040, 23178, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:56:23', '2021-03-18 14:56:23'),
(29649, 3040, 23178, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'Already covered under Multiplan. No Need to add group and providers. ', NULL, NULL, '2021-06-02 15:45:01', '2021-06-02 15:45:01'),
(29650, 3040, 23179, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:56:49', '2021-03-18 14:56:49'),
(29651, 3040, 23179, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 13:59:14', '2021-05-31 13:59:14'),
(29652, 3040, 23179, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 14:43:47', '2021-06-17 14:43:47'),
(29653, 3040, 23179, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com cc:	catherine.chang@careallies.com, shannon.luke@careallies.com,  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 16:48:47', '2021-07-05 16:48:47'),
(29654, 3040, 23179, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Re: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Hello Alanis,   Hope you are doing well. Do you have any update regarding the enrollment for the below mentioned group and providers.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:43:50', '2021-07-26 12:43:50'),
(29655, 11056, 23179, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:30:26', '2021-08-11 16:30:26'),
(29656, 3040, 23179, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:08:43', '2021-08-18 13:08:43'),
(29657, 3040, 23180, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:57:44', '2021-03-18 14:57:44'),
(29658, 3040, 23180, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - NUCC- TRPN  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 17:01:33', '2021-05-28 17:01:33'),
(29659, 3040, 23180, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067    Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-17 08:30:29', '2021-06-17 08:30:29'),
(29660, 3040, 23180, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group under the below mentioned locations. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429  Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:- Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067   Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI : 1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 15:25:53', '2021-07-05 15:25:53'),
(29661, 3040, 23180, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Mini Chennemkara is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 03/01/2016,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider James Piccione is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 05/29/2019,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/01/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Jeemol George is Active, effective date 06/09/2020,  Provider Julie Jose is Active, effective date 06/09/2020,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com', NULL, NULL, '2021-07-20 09:05:57', '2021-07-20 09:05:57'),
(29662, 3040, 23182, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 14:58:05', '2021-03-18 14:58:05'),
(29663, 1006, 23182, NULL, '2021-05-28 00:00:00.000', 'Initiated', 'Submitted group enrollment request via Wellcare\'s online form, attached for reference in group task. ', NULL, NULL, '2021-05-20 21:00:07', '2021-05-20 21:00:07'),
(29664, 3040, 23182, NULL, '2021-06-16 00:00:00.000', 'In Process', 'I had a word with (Mary J) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: MXJINANG ', NULL, NULL, '2021-06-09 10:03:27', '2021-06-09 10:03:27'),
(29665, 3040, 23182, NULL, '2021-07-05 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-06-28 13:15:54', '2021-06-28 13:15:54'),
(29666, 3040, 23182, NULL, '2021-07-23 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-16 16:44:52', '2021-07-16 16:44:52'),
(29667, 11056, 23182, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:59:51', '2021-08-11 13:59:51'),
(29668, 3040, 23182, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:28:13', '2021-09-07 16:28:13'),
(29669, 10057, 23182, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:52:25', '2021-10-19 11:52:25'),
(29670, 10057, 23182, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-11-22 14:14:06', '2021-11-22 14:14:06');
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
(29671, 10057, 23182, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 15:11:07', '2021-12-02 15:11:07'),
(29672, 10057, 23182, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:20:38', '2021-12-09 13:20:38'),
(29673, 10057, 23182, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:10:24', '2021-12-17 14:10:24'),
(29674, 10057, 23182, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:21:17', '2021-12-23 11:21:17'),
(29675, 10057, 23182, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:53:40', '2021-12-30 13:53:40'),
(29676, 20067, 23182, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare   Hello,  Hope you are doing great. I would like to know the enrollment status of the below-mentioned providers under these locations, and if any of the provider is enrolled kindly send me the welcome letter.  Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Glory Abraham	1194206490 Jeena Abraham	1467901587 Brittany Brown	1275163537 Mini Chennemkara	1841755956 Limy Fernandus	1972005189 Jeemol George	1497219067 Jaya Jacob	1194336149 Jeny John	1073019493 Julie Jose	1447883061 Molly Joseph	1396380077 Vibitha Joseph	1952931560 Odette Kourouma	1134525868 SIGI PAUL	1033623616 James Piccione JR	1356321509 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-06 12:28:23', '2022-01-06 12:28:23'),
(29677, 20067, 23182, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Good afternoon!  Hope you are doing well. Any update on the previous request? Your Early response will be highly appreciated  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 16:47:24', '2022-01-14 16:47:24'),
(29678, 20067, 23182, NULL, '2022-01-27 00:00:00.000', 'Approved', 'Received the following email from: ashley.stevens@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Please see welcome letter attached for roster of par providers.  Effective Date: 05/03/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-20 17:34:52', '2022-01-20 17:34:52'),
(29679, 3040, 23197, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 15:07:02', '2021-03-18 15:07:02'),
(29680, 3040, 23197, NULL, '2021-04-08 00:00:00.000', 'New/Not Initiated', 'Multiplan is in process once the provider enrolled with insurance after that we can start enroll the providers in Multiplan Medicare Advantage Plan.', NULL, NULL, '2021-04-01 13:17:48', '2021-04-01 13:17:48'),
(29681, 1006, 23197, NULL, '2021-04-09 00:00:00.000', 'On Hold', 'The request is pending enrollment with Multiplan and Medicare. ', NULL, NULL, '2021-04-02 20:06:43', '2021-04-02 20:06:43'),
(29682, 1006, 23197, NULL, '2021-06-03 00:00:00.000', 'Not Eligible', 'This is a redundant task and not mentioned in Credentialing New Structure sheet by billing team. ', NULL, NULL, '2021-05-27 14:33:18', '2021-05-27 14:33:18'),
(29683, 3040, 23198, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 15:07:22', '2021-03-18 15:07:22'),
(29684, 3040, 23198, NULL, '2021-04-09 00:00:00.000', 'New/Not Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Ladot Healthcare LLC || Dada, Oladipo & Dada, Atinuke || TRPN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in TRPN under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-02 14:05:14', '2021-04-02 14:05:14'),
(29685, 1006, 23198, NULL, '2021-04-09 00:00:00.000', 'Initiated', NULL, NULL, NULL, '2021-04-02 15:46:48', '2021-04-02 15:46:48'),
(29686, 3040, 23198, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com,trpndataentry@trpnppo.com  Subject: Re: Enroll Group & Providers || Ladot Healthcare LLC || Dada, Oladipo & Dada, Atinuke || TRPN||  Hello,  I wanted to enroll the group and providers in TRPN for our group Ladot Healthcare LLC. Can you advise me about the process?   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-06 15:26:08', '2021-05-06 15:26:08'),
(29687, 3040, 23198, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enroll Group & Providers || Ladot Healthcare LLC || Dada, Oladipo & Dada, Atinuke || TRPN||  Hello Max,   Hope you are doing well. Please find the attached agreement as per 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, '2021-05-26 10:51:47', '2021-05-26 10:51:47'),
(29688, 1006, 23198, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ Max Flores mflores@trpnppo.com:  Sub: Re: FW: Enroll Group & Providers || Ladot Healthcare LLC || Dada, Oladipo & Dada, Atinuke || TRPN||  \"Hello Max,   I hope you\'re doing well, I wanted to verify when can we expect the group and providers to be enrolled with TRPN or the copy of the countersigned agreement?  Thank you!\"', NULL, NULL, '2021-06-15 14:34:11', '2021-06-15 14:34:11'),
(29689, 1006, 23198, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following reply from Max:  Sub:   \"Brad,  You should be receiving the countersigned copy before the end of this week. Once you receive the countersigned copy the providers will also be considered enrolled at that time.  Kind regards,  Max Flores Contracting Manager 6970 O’Bannon Drive Las Vegas, Nevada 89117 Phone: (619) 737-9546 Fax: (619) 271-6316 mflores@trpnppo.com www.trpnppo.com\"  Sent reply:  \"Hello Max,   We still haven\'t received any update on this, please get back to me as soon as you\'re able.   Thank you!\"', NULL, NULL, '2021-06-21 14:13:28', '2021-06-21 14:13:28'),
(29690, 1006, 23198, NULL, '2021-06-29 00:00:00.000', 'Approved', 'The group and providers are approved with TRPN.   EFF: 05/26/2021  Approval confirmation and signed contract are attached for reference. ', NULL, NULL, '2021-06-22 16:50:38', '2021-06-22 16:50:38'),
(29691, 3046, 23201, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 15:56:48', '2021-03-18 15:56:48'),
(29692, 1006, 23201, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'We submitted a group enrollment request via the Wellcare website:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Enrollment form is attached in the group task for reference. ', NULL, NULL, '2021-06-08 16:30:50', '2021-06-08 16:30:50'),
(29693, 1006, 23201, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received the following reply from ProspectiveProviderTX ProspectiveProviderTX@wellcare.com:  Sub: RE: Become A Provider - Unsecured - Not Applicable - Texas  \"Dear Provider:  Thank you for your interest in joining our network, please allow 30 Calendar days for us to review your request.  Sincerely, Network Management – Texas | www.wellcare.com\"  Sent f/u email:   \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of my application. Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-25 10:19:28', '2021-06-25 10:19:28'),
(29694, 1006, 23201, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent another f/u email @ ProspectiveProviderTX@wellcare.com:  Sub: RE: Become A Provider - Unsecured - Not Applicable - Texas  \"Hello,   I hope you\'re doing well, I\'m still waiting on the status of this enrollment request.  Please get back to me as soon as you\'re able.  Thank you.\"', NULL, NULL, '2021-07-14 17:15:56', '2021-07-14 17:15:56'),
(29695, 1006, 23201, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Sent enrollment requests for providers @ shp.networkdevelopment@superiorhealthplan.com, information updated in their tasks.', NULL, NULL, '2021-07-26 10:07:44', '2021-07-26 10:07:44'),
(29696, 11056, 23201, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Sent enrollment requests for providers @ shp.networkdevelopment@superiorhealthplan.com, information updated in their tasks.', NULL, NULL, '2021-08-18 16:58:31', '2021-08-18 16:58:31'),
(29697, 11056, 23201, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent enrollment requests for providers @ shp.networkdevelopment@superiorhealthplan.com, information updated in their tasks.', NULL, NULL, '2021-08-24 13:50:24', '2021-08-24 13:50:24'),
(29698, 11056, 23201, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Sent enrollment requests for providers @ shp.networkdevelopment@superiorhealthplan.com, information updated in their tasks.', NULL, NULL, '2021-09-01 14:38:48', '2021-09-01 14:38:48'),
(29699, 11056, 23201, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Rep : Rose S  Katherine Paterson in network 07/01/2021 participating with wellcare  Mercedita Flynn in network 07/01/2021 participating with wellcare  interaction code : 1296311845  application needed for the group.', NULL, NULL, '2021-09-17 17:12:30', '2021-09-17 17:12:30'),
(29700, 11056, 23201, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : TERESA.Argueta@wellcare.com & ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC   Good afternoon!  Hope all is well with you. I want to get the latest update regarding the enrollment status of the below mentioned providers under the facility TIN with Wellcare.   Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811  If you have any questions or concerns feel free to reach out to me soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-29 13:26:21', '2021-09-29 13:26:21'),
(29701, 11056, 23201, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Approval Email received from : ProspectiveProviderTX@wellcare.com & cynthia.barnett@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC   New Providers for Costal Bend Urgent Care  Hello,   The providers below are PAR effective 7/1/2021.   Hi Ahmed,  Here is the spreadsheet on your providers for Coastal Bend Urgent Care.  Take care.  Cyn  Please see the attachment.', NULL, NULL, '2021-09-30 14:02:02', '2021-09-30 14:02:02'),
(29702, 11056, 23201, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Hello,   We are in process of loading the contract and provider.   We will let you know once complete.   Signed contract was sent to configuration to load to WellCare 9.10.2021.   Thanks  Network Development', NULL, NULL, '2021-10-07 14:55:48', '2021-10-07 14:55:48'),
(29703, 11056, 23201, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Good afternoon!  Hope this email finds you well. Yes, this request is to add an additional provider highlighted below. And add a secondary location for an already approved provider with the main address.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811 Mercedita Flynn ( Approved ) 1619166188 : Please list the secondary location below this provider.  If you have any questions or require additional information or documents please let me know.   Thank you! Have a great day!', NULL, NULL, '2021-10-14 16:49:54', '2021-10-14 16:49:54'),
(29704, 11056, 23201, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Good Afternoon,   To add an additional provider please submit all requests via our website. Also, this inbox is for contract change requests only. If you need to update demographic or location information, please reach out to your Account Manager.    https://www.wellcare.com/en/Texas/Become-a-Provider', NULL, NULL, '2021-10-22 09:21:19', '2021-10-22 09:21:19'),
(29705, 11056, 23201, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub : Add Provider- Katherine Paterson - CBUC & GWMC  Thank you for the information.  We have already submitted an online application for the provider, Monica Gonzalez.  Please see the attachment.  Thank you!  Application has been submitted and attached.', NULL, NULL, '2021-11-09 16:45:09', '2021-11-09 16:45:09'),
(29706, 11056, 23201, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email sent to:  ProspectiveProviderTX@wellcare.com  Sub: Add Provider- Katherine Paterson - CBUC & GWMC   Good morning!  Hope all is well with you. Please let us know the credentialing status of the below-mentioned providers with Wellcare.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Monica Gonzalez 	1871132811 Mercedita Flynn ( Approved ) 1619166188:  Please list the secondary location below this provider in your systems.  Please let us know the Account Manager of our area. And do provide his email & contact no. too.  Thank you! Have a great weekend!', NULL, NULL, '2021-11-24 14:08:13', '2021-11-24 14:08:13'),
(29707, 11056, 23201, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email received from:  ProspectiveProviderTX@wellcare.com  Sub: Add Provider- Katherine Paterson - CBUC & GWMC  Hello,   This provider is still being processed. You will be notified once completed.     Sincerely,     Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-12-06 17:43:04', '2021-12-06 17:43:04'),
(29708, 11056, 23201, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub:  Add Provider- Katherine Paterson - CBUC & GWMC  Good morning!  Hope all is well with you. Please do provide the welcome letter for the provider, Monica Gonzalez. And also confirm about the locations, Have both of the locations been mentioned and listed under the provider? Also, list the provider in the Wellcare provider directory as soon a possible.  Eagerly, waiting for your response.   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-21 17:18:08', '2021-12-21 17:18:08'),
(29709, 19067, 23201, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||    Good Morning!  Hope you are having a productive day.  I would like to know the enrollment status of the following Provider and Groups.  Group Name	Beeville Medical Clinic Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S Hillside DR STE 4, Beeville, TX 78102-5324 Provider Name	NPI	Location Mercedita Flynn	1619166188	504A Houston Street, Live Oak County, George West, TX 78022-3663 Monica Gonzalez	1871132811	504A Houston Street, Live Oak County, George West, TX 78022-3663  Eagerly waiting for your response.    Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 10:23:32', '2022-01-04 10:23:32'),
(29710, 19067, 23201, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||   Greetings!  Any updates on the previously mentioned request?  Waiting to hear from you soon.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:33:10', '2022-01-09 22:33:10'),
(29711, 19067, 23201, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: 	Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||  Good Morning,   Here are the providers that are active and par for HMO and PPO lines of business   ACCEPT NEW PATIENTS	LINE OF BUSINESS	EFFECTIVE DATE	TERM DATE	PCP FLAG	MEMB COUNT	PROVIDER ID	LAST NAME	FIRST NAME	PROVIDER TYPE	SPECIALTY TYPE	PRIMARY SPECIALTY	IPA ID	IPA AFFIL	NATIONAL PROVIDER ID	PRIMARY NPI	DEFAULT VENDOR ADDR	VENDOR ID	VENDOR NAME	IRS TAX ID Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695112	PATERSON	KATHERINE	ALLIED	NURPRC	Y	 	TX15205	1164776548	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695112	PATERSON	KATHERINE	ALLIED	NURPRC	Y	 	TX15205	1164776548	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695133	FLYNN	MERCEDITA	ALLIED	NURPRC	Y	 	TX15205	1619166188	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695133	FLYNN	MERCEDITA	ALLIED	NURPRC	Y	 	TX15205	1619166188	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	7/1/2021 12:00:00 AM	 	N	0	2695406	TUDOR	JENNIFER	ALLIED	NURPRC	Y	 	TX15205	1720455835	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	7/1/2021 12:00:00 AM	 	N	0	2695406	TUDOR	JENNIFER	ALLIED	NURPRC	Y	 	TX15205	1720455835	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	NURPRC	Y	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	TLR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	REGIST	N	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	NURPRC	Y	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349 Y	UXR	10/18/2021 12:00:00 AM	 	N	0	2734519	GONZALEZ	MONICA	ALLIED	REGIST	N	 	TX15205	1871132811	Y	Y	879621	COSTAL BEND URGENT CARE LLC	811890349  Sincerely,     Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com  1634667499561', NULL, NULL, '2022-01-20 23:49:19', '2022-01-20 23:49:19'),
(29712, 19067, 23201, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||   Hello,  Can I get the approval letter for the group? Kindly respond promptly.  Thanks, Hammad Ahmed', NULL, NULL, '2022-04-14 10:12:32', '2022-04-14 10:12:32'),
(29713, 19067, 23201, NULL, '2022-04-22 00:00:00.000', 'Approved', 'Email received from: Cynthia.Barnett@wellcare.com  Subject: RE: Enrollment Query || CBUC & GWMC || Providers & Groups || Wellcare ||    Received the executed agreement. Effective date: 12/01/2017', NULL, NULL, '2022-04-15 15:19:49', '2022-04-15 15:19:49'),
(29714, 3046, 23207, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 16:00:26', '2021-03-18 16:00:26'),
(29715, 1005, 23207, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:57:12', '2021-06-01 13:57:12'),
(29716, 3046, 23210, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 16:00:30', '2021-03-18 16:00:30'),
(29717, 1005, 23210, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving their Nasa\'s Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 13:49:27', '2021-06-01 13:49:27'),
(29718, 3046, 23214, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 16:02:43', '2021-03-18 16:02:43'),
(29719, 1006, 23214, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Enrollment request submitted via wellcare website, enrollment form is attached in main group task for reference.', NULL, NULL, '2021-06-08 11:30:53', '2021-06-08 11:30:53'),
(29720, 11056, 23214, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Update - NASA HEALTH CLINIC - WELLCARE  Hello,   I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Thank you!', NULL, NULL, '2021-06-25 10:37:07', '2021-06-25 10:37:07'),
(29721, 1006, 23214, NULL, '2021-07-22 00:00:00.000', 'In Process', 'We received the following update from .ProspectiveProviderTX ProspectiveProviderTX@wellcare.com:  Sub; RE: Become A Provider - Unsecured - General Practice - Texas  \"Hello,  This provider is already PAR with NASA HEALTH CLINIC effective 5/1/2021.\"  Sent query:  \"Hello,   I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Thank you!\"', NULL, NULL, '2021-07-15 16:10:08', '2021-07-15 16:10:08'),
(29722, 11056, 23214, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : RE: Become A Provider - Unsecured - General Practice - Texas  Hello,   I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Thank you', NULL, NULL, '2021-07-30 17:19:45', '2021-07-30 17:19:45'),
(29723, 11056, 23214, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Hello,  I appreciate the update, I just wanted to verify if the secondary address is also listed for the group and provider?  Practice: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI # : 1629418025  Thank you! Have a great day!', NULL, NULL, '2021-08-17 08:48:48', '2021-08-17 08:48:48'),
(29724, 11056, 23214, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Good morning!  Hope all is well. I appreciate the update. I just wanted to verify if the secondary address is also listed for the group and provider? Please inform me soon.  Practice Details: Practice Name : Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider Details: Provider Name: Segun Adeoye Provider NPI # : 1629418025  If you have any questions or queries let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-26 16:11:33', '2021-08-26 16:11:33'),
(29725, 11056, 23214, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.   Online Application has been submitted.', NULL, NULL, '2021-09-15 09:34:55', '2021-09-15 09:34:55'),
(29726, 11056, 23214, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : webuser@wellcare.com & ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Provider First Name Segun  Provider Last Name Adeoye  Degree Type MD  Check to add provider to existing agreement: False  Check to join as a group: True  Check if you service more than one state: False  Group Name Nasa Health Clinic  Tax Identification Number 47-2682655  Specialty Internal Medicine  Line of Business All  Street Address 985 NASA Parkway  City Houston  State Texas  ZIP Code 77058  County Harris  Facility Walk in clinic  NPI 1629418025  CAQH Number 12779522  Medicare Number 746150  Medicaid Number 391190102  License Number R7637  Primary Contact Name Ahmed Talha  Email nasa@claimsmedinc.com  Phone Number (713) 893-6214  Please provide any additional information Secondary Location : 3623 S. Main St. Suite 109 Stafford , TX 77477-5406 Please list the secondary location too under same Tax I.D and NPI  Confirmation email of our application submission', NULL, NULL, '2021-09-28 15:31:04', '2021-09-28 15:31:04'),
(29727, 11056, 23214, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope all is well with you. Please let us know who is our provider Relations representative and provide us with his contact no. and email address as soon as possible.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 15:51:23', '2021-10-08 15:51:23'),
(29728, 11056, 23214, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope all is well. Please provide the latest updates regarding the credentialing process of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-10-15 16:48:15', '2021-10-15 16:48:15'),
(29729, 11056, 23214, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Hello-   I have responded before… Dr. Adeoye is loaded properly and so are both addresses.   You will be able to see that using our directory as well. His Provider ID is 2504675.    Kindest Regards, Macy Mertens, LL.M. Network Performance Advisor', NULL, NULL, '2021-10-22 15:48:13', '2021-10-22 15:48:13'),
(29730, 11056, 23214, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope this email finds you well. My question is simply that the effective date mentioned in the agreement is for both locations and the provider or not? Kindly, also do assist me in finding the provider in the Wellcare provider directory.  Take Care of Yourself!  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 12:30:06', '2021-11-11 12:30:06'),
(29731, 11056, 23214, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope this email finds you well. My question is simply that the effective date mentioned in the agreement is for both locations and the provider or not? Kindly, also do assist me in finding the provider in the Wellcare provider directory.  Take Care of Yourself!  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 12:34:32', '2021-11-11 12:34:32'),
(29732, 11056, 23214, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email received from: Macy.Mertens@wellcare.com  Sub:  Re: Become A Provider - Unsecured - Internal Medicine - Texas   Dr. Adeoye is effective 5/1/21 for UXR, which is the WellCare LOB.  I understand. NASA Health is loaded and so is the provider.  His Provider ID is 2504675.  Hi-     Locations are added. Update is completed.', NULL, NULL, '2021-11-15 16:35:01', '2021-11-15 16:35:01'),
(29733, 3046, 23217, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 16:02:46', '2021-03-18 16:02:46'),
(29734, 1006, 23217, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent following enrollment request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - NASA HealthClinic - Christus Spohn  \"Hello,  I hope you\'re doing well, we wish to enroll the following group and providers with the mentioned addresses, the information is as follows:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025 Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 08:41:21', '2021-06-08 08:41:21'),
(29735, 11056, 23217, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'It is not in our service area. Please see the attached link  https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area', NULL, NULL, '2021-06-25 12:41:09', '2021-06-25 12:41:09'),
(29736, 3046, 23223, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 16:06:17', '2021-03-18 16:06:17'),
(29737, 1006, 23223, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent following enrollment request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - NASA HealthClinic - Christus Spohn  \"Hello,  I hope you\'re doing well, we wish to enroll the following group and providers with the mentioned addresses, the information is as follows:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025 Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 08:41:15', '2021-06-08 08:41:15'),
(29738, 11056, 23223, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'It is not in our service area. Please see the attached link  https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area', NULL, NULL, '2021-06-25 12:40:59', '2021-06-25 12:40:59'),
(29739, 3046, 23229, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 16:08:59', '2021-03-18 16:08:59'),
(29740, 1005, 23229, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 14:02:29', '2021-06-01 14:02:29'),
(29741, 3046, 23230, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 16:09:00', '2021-03-18 16:09:00'),
(29742, 1005, 23230, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'Not receiving the Bills for this location. Updating the task as Not Eligible after Supervisor\'s confirmation.', NULL, NULL, '2021-06-01 14:16:46', '2021-06-01 14:16:46'),
(29743, 3046, 23234, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 16:11:07', '2021-03-18 16:11:07'),
(29744, 1006, 23234, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Group enrollment request submitted via wellcare website, attachment of form is attached in main group task for reference. ', NULL, NULL, '2021-06-08 11:26:45', '2021-06-08 11:26:45'),
(29745, 11056, 23234, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub :  Enrollment Request Status - NASA Urgent Care - Wellcare  Good Morning !  Hope you are doing well. I want to know the enrollment status of the provider and group mentioned below. We have already filled out the form starting this month. Waiting for your reply.  Practice: Practice name : Nasa Urgent Care Inc. Practice NPI :1821542432 Practice TIN : 81-3237149 Main Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109,, Stafford , TX 77477-5406  Provider: Provider name : Adeoye, Segun P Provider NPI # : 1629418025  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 10:15:12', '2021-06-25 10:15:12'),
(29746, 1006, 23234, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ \".ProspectiveProviderTX\" ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Request Status - NASA Urgent Care - Wellcare  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status of our group and provider.  Please get back to me as soon as possible.  Thanks.\"', NULL, NULL, '2021-07-15 16:32:54', '2021-07-15 16:32:54'),
(29747, 11056, 23234, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Request Status - NASA Urgent Care - Wellcare  Good Evening!  Hope you are doing well. I want to know the enrollment status of the provider and group mentioned below. We have already filled out the form starting this month. Waiting for your reply.  Practice: Practice name : Nasa Urgent Care Inc. Practice NPI :1821542432 Practice TIN : 81-3237149 Main Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109,, Stafford , TX 77477-5406  Provider: Provider name : Adeoye, Segun P Provider NPI # : 1629418025  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-28 11:13:20', '2021-07-28 11:13:20'),
(29748, 11056, 23234, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Request Status - NASA Urgent Care - Wellcare   Good morning,  I have reached out to the Contract Negotiators and they said the amendment to add WellCare to their existing Superior HealthPlan agreement will be sent through Adobe for electronic signature.   Have you signed and returned it to be processed?  Thanks Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-08-17 08:34:34', '2021-08-17 08:34:34'),
(29749, 11056, 23234, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Request Status - NASA Urgent Care - Wellcare  Good Evening!  Hope you are doing well. I want to know the enrollment status of the provider and group mentioned below. We have already signed and returned Superior HealthPlan agreement through Adobe .  Practice Details: Practice name : Nasa Urgent Care Inc. Practice NPI :1821542432 Practice TIN : 81-3237149 Main Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109,, Stafford , TX 77477-5406  Provider Details: Provider name : Adeoye, Segun P Provider NPI # : 1629418025  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-26 16:07:08', '2021-08-26 16:07:08'),
(29750, 11056, 23234, NULL, '2021-09-22 00:00:00.000', 'In Process', '	 Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.   Online Application has been submitted.', NULL, NULL, '2021-09-15 09:41:32', '2021-09-15 09:41:32'),
(29751, 11056, 23234, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Provider First Name Segun  Provider Last Name Adeoye  Degree Type MD  Check to add provider to existing agreement: False  Check to join as a group: True  Check if you service more than one state: False  Group Name Nasa Urgent Care Inc.  Tax Identification Number 81-3237149  Specialty Internal Medicine  Street Address 985 NASA Parkway  City Houston  State Texas  ZIP Code 77058  County Harris  Facility Urgent Care  NPI 1629418025  CAQH Number 12779522  Medicare Number 738034  Medicaid Number 391190101  License Number R7637  Primary Contact Name Ahmed Talha  Email nasa@claimsmedinc.com  Phone Number (713) 893-6214  Please provide any additional information Secondary Location : 3623 S. Main St. Suite 109 Stafford , TX 77477-5406 Please list the secondary location too under same Tax I.D and NPI.  Confirmation email of our application submission.', NULL, NULL, '2021-09-28 15:33:42', '2021-09-28 15:33:42'),
(29752, 11056, 23234, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good afternoon!  Hope all is well with you. Please provide the latest updates regarding the credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day! ', NULL, NULL, '2021-10-08 15:44:38', '2021-10-08 15:44:38'),
(29753, 11056, 23234, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email received from : Macy.Mertens@wellcare.com  Sub  : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Hello Macy,  The provider below would like to add an additional location for the provider below.    Talha,   The Prospective Provider box does not need to be included on further emails.  Thank you, Network Development', NULL, NULL, '2021-10-15 16:43:10', '2021-10-15 16:43:10'),
(29754, 11056, 23234, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: Macy.Mertens@wellcare.com  Sub  : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Hello-     Please see the email attached which I never got a response to…so I do apologize but I have not added the second location.     I will submit a request for the 2nd location and process it as STAT. I’m very sorry for the delay.', NULL, NULL, '2021-10-22 15:55:39', '2021-10-22 15:55:39'),
(29755, 11056, 23234, NULL, '2021-11-18 00:00:00.000', 'In Process', '	 Email sent to: Macy.Mertens@wellcare.com  Sub : Re: Become A Provider - Unsecured - Internal Medicine - Texas  Good evening Macy!  Hope this email finds you well.  No problem, thank you for the update. There is no need for any apology. Please do add the locations properly as  Practice Name: Primary/ billing Address : 985 NASA Parkway, Houston , TX 77058-3039    I thought so this one is missing.& it is the main location. Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406 .  Please also confirm the effective dates.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 12:12:56', '2021-11-11 12:12:56'),
(29756, 11056, 23234, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email received from: Macy.Mertens@wellcare.com  Sub: Re: Become A Provider - Unsecured - Internal Medicine - Texas   Hi-   Location is added. The update is completed.    Kindest Regards,  Macy Mertens, LL.M. Network Performance Advisor cid:image002.png@01D79E5C.9D608FD0  4888 Loop Central Drive, Suite 300 Houston, Texas 77081 Direct Mobile 281-217-0142', NULL, NULL, '2021-11-19 11:16:20', '2021-11-19 11:16:20'),
(29757, 11056, 23234, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  Macy.Mertens@wellcare.com  Sub:  Re: Become A Provider - Unsecured - Internal Medicine - Texas   Good afternoon Macy!  I am very grateful to you. Great, thank you so much!  Please provide me with a welcome letter. Can we send claims on that address?  Take Care!  Have a wonderful day!', NULL, NULL, '2021-12-03 16:55:43', '2021-12-03 16:55:43'),
(29758, 11056, 23234, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from: Sara.Sanchez@wellcare.com  Sub: Re: Become A Provider - Unsecured - Internal Medicine - Texas   Good morning,     Macy is out of the office but I have pulled a copy of our provider report.  You can see Dr. Adeoye’s effective date, along with other information.  If you scroll right you can see the addresses that are affiliated with the practice.   Please let me know if I can assist with anything else.     Hope this helps!  Have a great day,        Sara Sanchez  Provider Account Manager  1700 N. Zaragoza Ste 140     El Paso, TX 79936  Direct Line: 1.915.856.2502   Mobile: 1.915.801.5226    Fax: 1.915.856.2513  sara.sanchez@wellcare.com   |   https://www.wellcare.com', NULL, NULL, '2021-12-14 18:12:49', '2021-12-14 18:12:49'),
(29759, 11056, 23234, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email sent to: Macy.N.Roberts@wellcare.com  Sub: Re: Become A Provider - Unsecured - Internal Medicine - Texas   Good afternoon!  Hope you are staying healthy. I have already submitted the Online application for it in the past. And again on 15, September 2021. Kindly let me know what to do now, and how many times I have to submit an application for credentialing and enrolling.  Kindly, do us a favor, please figure this out soon. Let this be resolved permanently and properly.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-22 17:31:32', '2021-12-22 17:31:32'),
(29760, 19067, 23234, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: Macy.N.Roberts@wellcare.com  Subject: Enrollment Query || Nasa Urgent Care || Segun Adeoye & Groups || Wellcare ||    Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Groups with Wellcare.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway, Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:39:26', '2021-12-30 14:39:26'),
(29761, 19067, 23234, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Macy.N.Roberts@wellcare.com  Subject: Enrollment Query || Nasa Urgent Care || Segun Adeoye & Groups || Wellcare ||    Hello!  Hope you are doing well.  This is my Second reminder on the previous mentioned request.  Kindly get in touch as soon as you have time.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-09 19:09:30', '2022-01-09 19:09:30'),
(29762, 3046, 23237, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 16:11:11', '2021-03-18 16:11:11'),
(29763, 1006, 23237, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent following enrollment request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - NASA UrgentCare - Christus Spohn  \"Hello,  I hope you\'re doing well, we wish to enroll the following group and providers with the mentioned addresses, the information is as follows:   Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 08:40:38', '2021-06-08 08:40:38'),
(29764, 11056, 23237, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'It is not in our service area. Please see the attached link  https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area', NULL, NULL, '2021-06-25 12:47:35', '2021-06-25 12:47:35'),
(29765, 3046, 23241, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-18 16:18:34', '2021-03-18 16:18:34'),
(29766, 3040, 23241, NULL, '2021-04-07 00:00:00.000', 'Initiated', 'Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.', NULL, NULL, '2021-03-31 15:38:10', '2021-03-31 15:38:10'),
(29767, 9057, 23241, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Request isn\'t showing up on wellcare\'s end, talked to representative and he has forwarded our request to provider relations to call us back. ', NULL, NULL, '2021-05-26 14:31:17', '2021-05-26 14:31:17'),
(29768, 3040, 23241, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com   Subject: Enroll Group || Statcare Minor Emergency Clinic || Group || Wellcare ||  Greetings,   Hope all is well. I wanted to know the enrollment status for the below mentioned group in Wellcare under the below locations. We already sent the request for enrollment on 03/31/2021.   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Secondary Address: 4042 River Hill Corpus Christi , TX 78410 Tertiary Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-15 16:43:12', '2021-06-15 16:43:12'),
(29769, 11056, 23241, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com   Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare ||  Greetings,  Kindly respond soon. Hope all is well. I wanted to know the enrollment status for the below mentioned group in Wellcare under the below locations. We already sent the request for enrollment on 03/31/2021.  Practice: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Secondary Address: 4042 River Hill Corpus Christi , TX 78410 Tertiary Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Please get back to me as soon as you can get a chance. Waiting for your reply.  Thank you !', NULL, NULL, '2021-07-01 17:05:03', '2021-07-01 17:05:03'),
(29770, 1006, 23241, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference. ', NULL, NULL, '2021-07-15 11:03:43', '2021-07-15 11:03:43');
