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
(5849, 3040, 9306, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well. I just wanted to follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-02 12:45:35', '2021-02-02 12:45:35'),
(5850, 3040, 9306, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well. I just wanted to follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-09 12:22:43', '2021-02-09 12:22:43'),
(5851, 3040, 9306, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Good Morning,  This provider is showing under all 3 locations.  Thank you.', NULL, NULL, '2021-02-09 13:53:21', '2021-02-09 13:53:21'),
(5852, 3040, 9306, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Can you please send me the copy of welcome letter or provider roster.  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-02-09 13:54:21', '2021-02-09 13:54:21'),
(5853, 3040, 9306, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)3  I do not have a welcome letter for providers; please log into the Humana Military provider portal to see all your provider information. You can register at the below link if you have not done so already: https://infocenter.humana-military.com/provider/service/Account/Login   ', NULL, NULL, '2021-02-09 13:55:37', '2021-02-09 13:55:37'),
(5854, 3040, 9306, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  I checked on the Humana Military provider portal and it\'s showing me only 2 addresses over there and under one address the provider Eder Harnandez is showing in process. For your reference I attached the addresses screen shot.  Waiting for your response.  Thanks', NULL, NULL, '2021-02-09 13:56:36', '2021-02-09 13:56:36'),
(5855, 3040, 9306, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Thank you Adil for the screen shot. I submitted to our IT Team to review this issue. I will email once it has been corrected. ', NULL, NULL, '2021-02-09 13:57:23', '2021-02-09 13:57:23'),
(5856, 3040, 9306, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  As you mentioned in your previous email the provider is showing under all 3 locations. I attached the screenshot from Tricare portal for your reference its not showing the provider completed only once location showing the provider is in process.  Waiting for your response.  Thanks', NULL, NULL, '2021-02-16 13:16:04', '2021-02-16 13:16:04'),
(5857, 3040, 9306, NULL, '2021-03-02 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well. Has there been any update regarding adding locations? Also provider still showing in process in only in one location. For your reference I attached the screenshot.   Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-23 12:23:36', '2021-02-23 12:23:36'),
(5858, 3040, 9306, NULL, '2021-03-09 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well. Please find the attached screenshot for your reference its not showing the provider in-network or completed. As per your previous email that provider is already in-network with all 03 locations. Can you please check and advise.  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-02 15:10:14', '2021-03-02 15:10:14'),
(5859, 3040, 9306, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Hello Katherine,  Hope you are doing well. Please find the attached the screenshot for your reference in which its showing the below mentioned provider in process only 02 locations. For the location McAllen the provider name is not showing. Can you please check & advise.  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-11 14:36:03', '2021-03-11 14:36:03'),
(5860, 3040, 9306, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject; Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Same for Eder Francisco, his application is still pending review.', NULL, NULL, '2021-03-11 14:37:20', '2021-03-11 14:37:20'),
(5861, 3040, 9306, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Hello Katherine,  I am asking for Hernandez, Eder Francisco. Please advise.  Thanks', NULL, NULL, '2021-03-11 14:38:09', '2021-03-11 14:38:09'),
(5862, 3040, 9306, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  > Good Afternoon,  If you are talking about Moses Campos, his application is still under review for credentialing.  Please allow more time. ', NULL, NULL, '2021-03-11 14:38:56', '2021-03-11 14:38:56'),
(5863, 3040, 9306, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Hello Katherine,   Hope you are doing well. Please advise me the status for additional location for the below mentioned provider. Also I need the effective date.   Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Hernandez, Eder Francisco (Provider is not showing on portal) Provider NPI# 1386956852 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-15 13:57:53', '2021-04-15 13:57:53'),
(5864, 3040, 9306, NULL, '2021-05-12 00:00:00.000', 'Approved', 'Provider participating with Tricare.   Approval confirmation attached. ', NULL, NULL, '2021-05-05 10:54:13', '2021-05-05 10:54:13'),
(5865, 1006, 9307, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-16 15:38:08', '2020-10-16 15:38:08'),
(5866, 1006, 9307, NULL, '2020-10-23 00:00:00.000', 'Initiated', 'Submitted online enrollment request: \"Your request to join the network has been received. You can expect to hear from us in the next 45 days. If it has been more than 60 days and you haven\'t heard from us regarding next steps, please call 800-353-1232 for assistance. Reference code BH. \"', NULL, NULL, '2020-10-16 15:39:36', '2020-10-16 15:39:36'),
(5867, 1006, 9307, NULL, '2020-10-30 00:00:00.000', 'In Process', 'Sent a follow-up email to Bevin Laura:   \"Hey Laura,   Hope you\'re doing great, I wanted to check in with you regarding an enrollment request that I submitted a few weeks ago for the following provider:  Name: Jessica Hartman NPI# 1326665472 TIN# 83-4482753  Appreciate all the help!\"', NULL, NULL, '2020-10-23 17:49:32', '2020-10-23 17:49:32'),
(5868, 1006, 9307, NULL, '2020-11-05 00:00:00.000', 'In Process', 'Received following update from Bevin, Laura J Laura.Bevin@aetna.com>: \"Good morning,  The application for Jessica Hartman was received and she is early in the credentialing process.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-10-30 14:46:11', '2020-10-30 14:46:11'),
(5869, 1006, 9307, NULL, '2020-11-12 00:00:00.000', 'In Process', 'Sent a follow-up email to Laura.Bevin@aetna.com ', NULL, NULL, '2020-11-05 13:54:32', '2020-11-05 13:54:32'),
(5870, 1006, 9307, NULL, '2020-11-19 00:00:00.000', 'In Process', 'No response, sent another follow-up email: \"Hello Laura,   I wanted to follow-up again regarding the status of the following provider, have there been any updates? Name: Jessica Hartman NPI# 1326665472  Thanks. \"', NULL, NULL, '2020-11-12 18:20:47', '2020-11-12 18:20:47'),
(5871, 1006, 9307, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Received following update from Laura:  \"Hello,  Our Credentialing Dept. is verifying the information in her CAQH application.  Thank you  Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-11-16 10:38:04', '2020-11-16 10:38:04'),
(5872, 1006, 9307, NULL, '2020-11-30 00:00:00.000', 'New/Not Initiated', NULL, NULL, NULL, '2020-11-23 17:59:29', '2020-11-23 17:59:29'),
(5873, 1006, 9307, NULL, '2020-11-30 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-11-23 17:59:34', '2020-11-23 17:59:34'),
(5874, 1006, 9307, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Sent a follow-up email to Laura; \"Bevin, Laura J\" Laura.Bevin@aetna.com', NULL, NULL, '2020-11-30 17:32:59', '2020-11-30 17:32:59'),
(5875, 1006, 9307, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Received following update from Bevin: \"Hello,  Jessica Hartman, 6715913 has completed the credentialing process and is waiting to be added to the group contract.  Thank you   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-12-07 09:21:12', '2020-12-07 09:21:12'),
(5876, 1006, 9307, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Received following update from Laura: \"Good morning,  Jessica Hartman, 6715913 – waiting to be linked to the contract  Thank you   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-12-15 10:51:00', '2020-12-15 10:51:00'),
(5877, 1006, 9307, NULL, '2020-12-25 00:00:00.000', 'Approved', 'Received following approval email from Aetna: \"Hi Jessica Hartman,  Welcome to the provider network effective 11/27/2020. Your Provider Identification Number (PIN) is: 6715913  To make your onboarding easy, just check out the attached welcome kit.    Register here to attend our New Provider Onboarding Webinar on the 2nd and 3rd Tuesday of each month from 1pm – 2pm EST. You\'ll discover additional online tools and resources to make your day-to-day Aetna tasks quick and simple.  We\'re glad to have you with us. \"', NULL, NULL, '2020-12-18 13:09:26', '2020-12-18 13:09:26'),
(5878, 1006, 9308, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-16 17:09:56', '2020-10-16 17:09:56'),
(5879, 1006, 9308, NULL, '2020-10-23 00:00:00.000', 'Initiated', 'Submitted enrollment form to Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com. Attached.  ', NULL, NULL, '2020-10-16 17:10:35', '2020-10-16 17:10:35'),
(5880, 1006, 9308, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Sent a followup email to Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com>:  \"Hello,  I wanted to check in to see if the following application has been received and is in-process as of yet? If so, what is the expected turn-around time for enrollment?   Thank you.\"', NULL, NULL, '2020-10-23 17:51:32', '2020-10-23 17:51:32'),
(5881, 1006, 9308, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Sent another follow-up email to Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com> waiting on update. ', NULL, NULL, '2020-11-04 17:33:45', '2020-11-04 17:33:45'),
(5882, 1006, 9308, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Sent a follow-up email to Kody Dunnet & Tufts Credentialing. Will call next time for further clarification on the delayed response. ', NULL, NULL, '2020-11-12 18:37:41', '2020-11-12 18:37:41'),
(5883, 1006, 9308, NULL, '2020-11-20 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-11-19 18:09:51', '2020-11-19 18:09:51'),
(5884, 1006, 9308, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Received following reply from Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com:  \"Hi Brad  Just forwarded this over to BH Contracting, as they still need to select her a contract.  So she will be sent a contract next week.  Once signed, returned and processed, she will be put into credentialing.  Once cred is complete, she will be all set.  Please be sure to have the provider’s signature on the contract.  Thank you Provider Operations\"', NULL, NULL, '2020-11-20 11:44:55', '2020-11-20 11:44:55'),
(5885, 1006, 9308, NULL, '2020-12-09 00:00:00.000', 'In Process', 'Received email and sent countersigned agreement to Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com: \"Hello,   Please find the signed contract, do let me know if anything else is required and what the expected time-frame is for the enrollment?  Thanks. \"', NULL, NULL, '2020-11-25 18:10:35', '2020-11-25 18:10:35'),
(5886, 1006, 9308, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Sent follow-up email @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com regarding updated status. ', NULL, NULL, '2020-12-10 15:54:47', '2020-12-10 15:54:47'),
(5887, 1006, 9308, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Received following reply from Tufts: \"incident number - PPO0078251   Hello,   This provider\'s credentialing is still in process however it is in the final stages - they should be all set within 1-2 weeks now.   Thank you\"', NULL, NULL, '2020-12-17 16:43:56', '2020-12-17 16:43:56'),
(5888, 1006, 9308, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Sent a follow-up @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com ', NULL, NULL, '2020-12-29 11:16:27', '2020-12-29 11:16:27'),
(5889, 1006, 9308, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Sent a follow-up email @ Tufts_Health_Plan_Credentialing_Department@tufts-health.com. ', NULL, NULL, '2021-01-15 18:13:16', '2021-01-15 18:13:16'),
(5890, 1006, 9308, NULL, '2021-02-02 00:00:00.000', 'Approved', 'Received following reply from IT Service Desk Tufts_Health_Plan_Credentialing_Department@tufts-health.com:  \"Hi Brad   Barbara Hignite, APRN - all set eff 1.7.2021, ID 370708   Carlee Rozell, NP - all set eff 1.22.2021, ID 228943   Jessica Hartman, APRN - all set eff 12.31.2021, ID 869409   Thank you Provider Operations\"', NULL, NULL, '2021-01-26 17:06:23', '2021-01-26 17:06:23'),
(5891, 2027, 9309, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-16 17:51:52', '2020-10-16 17:51:52'),
(5892, 2027, 9309, NULL, '2020-10-23 00:00:00.000', 'Approved', 'Provider is now linked with medicaid in all three locations of (VMUC) and effective date is 09/01/2020. Welcome letter is attached', NULL, NULL, '2020-10-16 17:52:05', '2020-10-16 17:52:05'),
(5893, 2027, 9310, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-16 17:54:56', '2020-10-16 17:54:56'),
(5894, 2027, 9310, NULL, '2020-10-23 00:00:00.000', 'Approved', 'Provider is now linked with medicaid in all three locations of (VMUC) and effective date is 09/01/2020. Welcome letter is attached', NULL, NULL, '2020-10-16 17:55:12', '2020-10-16 17:55:12'),
(5895, 2027, 10306, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-20 12:10:41', '2020-10-20 12:10:41'),
(5896, 2027, 10306, NULL, '2020-10-27 00:00:00.000', 'Approved', 'This provider is now showing linked with the insurance and effective date is 08/22/2020. Plans are mentioned in the welcome letter and attached in the attachments. ', NULL, NULL, '2020-10-20 12:11:00', '2020-10-20 12:11:00'),
(5897, 2027, 10307, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-20 12:13:41', '2020-10-20 12:13:41'),
(5898, 2027, 10307, NULL, '2020-10-27 00:00:00.000', 'Approved', 'This provider is now showing linked with the insurance and effective date is 08/22/2020. Plans are mentioned in the welcome letter and attached in the attachments. ', NULL, NULL, '2020-10-20 12:13:58', '2020-10-20 12:13:58'),
(5899, 2037, 10308, NULL, NULL, 'New/Not Initiated', 'From: Juliana.Mata@molinahealthcare.com Sub:Molina Contract Packet - Rabagos Health Care PLLC  Good afternoon,  Provider is in process of credentialing.  Process might take 30-45 days if no additional information is required.  Credentialing department might be reaching out to you should they need any further assistance.  Once credentialing is complete, we will go ahead and send contract to get executed by our plan’s president.  Once contract is executed, we will go ahead and forward contract to be loaded into networks billing system. Process might take 60 – 90 days to complete.     Thank you for your patience', NULL, NULL, '2020-10-20 16:35:55', '2020-10-20 16:35:55'),
(5900, 2037, 10308, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Called Molina Health @ (855) 322-4080 and spoke to Sandra from the contracting department our contracting is still under process and everything is going smooth as of now there is nothing required from our end.Need to allow more time.The process can sometimes take 60 to 90 days maximum. Reference # : Ref#c0001568504.', NULL, NULL, '2020-10-20 16:36:06', '2020-10-20 16:36:06'),
(5901, 2037, 10308, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Currently in process. Allow more time to process.', NULL, NULL, '2020-10-20 16:36:17', '2020-10-20 16:36:17'),
(5902, 2037, 10308, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Received Credentialing Approval letter for Molina from K-Rabagos. and now moved to the contracting process.  Approval Letter uploaded on EMRBs', NULL, NULL, '2020-10-20 16:36:23', '2020-10-20 16:36:23'),
(5903, 2037, 10308, NULL, '2020-10-27 00:00:00.000', 'In Process', 'Sent a follow up email @ \"Mata, Juliana\" Juliana.Mata@molinahealthcare.com -------------- Hi Juliana, Following up on the contracting process for the above approved application. The details are as follows: Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904  Thank you!', NULL, NULL, '2020-10-20 16:36:32', '2020-10-20 16:36:32'),
(5904, 2037, 10308, NULL, '2020-10-27 00:00:00.000', 'Approved', 'Welcome Letter with Executed contract received for Katherine Rabagos effective 10/01/2020.Attachments uploaded .Marketplace and Medicare products.  Medicaid is still not added (In-Process) .Reference email as follows: ----------------------------------------------- Good morning Sherry,  Happy Tuesday!  Per information on our system NP Katherine Rabagos is loaded into network billing system participating with Molina healthcare under Statcare Minor Emergency clinic effective 10/1/2020 for Marketplace and Medicare products.  Per TMHP portal, provider NPI is not attested.  In order for provider to qualify for Medicaid products, NPI must be attested with TMHP.  Please see attached for welcome letter and executed provider service agreement.     Thank you   ', NULL, NULL, '2020-10-20 16:38:50', '2020-10-20 16:38:50'),
(5905, 2037, 10309, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-20 16:48:05', '2020-10-20 16:48:05'),
(5906, 2037, 10309, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Katherine (Ind.) got contracted . Requested contract for the facility Urget Care .Submitted Contract Request Forms for the three locations along with the W9 form @ MHTContractrequest@molinahealthcare.com C.C Juliana.Mata@molinahealthcare.com . Junliana is working on the application.', NULL, NULL, '2020-10-20 16:48:18', '2020-10-20 16:48:18'),
(5907, 2037, 10309, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Currently being processed .Need to allow more time. Jennifer Mata is working on it. --------------- Sherry Deen  Attachments Thu, Oct 22, 4:36 PM (11 days ago) to Juliana  You are welcome Juliana. Please find the copy of professional liability insurance attached.  Thank you!', NULL, NULL, '2020-11-03 16:49:23', '2020-11-03 16:49:23'),
(5908, 2037, 10309, NULL, '2021-02-28 00:00:00.000', 'On Hold', 'On Hold due to the absence of general liability coverage. Double checking with Katherine if she will be obtaining the coverage or not.', NULL, NULL, '2020-11-23 12:58:29', '2020-11-23 12:58:29'),
(5909, 1006, 10309, NULL, '2021-01-25 00:00:00.000', 'Approved', 'Group has been enrolled, effective date: 01/15/2021. Welcome Letter attached. ', NULL, NULL, '2021-01-18 18:05:48', '2021-01-18 18:05:48'),
(5910, 2037, 10310, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-20 16:48:09', '2020-10-20 16:48:09'),
(5911, 2037, 10310, NULL, '2020-11-03 00:00:00.000', 'In Process', 'Katherine (Ind.) got contracted . Requested contract for the facility Urget Care .Submitted Contract Request Forms for the three locations along with the W9 form @ MHTContractrequest@molinahealthcare.com C.C Juliana.Mata@molinahealthcare.com . Junliana is working on the application.', NULL, NULL, '2020-10-20 16:48:49', '2020-10-20 16:48:49'),
(5912, 2037, 10310, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Currently being processed .Need to allow more time. Jennifer Mata is working on it. --------------- Sherry Deen  Attachments Thu, Oct 22, 4:36 PM (11 days ago) to Juliana  You are welcome Juliana. Please find the copy of professional liability insurance attached.  Thank you!', NULL, NULL, '2020-11-03 16:49:33', '2020-11-03 16:49:33'),
(5913, 2037, 10310, NULL, '2021-02-28 00:00:00.000', 'On Hold', 'On Hold due to the absence of general liability coverage. Double checking with Katherine if she will be obtaining the coverage or not.', NULL, NULL, '2020-11-23 12:58:40', '2020-11-23 12:58:40'),
(5914, 1006, 10310, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Sent following email to \"Mata, Juliana\" Juliana.Mata@molinahealthcare.com as we received approval confirmation: \"Hello Juliana,   Happy Monday! I just wanted to confirm, is this a group contract or an ancillary/facility contract? I just want to know if we need to add all our providers under the group or not.   Did you receive a response back from credentialing regarding the third address?  Thanks a lot!\"', NULL, NULL, '2021-01-18 18:04:30', '2021-01-18 18:04:30'),
(5915, 3046, 10310, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Good morning Mr. Peterson,  Happy Tuesday!!  Thank you for your assistance filling out form.  Credentialing department is asking for general liability insurance and CMS survey could you please assist?', NULL, NULL, '2021-02-25 15:46:50', '2021-02-25 15:46:50'),
(5916, 3046, 10310, NULL, '2021-03-04 00:00:00.000', 'New/Not Initiated', 'Hello Juliana,  I apologize but we do not have general liability for the group and there hasn\'t been a CMS survey of the group to our knowledge.  Is there anything else that we could use instead? Thank you.', NULL, NULL, '2021-02-25 15:47:23', '2021-02-25 15:47:23'),
(5917, 3040, 10310, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract.  Please see attachment.', NULL, NULL, '2021-03-30 14:31:20', '2021-03-30 14:31:20'),
(5918, 2037, 10311, NULL, NULL, 'New/Not Initiated', 'Request for application form submitted @ enterprise.credentialing@memorialhermann.org', NULL, NULL, '2020-10-20 17:55:14', '2020-10-20 17:55:14'),
(5919, 2037, 10311, NULL, '2020-10-28 00:00:00.000', 'In Process', 'Request for application form submitted @ enterprise.credentialing@memorialhermann.org', NULL, NULL, '2020-10-21 12:11:05', '2020-10-21 12:11:05'),
(5920, 2037, 10311, NULL, '2020-11-04 00:00:00.000', 'In Process', 'Follow up email sent to Request for application form (Group) submitted @ enterprise.credentialing@memorialhermann.org', NULL, NULL, '2020-10-28 10:34:08', '2020-10-28 10:34:08'),
(5921, 1006, 10311, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Sent a follow-up email to enterprise.credentialing@memorialhermann.org regarding a status update. ', NULL, NULL, '2020-11-04 16:04:25', '2020-11-04 16:04:25'),
(5922, 2037, 10311, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Requested Information Submitted to Memorial Herman for the group credentialing.', NULL, NULL, '2020-11-11 15:51:36', '2020-11-11 15:51:36'),
(5923, 2037, 10311, NULL, '2021-02-28 00:00:00.000', 'On Hold', 'Received the below email for network closure .-------------------------------- MHHP Contracting 9:16 AM (7 hours ago) to me  Good morning Sherry. At this time, Corpus Christi, Texas is out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.     Thank you.     Camilla Paige', NULL, NULL, '2020-11-13 17:46:42', '2020-11-13 17:46:42'),
(5924, 1006, 10311, NULL, '2021-05-11 00:00:00.000', 'Not Eligible', NULL, NULL, NULL, '2021-05-04 10:38:07', '2021-05-04 10:38:07'),
(5925, 2027, 10312, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-21 13:58:15', '2020-10-21 13:58:15'),
(5926, 2027, 10312, NULL, '2020-10-28 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and effective date is 09/04/2020. Confirmation screenshot is attached.', NULL, NULL, '2020-10-21 13:59:18', '2020-10-21 13:59:18'),
(5927, 2027, 10313, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-22 09:33:48', '2020-10-22 09:33:48'),
(5928, 2027, 10313, NULL, '2020-10-29 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and the effective date is 08/01/2020. Screenshot for provider confirmation is attached. ', NULL, NULL, '2020-10-22 09:33:59', '2020-10-22 09:33:59'),
(5929, 2027, 10314, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-22 09:36:22', '2020-10-22 09:36:22'),
(5930, 2027, 10314, NULL, '2020-10-29 00:00:00.000', 'Approved', 'Provider is now showing linked with the insurance and the effective date is 08/01/2020. Screenshot for provider confirmation is attached. ', NULL, NULL, '2020-10-22 09:36:34', '2020-10-22 09:36:34'),
(5931, 2037, 10315, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-22 10:29:38', '2020-10-22 10:29:38'),
(5932, 2037, 10315, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Application submitted and is sent for review for approval.Turn around 30 business.Tracking#12366649. ', NULL, NULL, '2020-10-22 10:30:45', '2020-10-22 10:30:45'),
(5933, 2037, 10315, NULL, '2020-10-29 00:00:00.000', 'In Process', 'They said that the panels show open as of now however the certainty is subject to the approval of the initial request.', NULL, NULL, '2020-10-22 10:41:44', '2020-10-22 10:41:44'),
(5934, 2037, 10315, NULL, '2020-11-05 00:00:00.000', 'In Process', 'Waiting for the approval', NULL, NULL, '2020-10-29 16:57:10', '2020-10-29 16:57:10'),
(5935, 2037, 10315, NULL, '2020-11-12 00:00:00.000', 'In Process', 'Still in process.Under Medical Review.Waiting for the approval', NULL, NULL, '2020-11-05 17:57:25', '2020-11-05 17:57:25'),
(5936, 2037, 10315, NULL, '2020-11-18 00:00:00.000', 'In Process', 'As per live call to Cigna (Robert) the request is currently being reviewed waiting for the contracting approval. Ref: Robert:11/11/2020', NULL, NULL, '2020-11-11 09:43:58', '2020-11-11 09:43:58'),
(5937, 2037, 10315, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent for the status of the request.', NULL, NULL, '2020-11-18 14:06:12', '2020-11-18 14:06:12'),
(5938, 2037, 10315, NULL, '2020-12-10 00:00:00.000', 'In Process', 'The application got approved and is currently being processed. As per the live call Application# 12366649', NULL, NULL, '2020-11-19 12:44:59', '2020-11-19 12:44:59'),
(5939, 2037, 10315, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Currently in process need to allow more time', NULL, NULL, '2020-12-11 13:06:48', '2020-12-11 13:06:48'),
(5940, 2037, 10315, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Currently in process need to allow more time', NULL, NULL, '2020-12-11 13:20:39', '2020-12-11 13:20:39'),
(5941, 2037, 10315, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Need to allow more time ', NULL, NULL, '2020-12-29 10:39:42', '2020-12-29 10:39:42'),
(5942, 1006, 10315, NULL, '2021-02-02 00:00:00.000', 'New/Not Initiated', 'Sent follow up email for credentialing to intake_pdm@cigna.com', NULL, NULL, '2021-01-26 18:06:59', '2021-01-26 18:06:59'),
(5943, 1006, 10315, NULL, '2021-02-03 00:00:00.000', 'In Process', NULL, NULL, NULL, '2021-01-27 13:48:23', '2021-01-27 13:48:23'),
(5944, 1006, 10315, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email received:  We have confirmed that your application is complete, and have forwarded it for credentialing review', NULL, NULL, '2021-01-27 17:19:21', '2021-01-27 17:19:21'),
(5945, 1006, 10315, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Sent a follow-up email @ intake_pdm@cigna.com regarding status.  ', NULL, NULL, '2021-02-01 15:57:25', '2021-02-01 15:57:25'),
(5946, 1006, 10315, NULL, '2021-02-24 00:00:00.000', 'Approved', 'Dear PATRICK AYARZAGOITIA,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 02/05/2021. Your provider identification number is‍ ‌6223529. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).', NULL, NULL, '2021-02-17 18:17:05', '2021-02-17 18:17:05'),
(5947, 2037, 10316, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-22 12:46:24', '2020-10-22 12:46:24'),
(5948, 2037, 10316, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Filled out provider enrollment form and emailed to kmoten@humana.com with DEA,COI.', NULL, NULL, '2020-10-22 12:46:38', '2020-10-22 12:46:38'),
(5949, 2037, 10316, NULL, '2020-11-05 00:00:00.000', 'In Process', 'Got the confirmation of receiving over the secure email:  -------------- This application has been submitted for processing. Please allow 90 days.     Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana', NULL, NULL, '2020-10-22 12:47:23', '2020-10-22 12:47:23'),
(5950, 2037, 10316, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Follow up email sent to K-Moten.Turn around 90 days', NULL, NULL, '2020-10-23 10:36:38', '2020-10-23 10:36:38'),
(5951, 2037, 10316, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Follow up email sent.', NULL, NULL, '2020-11-09 18:02:56', '2020-11-09 18:02:56'),
(5952, 2037, 10316, NULL, '2020-12-03 00:00:00.000', 'In Process', 'Currently in process.Need to allow more time.', NULL, NULL, '2020-11-16 12:53:42', '2020-11-16 12:53:42'),
(5953, 1006, 10316, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Sent a follow-up email to Katherine @ KMoten4@humana.com', NULL, NULL, '2020-12-03 10:42:18', '2020-12-03 10:42:18'),
(5954, 2037, 10316, NULL, '2020-12-18 00:00:00.000', 'In Process', 'Currently being processed', NULL, NULL, '2020-12-11 17:38:08', '2020-12-11 17:38:08'),
(5955, 2037, 10316, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Response received from Katherine Moten. Yes this provider is showing affiliated with that TIN, eff: 10/22/20.However the provider is still in the process of being certified. Need to allow 90 days for the process to be completed. Submitted location addition request to add all three to HGBProviderRosters@humana.com: -------------------------------------- Greetings!  We need to add all three mentioned locations to the below provider exactly the same way they are set up for the below mentioned TIN.Kindly find the attached roster.  Provider Name: Mary Gonzalez NPI# 1952713083 TIN# 46-0575924   1) 500 E Caesar Ave, (Physical & Billing Address) Kingsville, TX 78363 (O)361.516.0800 (F)361.516.0855  2) 4042 River Hill Dr. (Physical Address) Corpus Christi, TX 78410 (O)361.933.5187 (F) 361.933.5189 Billing Address: 500 E Caesar Ave, Kingsville, TX 78363  3) 6646 S. Staples #122 (Physical Address) Corpus Christi, TX 78413 (O)361.334.2023 (F) 361.334.2025 Billing Address: 500 E Caesar Ave, Kingsville, TX 78363   Please let me know if you need any further information.', NULL, NULL, '2020-12-17 16:46:13', '2020-12-17 16:46:13'),
(5956, 2037, 10316, NULL, '2021-01-05 00:00:00.000', 'Approved', 'As per live call confirmation Mary is completely certified as of 10/22/2020 with Kingsville and Staples added. Snapshot updated in EMRBS. Welcome letter is in the process to be mailed out.', NULL, NULL, '2020-12-29 15:32:11', '2020-12-29 15:32:11'),
(5957, 2037, 10317, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-22 12:46:25', '2020-10-22 12:46:25'),
(5958, 2037, 10317, NULL, '2020-10-29 00:00:00.000', 'In Process', 'Filled out provider enrollment form and emailed to kmoten@humana.com with DEA,COI.', NULL, NULL, '2020-10-22 12:46:44', '2020-10-22 12:46:44'),
(5959, 2037, 10317, NULL, '2020-11-05 00:00:00.000', 'In Process', 'Got the confirmation of receiving over the secure email:  -------------- This application has been submitted for processing. Please allow 90 days.     Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana', NULL, NULL, '2020-10-22 12:47:05', '2020-10-22 12:47:05'),
(5960, 2037, 10317, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Follow up email sent to K-Moten.Turn around 90 days', NULL, NULL, '2020-10-23 10:36:22', '2020-10-23 10:36:22'),
(5961, 2037, 10317, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Follow up email sent.', NULL, NULL, '2020-11-09 18:03:01', '2020-11-09 18:03:01'),
(5962, 2037, 10317, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Currently in process.Need to allow more time.', NULL, NULL, '2020-11-16 12:53:52', '2020-11-16 12:53:52'),
(5963, 2037, 10317, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Response received from Katherine Moten. Yes this provider is showing affiliated with that TIN, eff: 10/22/20.However the provider is still in the process of being certified. Need to allow 90 days for the process to be completed. Submitted location addition request to add all three to HGBProviderRosters@humana.com: -------------------------------------- Greetings!  We need to add all three mentioned locations to the below provider exactly the same way they are set up for the below mentioned TIN.Kindly find the attached roster.  Provider Name: Mary Gonzalez NPI# 1952713083 TIN# 46-0575924   1) 500 E Caesar Ave, (Physical & Billing Address) Kingsville, TX 78363 (O)361.516.0800 (F)361.516.0855  2) 4042 River Hill Dr. (Physical Address) Corpus Christi, TX 78410 (O)361.933.5187 (F) 361.933.5189 Billing Address: 500 E Caesar Ave, Kingsville, TX 78363  3) 6646 S. Staples #122 (Physical Address) Corpus Christi, TX 78413 (O)361.334.2023 (F) 361.334.2025 Billing Address: 500 E Caesar Ave, Kingsville, TX 78363   Please let me know if you need any further information.', NULL, NULL, '2020-12-17 16:46:22', '2020-12-17 16:46:22'),
(5964, 2037, 10317, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Calallen location addition in process', NULL, NULL, '2020-12-29 15:28:52', '2020-12-29 15:28:52'),
(5965, 1006, 10317, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Sent email for update regarding the location addition to kmoten@humana.com ', NULL, NULL, '2021-01-26 18:14:57', '2021-01-26 18:14:57'),
(5966, 3046, 10317, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: kmoten@humana.com Subject: Updates for Location Addition || Statcare Minor Emergency Clinic || Tricare || Greetings, Kindly advise if all three below mentioned locations have been updated for Mary Gonzalez. Provider Name: Mary Gonzalez NPI# 1952713083 TIN# 46-0575924  a. 500 E Caesar Ave, (Physical & Billing Address) Kingsville, TX 78363 (O)361.516.0800 (F)361.516.0855  b. 4042 River Hill Dr. (Physical Address) Corpus Christi, TX 78410 (O)361.933.5187 (F) 361.933.5189 Billing Address: 500 E Caesar Ave, Kingsville, TX 78363  c. 6646 S. Staples #122 (Physical Address) Corpus Christi, TX 78413 (O)361.334.2023 (F) 361.334.2025 Billing Address: 500 E Caesar Ave, Kingsville, TX 78363   Your quick response in this regard is highly appreciated Thank you.', NULL, NULL, '2021-02-25 14:44:26', '2021-02-25 14:44:26'),
(5967, 3046, 10317, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email from: KMoten4@humana.com Subject: Updates for Location Addition || Statcare Minor Emergency Clinic || Tricare ||  Reply from Katherine.  This request has been completed. She has been added to  . 500 E Caesar Ave, (Physical & Billing Address)  Kingsville, TX 78363  (O)361.516.0800  (F)361.516.0855  b. 4042 River Hill Dr. (Physical Address)  Corpus Christi, TX 78410 (O)361.933.5187 (F) 361.933.5189 Billing Address: 500 E Caesar Ave, Kingsville, TX 78363 Please allow 3 Business days for updates to show in the system. Respectfully, Katherine Moten', NULL, NULL, '2021-02-25 15:18:16', '2021-02-25 15:18:16'),
(5968, 3046, 10317, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email to: KMoten4@humana.com Subject: Updates for Location Addition || Statcare Minor Emergency Clinic || Tricare ||  Katherine,  Thank you for your prompt response, I would like to request if you can also update me for the third location, as if that too has been updated. For your convenience I am mentioning the address below: c. 6646 S. Staples #122 (Physical Address) Corpus Christi, TX 78413 (O)361.334.2023 (F) 361.334.2025 Billing Address: 500 E Caesar Ave, Kingsville, TX 78363  Your quick response in this regard is highly appreciated Thank you.', NULL, NULL, '2021-02-25 15:20:14', '2021-02-25 15:20:14'),
(5969, 3046, 10317, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com Subject: Updates for Location Addition || Statcare Minor Emergency Clinic || Tricare ||  That location was already on the providers record. The other 2 were not, and I just added them.  Thank you.', NULL, NULL, '2021-02-25 15:40:39', '2021-02-25 15:40:39'),
(5970, 3046, 10317, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email to: KMoten4@humana.com Subject: Updates for Location Addition || Statcare Minor Emergency Clinic || Tricare ||', NULL, NULL, '2021-02-25 15:41:27', '2021-02-25 15:41:27'),
(5971, 3046, 10317, NULL, '2021-03-11 00:00:00.000', 'In Process', 'This request has been completed. She has been added to  . 500 E Caesar Ave, (Physical & Billing Address)  Kingsville, TX 78363  (O)361.516.0800  (F)361.516.0855     b. 4042 River Hill Dr. (Physical Address)  Corpus Christi, TX 78410  (O)361.933.5187  (F) 361.933.5189  Billing Address: 500 E Caesar Ave, Kingsville, TX 78363  Please allow 3 Business days for updates to show in the system. Respectfully, Katherine Moten   Katherine,   Thank you for your prompt response, I would like to request if you can also update me for the third location, as if that too has been updated. For your convenience I am mentioning the address below:  c. 6646 S. Staples #122 (Physical Address) Corpus Christi, TX 78413 (O)361.334.2023 (F) 361.334.2025 Billing Address: 500 E Caesar Ave, Kingsville, TX 78363  Your quick response in this regard is highly appreciated  Thank you.  That location was already on the providers record. The other 2 were not, and I just added them.  Thank you.', NULL, NULL, '2021-03-04 12:32:49', '2021-03-04 12:32:49'),
(5972, 3046, 10317, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: kmoten@humana.com Subject: Updates for Location Addition || Statcare Minor Emergency Clinic || Tricare ||  Dear Katherine,   Hope you are doing well.   Kindly note that I\'ve checked the Tricare provider directory and Mary Gonzalez is only showing on one location (6646 S. Staples #122, Corpus Christi, TX 78413) and the rest two are not showing. For your assistance I am sending you the screen-shot enclosed with this email. Kindly advise the status for the below mentioned locations, as when it is expected to be shown on Tricare provider directory.   Provider Name: Mary Gonzalez NPI# 1952713083 TIN# 46-0575924  a. 500 E Caesar Ave, (Physical & Billing Address) Kingsville, TX 78363 (O)361.516.0800 (F)361.516.0855  b. 4042 River Hill Dr. (Physical Address) Corpus Christi, TX 78410 (O)361.933.5187 (F) 361.933.5189 Billing Address: 500 E Caesar Ave, Kingsville, TX 78363     I hope to hear from you soon.   Thank you.  ', NULL, NULL, '2021-03-04 12:34:05', '2021-03-04 12:34:05'),
(5973, 1006, 10317, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\"', NULL, NULL, '2021-04-08 18:04:13', '2021-04-08 18:04:13'),
(5974, 9057, 10317, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:24:58', '2021-05-25 16:24:58'),
(5975, 1006, 10317, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:38', '2021-06-11 16:44:38'),
(5976, 1006, 10317, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com  Sub : RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Kindly inform me about the enrollment status of the new groups\' locations. The form has been filled out and faxed @ (608) 221-7535 Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Provider 2: Provider Name: Francis, William Provider NPI# 457994436 Provider 3: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Please respond to me soon.  Thank you!', NULL, NULL, '2021-06-30 11:04:16', '2021-06-30 11:04:16'),
(5977, 1006, 10317, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  The roster has been sent and is attached to the main group tasks.  ', NULL, NULL, '2021-08-09 16:51:27', '2021-08-09 16:51:27');
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
(5978, 1006, 10317, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:50:30', '2021-08-24 14:50:30'),
(5979, 11056, 10317, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:06:04', '2021-09-21 16:06:04'),
(5980, 11056, 10317, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:52:00', '2021-10-01 12:52:00'),
(5981, 11056, 10317, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:50:28', '2021-10-18 15:50:28'),
(5982, 11056, 10317, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 10:55:41', '2021-10-26 10:55:41'),
(5983, 11056, 10317, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 11:55:21', '2021-10-26 11:55:21'),
(5984, 11056, 10317, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:40:18', '2021-11-11 14:40:18'),
(5985, 11056, 10317, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Email received from: jtrenz@humana.com>  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon –  Mary Gonzalez  - I do not have a welcome letter available for this provider as she is not a brand new provider with TRICARE. Below are effective dates    Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363   EFFECTIVE 2/25/21 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413   EFFECTIVE 10/22/20 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410  EFFECTIVE  2/25/21 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  EFFECTIVE 8/27/21   Please see the attachment', NULL, NULL, '2021-11-30 12:01:36', '2021-11-30 12:01:36'),
(5986, 2027, 10318, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-22 14:15:30', '2020-10-22 14:15:30'),
(5987, 2027, 10318, NULL, '2020-10-29 00:00:00.000', 'Approved', 'This provider is showing in network with the insurance and the effective date is 8/28/2020. Welcome letter is attached', NULL, NULL, '2020-10-22 14:19:10', '2020-10-22 14:19:10'),
(5988, 2027, 10319, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-22 16:51:34', '2020-10-22 16:51:34'),
(5989, 2027, 10319, NULL, '2020-10-29 00:00:00.000', 'In Process', 'To: Marina_Machuca@bcbstx.com  Sub: (Abraham, Glory)-(Columbus Urgent Care PA)-(Blue Cross Blue Shield)   Hello Marina,  I want to enroll this below mentioned provider with (BCBS) please assist me how can I start the process. Provider Name: Abraham, Glory Provider NPI# 1194206490 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-10-22 16:57:15', '2020-10-22 16:57:15'),
(5990, 2027, 10319, NULL, '2020-11-06 00:00:00.000', 'In Process', 'To: Marina_Machuca@bcbstx.com  Sub: (Abraham, Glory)-(Columbus Urgent Care PA)-(Blue Cross Blue Shield)  I want to enroll this below mentioned provider with (BCBS) please assist me how can I start the process. Provider Name: Abraham, Glory Provider NPI# 1194206490 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.', NULL, NULL, '2020-10-30 09:48:23', '2020-10-30 09:48:23'),
(5991, 2027, 10319, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: Marina_Machuca@bcbstx.com  You will need to submit a Provider Onboarding Form to get him set up under this TAX ID#.  https://www.bcbstx.com/provider/network/network_participation.html          Thank you  Marina  ', NULL, NULL, '2020-11-06 10:10:29', '2020-11-06 10:10:29'),
(5992, 2027, 10319, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Online application has been submitted and screenshot is attached.', NULL, NULL, '2020-11-13 14:00:05', '2020-11-13 14:00:05'),
(5993, 2027, 10319, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: TXProviderUpdateSubmission@bcbstx.com  I have submitted the online application. May I know the current status of this below mentioned provider. Provider Name: Abraham, Glory Provider NPI# 1194206490 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151    Thanks.', NULL, NULL, '2020-11-20 10:40:14', '2020-11-20 10:40:14'),
(5994, 2027, 10319, NULL, '2020-11-30 00:00:00.000', 'In Process', 'From: txproviderupdatesubmission@bcbstx.com  Good afternoon,  I have researched your request, but was not able to find the application and I do not find this provider linked to your group. Please submit either the Application ID or Case Number that was assigned when you submitted your application online so we can locate it and provide further information.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2020-11-23 09:17:21', '2020-11-23 09:17:21'),
(5995, 2027, 10319, NULL, '2020-11-30 00:00:00.000', 'In Process', 'To: txproviderupdatesubmission@bcbstx.com  The application \"ID\" is 262702. Please confirm if this provider is linked.  Thanks. ', NULL, NULL, '2020-11-23 09:18:08', '2020-11-23 09:18:08'),
(5996, 2027, 10319, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: TXProviderUpdateSubmission@bcbstx.com  May I know the current status of the below mentioned provider: Provider Name: Abraham, Glory Provider NPI# 1194206490 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.  ', NULL, NULL, '2020-11-30 12:48:24', '2020-11-30 12:48:24'),
(5997, 2027, 10319, NULL, '2020-12-09 00:00:00.000', 'In Process', 'From: txproviderupdatesubmission@bcbstx.com  Hello,  Your application # 262702 dated 11/13/2020 is still in line to be completed.  Please allow more time for the application to be processed. Please refer to the application number when submitting status requests so we can be sure to provide the correct information.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2020-12-02 09:05:16', '2020-12-02 09:05:16'),
(5998, 2027, 10319, NULL, '2020-12-17 00:00:00.000', 'In Process', 'Request is still in process', NULL, NULL, '2020-12-10 12:57:21', '2020-12-10 12:57:21'),
(5999, 2037, 10319, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Need to allow mote time', NULL, NULL, '2020-12-17 16:50:00', '2020-12-17 16:50:00'),
(6000, 2037, 10319, NULL, '2021-01-19 00:00:00.000', 'In Process', '	 Need to allow mote time', NULL, NULL, '2020-12-29 16:55:29', '2020-12-29 16:55:29'),
(6001, 1006, 10319, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Sent a follow-up email @ txproviderupdatesubmission@bcbstx.com', NULL, NULL, '2021-02-02 18:03:47', '2021-02-02 18:03:47'),
(6002, 1006, 10319, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Sent another follow-up @ ProfessionalProviderNetworkDept@bcbstx.com as the previous email just gave me the record ID effective date.  ', NULL, NULL, '2021-02-05 10:35:55', '2021-02-05 10:35:55'),
(6003, 1006, 10319, NULL, '2021-02-15 00:00:00.000', 'Approved', 'Received the following update from TX NM Houston provider_relations_houston@bcbstx.com: \"Provider is effective 12-14-2020 with PPO, Blue Essentials, Blue Premier, Blue Advantage HMO, and Medicare Advantage PPO   Heather Swearingen Network Management Consultant\"', NULL, NULL, '2021-02-08 14:52:41', '2021-02-08 14:52:41'),
(6004, 2027, 10320, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-22 16:59:05', '2020-10-22 16:59:05'),
(6005, 2027, 10320, NULL, '2020-10-29 00:00:00.000', 'In Process', 'To: 	Alberta.Randall@superiorhealthplan.com  Sub: (Kourouma , Odette Tiranke)-(Columbus Urgent Care PA)-(Superior Health)  I want to enroll this below mentioned provider with (Superior Health) Kindly assist me how can I start the process.  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.  ', NULL, NULL, '2020-10-22 17:11:24', '2020-10-22 17:11:24'),
(6006, 2027, 10320, NULL, '2020-11-06 00:00:00.000', 'In Process', 'From: Alberta.Randall@superiorhealthplan.com  Sub: (Kourouma , Odette Tiranke)-(Columbus Urgent Care PA)-(Superior Health)  Good morning,     Please contact your Account Manager to assist you. Listed below is a link to help you find your Account Manager:     https://www.superiorhealthplan.com/providers/resources/find-my-provider-rep.html     Thank You,  Alberta Randall  Credentialing Specialist I  cid:image002.jpg@01D4BC6C.C5EB77A0  5900 E. Ben White Blvd.  Austin, TX 78741  Toll-Free: 1-800-218-7453 x42083  Fax: 1-866-702-4831  Alberta.Randall@SuperiorHealthPlan.com | SuperiorHealthPlan.com', NULL, NULL, '2020-10-30 10:37:14', '2020-10-30 10:37:14'),
(6007, 2027, 10320, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: Alberta.Randall@superiorhealthplan.com  This link is not working for some reason, can you please send me the email address of the account manager directly.  Thanks.', NULL, NULL, '2020-11-06 15:37:41', '2020-11-06 15:37:41'),
(6008, 2027, 10320, NULL, '2020-11-20 00:00:00.000', 'In Process', 'To: Alberta.Randall@superiorhealthplan.com  Can I have the email address of my network account manager?', NULL, NULL, '2020-11-13 15:36:04', '2020-11-13 15:36:04'),
(6009, 2027, 10320, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: AM.Austin@superiorhealthplan.com  I want to enroll this below mentioned provider with (Superior Health) Kindly assist me how can I start the process.  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Group Name: Columbus Urgent Care PA Group Tax-ID: 471914151  Thanks.   ', NULL, NULL, '2020-11-20 09:42:03', '2020-11-20 09:42:03'),
(6010, 2027, 10320, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: AM.Austin@superiorhealthplan.com SHP.NetworkDevelopment@superiorhealthplan.com  Please find the application attached in this email for the enrollment purpose of the provider.  Thanks.', NULL, NULL, '2020-11-20 15:17:58', '2020-11-20 15:17:58'),
(6011, 2027, 10320, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: AM.Austin@superiorhealthplan.com  I’ve cc’d our credentialing and contracting team', NULL, NULL, '2020-11-20 16:41:03', '2020-11-20 16:41:03'),
(6012, 2027, 10320, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: AM.Austin@superiorhealthplan.com  May I know the current status of this request?', NULL, NULL, '2020-11-30 14:30:53', '2020-11-30 14:30:53'),
(6013, 2027, 10320, NULL, '2020-12-09 00:00:00.000', 'Approved', 'This provider is now enrolled with (Superior Health) and effective date is 01/01/2021. Welcome letter is attached', NULL, NULL, '2020-12-02 13:16:36', '2020-12-02 13:16:36'),
(6014, 2027, 10321, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-22 17:44:10', '2020-10-22 17:44:10'),
(6015, 2027, 10321, NULL, '2020-10-29 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  Sub: (Abraham, Glory)-(Imperial Valley Urgent Care Center)-(Amerigroup)  Hello,  I have checked through your provider directory that (Normandy Urgent Care Center) has a location enrolled with amerigroup ( Normandy Urgent Care Center 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060) so I want to enroll this below mentioned provider in this location with amerigroup kindly assist me how can I start the process. Provider Name: Abraham, Glory  Provider NPI# 1194206490 Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429    Thanks.', NULL, NULL, '2020-10-22 17:51:21', '2020-10-22 17:51:21'),
(6016, 2027, 10321, NULL, '2020-11-06 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  Sub: (Abraham, Glory)-(Imperial Valley Urgent Care Center)-(Amerigroup)  Hello,  I have checked through your provider directory that (Normandy Urgent Care Center) has a location enrolled with amerigroup ( Normandy Urgent Care Center 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060) so I want to enroll this below mentioned provider in this location with amerigroup kindly assist me how can I start the process. Provider Name: Abraham, Glory  Provider NPI# 1194206490 Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429    Thanks.', NULL, NULL, '2020-10-30 11:00:29', '2020-10-30 11:00:29'),
(6017, 2027, 10321, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-06 10:45:16', '2020-11-06 10:45:16'),
(6018, 2037, 10321, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Email Sent:  txcredentialing@amerigroup.com (Abraham, Glory)-(Imperial Valley Urgent Care Center)-(Amerigroup) Hello,  Kindly find the attached credentialing application to add the provider to the below mentioned TIN with two Service location addresses. Provider Name: Abraham, Glory  Provider NPI# 1194206490  Group: Normandy Urgent Care CenterAddress: 779 Normandy St Ste 114                                Houston , TX 77015-3441.TIN: 27-0796429NPI: 1407171077 Secondary Location: Imperial Valley Urgent Care Center Address:16272 IMPERIAL VALLEY DR STE K,                 Houston , TX 77060Billing Address:16272 IMPERIAL VALLEY DR STE K,                          Houston , TX 77060. ', NULL, NULL, '2020-11-13 15:59:08', '2020-11-13 15:59:08'),
(6019, 2037, 10321, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Follow up email sent to txcredentialing@amerigroup.com', NULL, NULL, '2020-11-30 14:41:32', '2020-11-30 14:41:32'),
(6020, 2037, 10321, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Follow up email sent to txcredentialing@amerigroup.com', NULL, NULL, '2020-12-11 13:04:37', '2020-12-11 13:04:37'),
(6021, 2037, 10321, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-29 10:33:37', '2020-12-29 10:33:37'),
(6022, 1006, 10321, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Sent a follow-up email @ TX Credentialing txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com ', NULL, NULL, '2021-01-20 09:48:30', '2021-01-20 09:48:30'),
(6023, 1006, 10321, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent another follow-up @ TX Credentialing txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com ', NULL, NULL, '2021-02-16 15:19:42', '2021-02-16 15:19:42'),
(6024, 3040, 10321, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com  Subject: Enrollment Status || Imperial Valley Urgent Care Center || Abraham, Glory, Chennemkara, Mini Philip || Amerigroup ||  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   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 Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: Abraham, Glory Provider NPI# 1194206490  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-03-01 12:50:16', '2021-03-01 12:50:16'),
(6025, 1006, 10321, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:07:48', '2021-05-31 15:07:48'),
(6026, 11056, 10321, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 12:18:54', '2021-06-17 12:18:54'),
(6027, 3040, 10321, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  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 : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:53', '2021-07-06 09:58:53'),
(6028, 3040, 10321, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers 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# 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 : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  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 for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:40', '2021-07-26 15:24:40'),
(6029, 11056, 10321, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  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 Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:23:07', '2021-08-13 14:23:07'),
(6030, 3040, 10321, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups 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 Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:10', '2021-08-25 15:00:10'),
(6031, 3040, 10321, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups 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 Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:10', '2021-08-25 15:00:10'),
(6032, 3040, 10321, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup 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  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:52', '2021-09-09 13:07:52'),
(6033, 10057, 10321, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  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	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  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 15:09:54', '2021-10-18 15:09:54'),
(6034, 10057, 10321, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  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	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 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  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:06:44', '2021-11-11 13:06:44'),
(6035, 10057, 10321, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:53:24', '2021-11-30 10:53:24'),
(6036, 10057, 10321, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-14 09:37:32', '2021-12-14 09:37:32'),
(6037, 10057, 10321, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 14:01:43', '2021-12-20 14:01:43'),
(6038, 10057, 10321, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Call Details: (800) 600-4441  Rep: Victor  Ref # I146789022  Still in process, need to check next week, also send reminder to below mentioned emails.  latina.small@anthem.com nena.graves@amerigroup.com  Regards, Steve Albert', NULL, NULL, '2021-12-29 11:10:44', '2021-12-29 11:10:44'),
(6039, 19067, 10321, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Subject: Enrollment Query || IVUC || Glory Abraham || AmeriGroup ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:28:15', '2022-01-04 16:28:15'),
(6040, 19067, 10321, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: latina.small@anthem.com  Subject: RE: {EXTERNAL} Enrollment Query || IVUC || Glory Abraham || AmeriGroup ||    Good Afternoon,     The provider currently shows as participating, however, the address currently on file is not the same as mentioned. (16272 Imperial Valley DR STE K, Houston, TX 77060)     The current address on file is 779 Normandy St, Ste 114, Houston, TX 77015-3441. Should this address be removed or is it an additional address? Please let me know so that we can have the address updated accordingly.     Thank You in Advance,     Latina Small  Provider Experience Consultant  Amerigroup, Inc.     Houston Health Plan, Amerigroup Texas  5959 Corporate Dr. Suite 1300, Houston, TX 77036 l office/cell: 346-237-0834  fax: 1-866-495-7540  latina.small@Amerigroup.com  www.Amerigroup.com  For inquiries concerning:  Rejected claims – please contact EDI at 1-800-590-5745  Claims inquiries – please contact the Provider Services Unit at 1-800-454-3730  Multiplan credentialing- please contact Multiplan at 1-866-971-7427  TMHP website at www.tmhp.com or phone 1-800-925-9126     Electronic Business Transmission sign up or inquiries:  Electronic Remittance Advice (ERA) is through Availity.* To sign up, navigate to https://www.availity.com or call Customer Service at 1-800-282-4548.      Register today to receive our important monthly  Provider News via email     https://provider.amerigroup.com/docs/gpp/TX_CAID_SignUpToReceiveEmailFromAmerigroup.pdf?v=202106221519     Effective November 1, 2021, EnrollSafe will replace CAQH Enrollhub® as the electronic funds transfer (EFT) enrollment website for Amerigroup providers. As of November 1, 2021, CAQH Enrollhub will no longer offer EFT enrollment to new users. To sign up for EFT please go the the website at https://enrollsafe.payeehub.org      ', NULL, NULL, '2022-01-05 14:24:23', '2022-01-05 14:24:23'),
(6041, 19067, 10321, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com  Subject: Re: {EXTERNAL} Enrollment Query || IVUC || Glory Abraham || AmeriGroup ||   Hello!  Hope you are in great health,  There are 2 locations of this Practice which are as below:  1. Primary & Billing Address: 779 Normandy ST, STE 114, Houston, TX 77015-3441.  2. Secondary Address: 16272 Imperial Valley DR, STE K, Houston, TX 77060.   If the Secondary address is not on file then kindly add this address as a Secondary Location.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-05 14:26:23', '2022-01-05 14:26:23'),
(6042, 19067, 10321, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: latina.small@anthem.com  Subject: RE: {EXTERNAL} Enrollment Query || IVUC || Glory Abraham || AmeriGroup ||    Good Afternoon,     I have submitted the request for the address update. The reference number is PRVINT-00090537      Thank You in Advance,     Latina Small  Provider Experience Consultant  Amerigroup, Inc.     Houston Health Plan, Amerigroup Texas  5959 Corporate Dr. Suite 1300, Houston, TX 77036 l office/cell: 346-237-0834  fax: 1-866-495-7540  latina.small@Amerigroup.com', NULL, NULL, '2022-01-05 17:11:09', '2022-01-05 17:11:09');
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
(6043, 19067, 10321, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email received from: latina.small@anthem.com  Subject: RE: {EXTERNAL} Enrollment Query || IVUC || Glory Abraham || AmeriGroup ||    Good Afternoon,     Can you please provide the phone and fax number for each location please to process the address updates.     1. Primary & Billing Address: 779 Normandy ST, STE 114, Houston, TX 77015-3441.     2. Secondary Address: 16272 Imperial Valley DR, STE K, Houston, TX 77060.        Thank You in Advance,     Latina Small, MBA, BSBM', NULL, NULL, '2022-01-13 09:46:16', '2022-01-13 09:46:16'),
(6044, 19067, 10321, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com  Subject: Re: {EXTERNAL} Enrollment Query || IVUC || Glory Abraham || AmeriGroup ||   Greetings!  Hope this email finds you well.  Primary Phone# 713-453-8900 Primary Fax# 713-453-8901  Secondary Phone# 281-405-9600 Secondary Fax# 281-405-9605  Don\'t hesitate to reach out if you need anything else.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-13 09:52:49', '2022-01-13 09:52:49'),
(6045, 20067, 10321, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com  Sub: Re: {EXTERNAL} Enrollment Query || IVUC || Glory Abraham || AmeriGroup ||  Good Afternoon Latina,  Hope you had a great weekend. Any updates on the previous request? Now I am handling this case so feel free to contact me if you have any questions or concerns.  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-18 14:54:39', '2022-01-18 14:54:39'),
(6046, 20067, 10321, NULL, '2022-01-31 00:00:00.000', 'Approved', 'Received the following email  Good Afternoon,     The address update request is complete as of 1/18/22.', NULL, NULL, '2022-01-24 13:56:57', '2022-01-24 13:56:57'),
(6047, 2027, 10322, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-23 10:16:47', '2020-10-23 10:16:47'),
(6048, 2027, 10322, NULL, '2020-10-30 00:00:00.000', 'In Process', 'To: Marina_Machuca@bcbstx.com  Sub: (Abraham, Glory)-(Imperial Valley Urgent Care Center)-(Blue Cross Blue Shield)  Hello Marina,   I have checked through your provider directory that (Normandy Urgent Care Center) has a location enrolled with BCBS ( Normandy Urgent Care Center 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060) so I want to enroll this below mentioned provider in this location with BCBS kindly assist me how can I start the process. Provider Name: Abraham, Glory  Provider NPI# 1194206490 Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429    Thanks.', NULL, NULL, '2020-10-23 10:21:29', '2020-10-23 10:21:29'),
(6049, 2027, 10322, NULL, '2020-11-02 00:00:00.000', 'In Process', 'From: Latrice_Thomas@bcbstx.com  Sub: (Abraham, Glory)-(Imperial Valley Urgent Care Center)-(Blue Cross Blue Shield)  Good morning,     A request has been submitted to add the location to the providers profile.  Keep in mind we do not add individual providers to our directories, therefore you will only see the location listed under the Urgent Care Center.        with gratitude,', NULL, NULL, '2020-10-26 10:10:05', '2020-10-26 10:10:05'),
(6050, 2027, 10322, NULL, '2020-11-02 00:00:00.000', 'In Process', 'To: Latrice_Thomas@bcbstx.com  What is the expected time frame for the completion of this request ?', NULL, NULL, '2020-10-26 10:10:42', '2020-10-26 10:10:42'),
(6051, 2027, 10322, NULL, '2020-11-02 00:00:00.000', 'In Process', 'From: Latrice_Thomas@bcbstx.com  7 business days', NULL, NULL, '2020-10-26 10:48:41', '2020-10-26 10:48:41'),
(6052, 2027, 10322, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To: Latrice_Thomas@bcbstx.com  Sub: (Abraham, Glory)-(Imperial Valley Urgent Care Center)-(Blue Cross Blue Shield)  Hi Latrice,  Please confirm if this below mentioned provider is linked with the insurance under the practice. Provider Name: Abraham, Glory Provider NPI# 1194206490 Practice Name: (Normandy Urgent Care Center 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060) Tax-ID: 27-0796429    Thanks. ', NULL, NULL, '2020-11-02 10:50:48', '2020-11-02 10:50:48'),
(6053, 2027, 10322, NULL, '2020-11-10 00:00:00.000', 'Approved', 'The provider is now showing linked with the insurance on the requested location and the effective date is 10/28/2020', NULL, NULL, '2020-11-03 15:26:20', '2020-11-03 15:26:20'),
(6054, 2027, 10323, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-23 10:28:27', '2020-10-23 10:28:27'),
(6055, 2027, 10323, NULL, '2020-10-30 00:00:00.000', 'In Process', 'To: Kris.Olier@communityhealthchoice.org  Sub; (Abraham, Glory)-(Imperial Valley Urgent Care Center)-(Community Health Choice)  Hello Kris,  I have checked through your provider directory that (Normandy Urgent Care Center) has a location enrolled with (CHC) ( Normandy Urgent Care Center 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060) so I want to enroll this below mentioned provider in this location with (CHC) kindly assist me how can I start the process. Provider Name: Abraham, Glory  Provider NPI# 1194206490 Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429    Thanks.', NULL, NULL, '2020-10-23 10:32:22', '2020-10-23 10:32:22'),
(6056, 2027, 10323, NULL, '2020-11-05 00:00:00.000', 'In Process', 'To: chc.contracting@communityhealthchoice.org  Sub: (Abraham, Glory)-(Imperial Valley Urgent Care Center)-(Community Health Choice)  Please find the requested documents attached in this email for the enrollment purpose of this provider.  Thanks.', NULL, NULL, '2020-10-29 17:42:32', '2020-10-29 17:42:32'),
(6057, 2027, 10323, NULL, '2020-11-15 00:00:00.000', 'New/Not Initiated', 'To: chc.contracting@communityhealthchoice.org  May I know the current status of this request.  Thanks.', NULL, NULL, '2020-11-05 14:02:04', '2020-11-05 14:02:04'),
(6058, 2027, 10323, NULL, '2020-11-12 00:00:00.000', 'In Process', 'To: chc.contracting@communityhealthchoice.org  May I know the current status of this request.  Thanks.', NULL, NULL, '2020-11-05 14:03:30', '2020-11-05 14:03:30'),
(6059, 2027, 10323, NULL, '2020-11-13 00:00:00.000', 'In Process', 'From: CHC.Contracting@communityhealthchoice.org  Good Morning,  The documentation was received, however, we are missing a 2020 dated W-9. Please provide a W-9 at your earliest opportunity to assist with the request.     Thank you', NULL, NULL, '2020-11-06 10:26:31', '2020-11-06 10:26:31'),
(6060, 2027, 10323, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: CHC.Contracting@communityhealthchoice.org  Please find the updated W 9 attached as per your request.', NULL, NULL, '2020-11-06 10:27:26', '2020-11-06 10:27:26'),
(6061, 2027, 10323, NULL, '2020-11-13 00:00:00.000', 'In Process', 'From: CHC.Contracting@communityhealthchoice.org  Thank you for your prompt response and information. Please see attached letter for your records.  If further questions or concerns, feel free to contact us.     Best regards,  Contracting Dept.', NULL, NULL, '2020-11-06 10:29:35', '2020-11-06 10:29:35'),
(6062, 2037, 10323, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Follow up email sent for the confirmation of receiving of the W9 Form', NULL, NULL, '2020-11-13 16:01:30', '2020-11-13 16:01:30'),
(6063, 2037, 10323, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Request i currently being processed need to allow more time', NULL, NULL, '2020-11-20 10:54:08', '2020-11-20 10:54:08'),
(6064, 2037, 10323, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Follow up email sent to CHC.Contracting@communityhealthchoice.org  (Abraham, Glory)-(Imperial Valley Urgent Care Center)-(Community Health Choice)', NULL, NULL, '2020-12-11 13:17:45', '2020-12-11 13:17:45'),
(6065, 2037, 10323, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Follow up email sent:', NULL, NULL, '2020-12-29 10:43:29', '2020-12-29 10:43:29'),
(6066, 1006, 10323, NULL, '2021-02-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ CHC Contracting CHC.Contracting@communityhealthchoice.org', NULL, NULL, '2021-02-05 17:56:19', '2021-02-05 17:56:19'),
(6067, 1006, 10323, NULL, '2021-02-15 00:00:00.000', 'Approved', 'Received the following approval from CHC Contracting CHC.Contracting@communityhealthchoice.org: \"Good Morning Brad,  Glory Abraham is currently participating with Normandy Urgent Care. Please see attached provider profile for additional information. Should you need further assistance, feel free to advise.  Have a great day, Contracting Team\"  The attachment mentions IVUC location addition for reference. ', NULL, NULL, '2021-02-08 17:37:42', '2021-02-08 17:37:42'),
(6068, 2027, 10324, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-23 10:41:53', '2020-10-23 10:41:53'),
(6069, 2027, 10324, NULL, '2020-10-30 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Sub: (Abraham, Glory)-(Imperial Valley Urgent Care Center)-(Texas Children Health Plan)  Hello Juanita,  I have checked through your provider directory that (Normandy Urgent Care Center) has a location enrolled with (TCHP) ( Normandy Urgent Care Center 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060) so I want to enroll this below mentioned provider in this location with (TCHP) kindly assist me how can I start the process. Provider Name: Abraham, Glory  Provider NPI# 1194206490 Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429    For your reference I have attached a screenshot.  Thanks.', NULL, NULL, '2020-10-23 10:47:10', '2020-10-23 10:47:10'),
(6070, 2027, 10324, NULL, '2020-10-30 00:00:00.000', 'In Process', 'From: jxalanis@texaschildrens.org  Good morning Mr. Rodriguez,  Provider Abraham Glory cannot be added to the Imperial Valley location, provider needs to be attested to the service address.  Thank you', NULL, NULL, '2020-10-23 13:47:19', '2020-10-23 13:47:19'),
(6071, 2027, 10324, NULL, '2020-10-30 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  This provider is now attested to the service address of (Imperial Valley), I am attaching a screenshot for your reference.', NULL, NULL, '2020-10-23 13:47:56', '2020-10-23 13:47:56'),
(6072, 2027, 10324, NULL, '2020-10-30 00:00:00.000', 'In Process', 'From: jxalanis@texaschildrens.org  Martin,  I am going to forward this information to the appropriate department to update the system.', NULL, NULL, '2020-10-23 13:49:15', '2020-10-23 13:49:15'),
(6073, 2027, 10324, NULL, '2020-11-05 00:00:00.000', 'Approved', 'Provider is linked with the insurance and the effective date is 05/07/2020 screenshot from provider directory is attached', NULL, NULL, '2020-10-29 17:54:59', '2020-10-29 17:54:59'),
(6074, 2027, 10325, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-23 10:51:40', '2020-10-23 10:51:40'),
(6075, 2027, 10325, NULL, '2020-10-30 00:00:00.000', 'In Process', 'To: Kris.Olier@communityhealthchoice.org  Sub: (Brown, Brittany)-(Imperial Valley Urgent Care Center)-(Community Health Choice)  Hello Kris,  I have checked through your provider directory that (Normandy Urgent Care Center) has a location enrolled with (CHC) ( Normandy Urgent Care Center 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060) so I want to enroll this below mentioned provider in this location with (CHC) kindly assist me how can I start the process. Provider Name: Brown, Brittany  Provider NPI# 1275163537 Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429    Thanks.', NULL, NULL, '2020-10-23 10:53:56', '2020-10-23 10:53:56'),
(6076, 2027, 10325, NULL, '2020-11-06 00:00:00.000', 'In Process', 'From: Kris.Olier@communityhealthchoice.org  Please complete the attached roster and supervising physician form if provider is an NP. Return all information to chc.contracting@communityhealthchoice.org.', NULL, NULL, '2020-10-30 14:18:35', '2020-10-30 14:18:35'),
(6077, 2027, 10325, NULL, '2020-11-13 00:00:00.000', 'In Process', 'To: CHC.Contracting@communityhealthchoice.org  Please find the requested documents attached in this email to start the enrollment process of the provider.  Thanks.', NULL, NULL, '2020-11-06 13:07:01', '2020-11-06 13:07:01'),
(6078, 2027, 10325, NULL, '2020-11-18 00:00:00.000', 'In Process', 'From: CHC.Contracting@communityhealthchoice.org  Good Morning Martin,   Thank you for the confirmation and information. Please see attached letter for your records. If further questions or concerns, feel free to advise.  Thank you', NULL, NULL, '2020-11-11 10:40:37', '2020-11-11 10:40:37'),
(6079, 2037, 10325, NULL, '2020-11-19 00:00:00.000', 'Approved', 'Welcome letter received with the effective date of 11/12/2020.  Par Plans:STAR CHIP D-SNP Star Plus Community Marketplace ---------------  Taylor-Martinez, Jeannie Jeannie.Taylor-Martinez@communityhealthchoice.org Attachments 7:59 AM (44 minutes ago) to ivuc@claimsmedinc.com, mk@claimsmedinc.com  Good Morning,  I have submitted the add for rendering provider, please allow about 5 days to be completed.   Jeannie ', NULL, NULL, '2020-11-12 09:49:35', '2020-11-12 09:49:35'),
(6080, 2037, 11306, NULL, NULL, 'New/Not Initiated', 'Initiated', NULL, NULL, '2020-10-26 10:31:04', '2020-10-26 10:31:04'),
(6081, 2037, 11306, NULL, '2020-11-02 00:00:00.000', 'Approved', 'CBUC-Holds an URGENT CARE CONTRACT-2 Locations added .Effective 04/01/2018', NULL, NULL, '2020-10-26 10:33:07', '2020-10-26 10:33:07'),
(6082, 2027, 11307, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-26 11:02:42', '2020-10-26 11:02:42'),
(6083, 2027, 11307, NULL, '2020-11-02 00:00:00.000', 'In Process', 'To: Latrice_Thomas@bcbstx.com  Sub: (Abraham, Glory)-(Longpoint Medical Center)-(Blue Cross Blue Shield)  Hello Marina,   I have checked through your provider directory that (Normandy Urgent Care Center) has a location enrolled with BCBS ( Normandy Urgent Care Center 9504 LONG POINT RD STE E Houston , TX 77055-4226) so I want to enroll this below mentioned provider in this location with BCBS kindly assist me how can I start the process. Provider Name: Abraham, Glory  Provider NPI# 1194206490 Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429    Thanks.', NULL, NULL, '2020-10-26 11:04:54', '2020-10-26 11:04:54'),
(6084, 2027, 11307, NULL, '2020-11-02 00:00:00.000', 'In Process', 'From: Latrice_Thomas@bcbstx.com  Sub: (Abraham, Glory)-(Longpoint Medical Center)-(Blue Cross Blue Shield)  Hi Martin,     I have submitted a request to have this location added for Glory Abraham.  Please refer to my email sent to you this morning regarding the update.      Marina Machuca does not service Normandy Urgent Care please remove her from all future correspondence regarding this Center.     with gratitude,', NULL, NULL, '2020-10-26 12:16:36', '2020-10-26 12:16:36'),
(6085, 2027, 11307, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To: Latrice_Thomas@bcbstx.com  Sub: (Abraham, Glory)-(Longpoint Medical Center)-(Blue Cross Blue Shield)  Hi Latrice,  Please confirm if this below mentioned provider is linked with the insurance under the practice. Provider Name: Abraham, Glory Provider NPI# 1194206490 Practice Name: (Normandy Urgent Care Center 9504 LONG POINT RD STE E Houston , TX 77055-4226) Tax-ID: 27-0796429    Thanks. ', NULL, NULL, '2020-11-02 10:59:46', '2020-11-02 10:59:46'),
(6086, 2027, 11307, NULL, '2020-11-09 00:00:00.000', 'In Process', 'From: Latrice_Thomas@bcbstx.com  Sub: (Abraham, Glory)-(Longpoint Medical Center)-(Blue Cross Blue Shield)  No.  I\'ll have to submit a request to add that location.  What\'s the phone and fax for that location?           with gratitude,     R. Latrice Thomas | Provider Relations Representative – Large Physician Groups, Hospital Systems, Urgent Care Centers| Network Management Dept Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company 1800 West Loop South, Suite 600  Houston, TX 77027 phone: 713-354-7067 fax: 713-663-1227 | email: latrice_thomas@bcbstx.com  Visit our website:  www.bcbstx.com     Experience Wellness Everywhere', NULL, NULL, '2020-11-02 14:46:17', '2020-11-02 14:46:17'),
(6087, 2027, 11307, NULL, '2020-11-09 00:00:00.000', 'In Process', 'To: Latrice_Thomas@bcbstx.com  The phone and fax numbers for this location are as follows: Phone# (713) 461-3535 Fax# (713) 461-3518  Thanks.', NULL, NULL, '2020-11-02 14:49:01', '2020-11-02 14:49:01'),
(6088, 2027, 11307, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: Latrice_Thomas@bcbstx.com  May I know the current status of this request.', NULL, NULL, '2020-11-09 10:03:53', '2020-11-09 10:03:53'),
(6089, 2037, 11307, NULL, '2020-11-24 00:00:00.000', 'In Process', 'Follow up email sent to Latrice', NULL, NULL, '2020-11-16 12:24:52', '2020-11-16 12:24:52'),
(6090, 2037, 11307, NULL, '2020-12-01 00:00:00.000', 'In Process', 'in process', NULL, NULL, '2020-11-24 17:51:40', '2020-11-24 17:51:40'),
(6091, 2037, 11307, NULL, '2020-12-08 00:00:00.000', 'Approved', 'Location added successfully reflecting over the provider directory. Snap shot uploaded with Par Plan detais', NULL, NULL, '2020-12-01 11:01:40', '2020-12-01 11:01:40'),
(6092, 2027, 11308, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-26 14:20:58', '2020-10-26 14:20:58'),
(6093, 2027, 11308, NULL, '2020-11-02 00:00:00.000', 'Approved', 'PROVIDER NAME	DIEGO NARANJO NP PROVIDER PTAN	P02530359 PROVIDER NPI	1568929800 EFFECTIVE DATE	11/21/2019 END DATE	', NULL, NULL, '2020-10-26 14:22:15', '2020-10-26 14:22:15'),
(6094, 2027, 11309, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-26 14:24:37', '2020-10-26 14:24:37'),
(6095, 2027, 11309, NULL, '2020-11-02 00:00:00.000', 'Approved', 'PROVIDER NAME	DIEGO NARANJO NP PROVIDER PTAN	P02530359 PROVIDER NPI	1568929800 EFFECTIVE DATE	11/21/2019 END DATE	', NULL, NULL, '2020-10-26 14:25:28', '2020-10-26 14:25:28'),
(6096, 2027, 11310, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-26 17:09:39', '2020-10-26 17:09:39'),
(6097, 2027, 11310, NULL, '2020-11-02 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Sub: (Providers)-(Imperial Valley Urgent Care Center)-(Texas Children Health Plan)  Hello Juanita,  I have checked through your provider directory that (Normandy Urgent Care Center) has a location enrolled with (TCHP) ( Normandy Urgent Care Center 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060) so I want to enroll these below mentioned providers in this location with (TCHP) kindly assist me how can I start the process. Provider Name: Brown, Brittany  Provider NPI# 1275163537 Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429    Thanks.', NULL, NULL, '2020-10-26 17:16:00', '2020-10-26 17:16:00'),
(6098, 2027, 11310, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Sent reminder', NULL, NULL, '2020-11-02 12:12:20', '2020-11-02 12:12:20'),
(6099, 2027, 11310, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Please find the LOI attached for the provider to start the enrollment process as per your request.  Thanks.', NULL, NULL, '2020-11-09 10:46:00', '2020-11-09 10:46:00'),
(6100, 2027, 11310, NULL, '2020-11-17 00:00:00.000', 'In Process', 'From: jxalanis@texaschildrens.org  Mr. Rodriguez,  Please allow 90 days for credentialing process.  Thank you', NULL, NULL, '2020-11-10 10:34:12', '2020-11-10 10:34:12'),
(6101, 2037, 11310, NULL, '2020-12-12 00:00:00.000', 'In Process', 'Credentialing is in process need to allow more time', NULL, NULL, '2020-11-18 16:43:46', '2020-11-18 16:43:46'),
(6102, 2037, 11310, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Credentialing is in process under Normandy. Will request to add location once the process finalizes.  ------------------------- Alanis, Juanita 11:39 AM (22 minutes ago) to me  Sherry,  These providers, Ani Stephen NPI: 1588959118, Jeemol George. NPI: 1497219067, Julie Jose, NPI: 1447883061 and Brittany Brown.  NPI: 1275163537 are not contracted with TCHP yet; there for cannot be added to the locations you are requesting. ', NULL, NULL, '2020-11-20 13:09:44', '2020-11-20 13:09:44'),
(6103, 2037, 11310, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Currently being credentialed under normandy.Need to allow a bit more time.', NULL, NULL, '2020-12-23 17:18:49', '2020-12-23 17:18:49'),
(6104, 1006, 11310, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Received the following update from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org: \"Provider Name: Brittany Brown –in process\" ', NULL, NULL, '2021-01-29 09:41:45', '2021-01-29 09:41:45'),
(6105, 1006, 11310, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Carter, Krisheena J.\" kjcarter@texaschildrens.org regarding the status of the PIF forms that were submitted on 11/13/2020 for the provider.  ', NULL, NULL, '2021-02-16 17:13:07', '2021-02-16 17:13:07'),
(6106, 3040, 11310, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: kjcarter@texaschildrens.org  Subject: Stephen Ani & Brittany Brown- TCHP Letter of Interest  Greetings,  Please advise me the enrollment status for the below mentioned providers.   Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-26 13:54:21', '2021-02-26 13:54:21'),
(6107, 3040, 11310, NULL, '2021-03-23 00:00:00.000', 'Approved', 'Email rcvd from: axhartma@texaschildrens.org  Subject: TCHP Welcome Letter - Brittany Brown, FNP - Normandy Urgent Care Center PA - Imperial Valley Dr. and Normandy St.  Good Morning,  Welcome to TCHP. Brittany Brown, FNP is now participating with Texas Children’s Health Plan under Normandy Urgent Care Center PA. Attached you will find a welcome letter with an effective date for all contracted products as well as the contact information for your Provider Relations Representative.  Please reach out to your PR Rep or the main Contracting Department phone line at (832) 828-1063 with any questions.  Thank you,  Anna Hartmann Contract Specialist Texas Children\'s Health Plan *: axhartma@texaschildrens.org (: (832) 828-1063', NULL, NULL, '2021-03-16 14:41:56', '2021-03-16 14:41:56'),
(6108, 20067, 11310, NULL, '2022-03-03 00:00:00.000', 'Approved', 'Received an attached roster.  Effective Date: 11/13/2020 Provider ID: PR00002343736', NULL, NULL, '2022-02-24 12:44:27', '2022-02-24 12:44:27'),
(6109, 2027, 11311, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-26 17:10:43', '2020-10-26 17:10:43'),
(6110, 2027, 11311, NULL, '2020-11-02 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Sub: (Providers)-(Imperial Valley Urgent Care Center)-(Texas Children Health Plan)  Hello Juanita,  I have checked through your provider directory that (Normandy Urgent Care Center) has a location enrolled with (TCHP) ( Normandy Urgent Care Center 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060) so I want to enroll these below mentioned providers in this location with (TCHP) kindly assist me how can I start the process. Provider Name: Brown, Brittany  Provider NPI# 1275163537 Provider Name: Jose, Julie Provider NPI# 1447883061 Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429    Thanks.', NULL, NULL, '2020-10-26 17:14:22', '2020-10-26 17:14:22'),
(6111, 2027, 11311, NULL, '2020-11-09 00:00:00.000', 'In Process', 'Sent Reminder', NULL, NULL, '2020-11-02 13:52:56', '2020-11-02 13:52:56'),
(6112, 2027, 11311, NULL, '2020-11-16 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  May I know the current status of the provider Jose, Julie?  Thanks.', NULL, NULL, '2020-11-09 15:36:28', '2020-11-09 15:36:28'),
(6113, 2027, 11311, NULL, '2020-11-17 00:00:00.000', 'In Process', 'From: jxalanis@texaschildrens.org  Mr. Rodriguez,  Please allow 90 days for credentialing process.  Thank you', NULL, NULL, '2020-11-10 10:35:03', '2020-11-10 10:35:03'),
(6114, 2037, 11311, NULL, '2020-12-12 00:00:00.000', 'In Process', 'Credentialing is in process .Need to allow more time', NULL, NULL, '2020-11-18 15:53:44', '2020-11-18 15:53:44'),
(6115, 2037, 11311, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Received PIFs filled out and submitted back to \"tchpnetworkmanagement@texaschildrens.org\" with IVUC as the secondary Location.= and request.', NULL, NULL, '2020-11-19 10:42:48', '2020-11-19 10:42:48'),
(6116, 2037, 11311, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Credentialing is in process under Normandy. Will request to add location once the process finalizes.  ------------------------- Alanis, Juanita 11:39 AM (22 minutes ago) to me  Sherry,  These providers, Ani Stephen NPI: 1588959118, Jeemol George. NPI: 1497219067, Julie Jose, NPI: 1447883061 and Brittany Brown.  NPI: 1275163537 are not contracted with TCHP yet; there for cannot be added to the locations you are requesting. ', NULL, NULL, '2020-11-20 13:10:02', '2020-11-20 13:10:02'),
(6117, 2037, 11311, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Currently being credentialed under normandy.Need to allow a bit more time.', NULL, NULL, '2020-12-23 17:18:41', '2020-12-23 17:18:41'),
(6118, 1006, 11311, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Received the following reply from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  \"Provider Name: Julie Jose –in process\" ', NULL, NULL, '2021-01-29 09:38:27', '2021-01-29 09:38:27'),
(6119, 1006, 11311, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Carter, Krisheena J.\" kjcarter@texaschildrens.org regarding the status of the PIF forms that were submitted on 11/13/2020 for the provider.  ', NULL, NULL, '2021-02-16 17:16:28', '2021-02-16 17:16:28'),
(6120, 3040, 11311, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: kjcarter@texaschildrens.org  Subject: Stephen Ani & Brittany Brown- TCHP Letter of Interest  Greetings,  Please advise me the enrollment status for the below mentioned providers.   Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-02-26 13:54:31', '2021-02-26 13:54:31'),
(6121, 3040, 11311, NULL, '2021-03-25 00:00:00.000', 'Approved', 'Email rcvd from: axhartma@texaschildrens.org  Subject: TCHP Welcome Letter - Julie Jose, NP - Normandy Urgent Care Center PA - Imperial Valley Dr. and Normandy St.  Good Afternoon,  Welcome to TCHP. Julie Jose, NP is now participating with Texas Children’s Health Plan under Normandy Urgent Care Center PA. Attached you will find a welcome letter with an effective date for all contracted products as well as the contact information for your Provider Relations Representative.  Please reach out to your PR Rep or the main Contracting Department phone line at (832) 828-1063 with any questions.  Thank you,  Anna Hartmann Contract Specialist Texas Children\'s Health Plan *: axhartma@texaschildrens.org (: (832) 828-1063', NULL, NULL, '2021-03-18 12:40:52', '2021-03-18 12:40:52'),
(6122, 20067, 11311, NULL, '2022-03-03 00:00:00.000', 'Approved', 'Received an attached roster.  Effective date: 11/13/2020 Provider ID: PR00002343561 ', NULL, NULL, '2022-02-24 12:42:56', '2022-02-24 12:42:56'),
(6123, 2027, 11312, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 12:23:59', '2020-10-27 12:23:59'),
(6124, 2027, 11312, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Sub: (Abraham, Glory)-(Longpoint Medical Center)-(Texas Children Health Plan)  Hello Juanita,  I have checked through your provider directory that (Normandy Urgent Care Center) has a location enrolled with TCHP ( Normandy Urgent Care Center 9504 LONG POINT RD STE E Houston , TX 77055-4226) so I want to enroll this below mentioned provider in this location with TCHP kindly assist me how can I start the process. Provider Name: Abraham, Glory  Provider NPI# 1194206490 Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429    Thanks.', NULL, NULL, '2020-10-27 12:27:37', '2020-10-27 12:27:37'),
(6125, 2027, 11312, NULL, '2020-11-10 00:00:00.000', 'In Process', 'From: jxalanis@texaschildrens.org  Sub: (Abraham, Glory)-(Longpoint Medical Center)-(Texas Children Health Plan)  Mr. Rodriguez,  The welcome letter indicates the Provider’s  primary address with Normandy Urgent Care Group.  Is the Provider seeing members at all locations?  Thank you.', NULL, NULL, '2020-11-03 10:17:41', '2020-11-03 10:17:41'),
(6126, 2027, 11312, NULL, '2020-11-10 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Yes, She works in all locations on different weekdays. Kindly send me the welcome letter of the location mentioned below for this provider: (Normandy Urgent Care Center with this location 9504 LONG POINT RD STE E, Houston , TX 77055-4226) .  Thanks. ', NULL, NULL, '2020-11-03 10:18:14', '2020-11-03 10:18:14'),
(6127, 2027, 11312, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  May I know the current status of my request regarding the welcome letter of the provider (Abraham Glory).  Thanks.', NULL, NULL, '2020-11-10 12:31:12', '2020-11-10 12:31:12'),
(6128, 2037, 11312, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent for location addition confirmation to Juanita', NULL, NULL, '2020-11-18 16:00:05', '2020-11-18 16:00:05'),
(6129, 2037, 11312, NULL, '2020-11-27 00:00:00.000', 'Approved', 'Received the location addition confirmation from juanita (TCHP) ', NULL, NULL, '2020-11-20 10:03:39', '2020-11-20 10:03:39'),
(6130, 2027, 11313, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 12:36:10', '2020-10-27 12:36:10'),
(6131, 2027, 11313, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: 	HumanaHoustonPD@humana.com  Sub: (Abraham, Glory)-(Longpoint Medical Center)-(Humana)  I want to enroll this below mentioned provider with humana, Kindly assist me how I can start the process: Provider Name: Abraham, Glory  Provider NPI# 1194206490  Group Name: Longpoint Medical Center  Thanks.', NULL, NULL, '2020-10-27 12:44:11', '2020-10-27 12:44:11'),
(6132, 2027, 11313, NULL, '2020-11-10 00:00:00.000', 'In Process', 'From: HumanaHoustonPD@humana.com  Sub: (Abraham, Glory)-(Longpoint Medical Center)-(Humana)  The Houston Market no longer covers East Texas.  East Texas has become the responsibility of the North Texas market.  You can forward your request to NTXNM@humana.com for handling.', NULL, NULL, '2020-11-03 10:21:08', '2020-11-03 10:21:08'),
(6133, 2027, 11313, NULL, '2020-11-10 00:00:00.000', 'In Process', 'To: HumanaHoustonPD@humana.com  Sub: (Abraham, Glory)-(Longpoint Medical Center)-(Humana)  The Houston Market no longer covers East Texas.  East Texas has become the responsibility of the North Texas market.  You can forward your request to NTXNM@humana.com for handling.', NULL, NULL, '2020-11-03 10:23:24', '2020-11-03 10:23:24'),
(6134, 2027, 11313, NULL, '2020-11-10 00:00:00.000', 'In Process', 'To: 	NTXNM@humana.com  I want to enroll this below mentioned provider with humana, Kindly assist me how I can start the process: Provider Name: Abraham, Glory  Provider NPI# 1194206490  Group Name: Longpoint Medical Center  Thanks. ', NULL, NULL, '2020-11-03 10:24:13', '2020-11-03 10:24:13'),
(6135, 2027, 11313, NULL, '2020-11-10 00:00:00.000', 'In Process', 'From: HumanaHoustonPD@humana.com  Sub: (Abraham, Glory)-(Longpoint Medical Center)-(Humana)  Please advise of the practice address.', NULL, NULL, '2020-11-03 17:13:03', '2020-11-03 17:13:03'),
(6136, 2027, 11313, NULL, '2020-11-10 00:00:00.000', 'In Process', 'To: HumanaHoustonPD@humana.com  The address is (9504 LONG POINT RD STE E, Houston , TX 77055-4226)', NULL, NULL, '2020-11-03 17:13:44', '2020-11-03 17:13:44'),
(6137, 2027, 11313, NULL, '2020-11-11 00:00:00.000', 'In Process', 'To: HumanaHoustonPD@humana.com NTXNM@humana.com  Please find the requested documents attached in this email to start the enrollment process of the provider.  Thanks.', NULL, NULL, '2020-11-04 14:05:34', '2020-11-04 14:05:34'),
(6138, 2027, 11313, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To: HumanaHoustonPD@humana.com  May I know the status of my request regarding the provider (Abraham glory).   Thanks.', NULL, NULL, '2020-11-11 13:29:49', '2020-11-11 13:29:49'),
(6139, 2037, 11313, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Follow up email sent for the effective date and Par Plan information to HumanaHoustonPD@humana.com -------------------------  (Abraham, Glory)-(Longpoint Medical Center)-(Humana)  Greetings, May I have the effective date of the provider Glory Abraham for the below mentioned TIN/Location.In addition to that if you could provide me with the par plan details and the welcome letter. Provider Name: Abraham, Glory  Provider NPI# 1194206490  Group Name: Longpoint Medical Center TIN: 76-0612416Address: 9504 LONG POINT RD STE E, Houston , TX 77055-4226 Thank you! ', NULL, NULL, '2020-11-13 17:44:43', '2020-11-13 17:44:43'),
(6140, 2037, 11313, NULL, '2020-11-26 00:00:00.000', 'Approved', 'Approval letter received the provider is in Network and Linked to LPMC TIN as of  05/22/2019. Par Plan details added in the notes.Welcome Letter uploaded in EMRBS, ', NULL, NULL, '2020-11-19 10:04:40', '2020-11-19 10:04:40'),
(6141, 2027, 11314, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 12:46:28', '2020-10-27 12:46:28'),
(6142, 2027, 11314, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Sub: (Stephen, Ani)-(Longpoint Medical Center)-(Texas Children Health Plan)  Hello Juanita,  I have checked through your provider directory that (Normandy Urgent Care Center) has a location enrolled with TCHP ( Normandy Urgent Care Center 9504 LONG POINT RD STE E Houston , TX 77055-4226) so I want to enroll this below mentioned provider in this location with TCHP kindly assist me how can I start the process. Provider Name: Stephen, Ani Provider NPI# 1588959118 Group Name: Normandy Urgent Care Center  Group Tax-ID: 27-0796429    Thanks.', NULL, NULL, '2020-10-27 12:48:51', '2020-10-27 12:48:51'),
(6143, 2027, 11314, NULL, '2020-11-10 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Please find the requested LOI form attached in this email for the enrollment process of the provider.  Thanks.', NULL, NULL, '2020-11-03 15:18:14', '2020-11-03 15:18:14'),
(6144, 2027, 11314, NULL, '2020-11-12 00:00:00.000', 'In Process', 'From: tchpnetworkmanagement@texaschildrens.org   Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.     Liz J. Ramirez  Texas Children’s Health Plan', NULL, NULL, '2020-11-05 15:34:02', '2020-11-05 15:34:02'),
(6145, 2037, 11314, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-11-12 10:51:40', '2020-11-12 10:51:40'),
(6146, 2037, 11314, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Credentialing is in process under Normandy. Will request to add location once the process finalizes.  ------------------------- Alanis, Juanita 11:39 AM (22 minutes ago) to me  Sherry,  These providers, Ani Stephen NPI: 1588959118, Jeemol George. NPI: 1497219067, Julie Jose, NPI: 1447883061 and Brittany Brown.  NPI: 1275163537 are not contracted with TCHP yet; there for cannot be added to the locations you are requesting. ', NULL, NULL, '2020-11-20 13:07:30', '2020-11-20 13:07:30'),
(6147, 2037, 11314, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Currently being credentialed under normandy.Need to allow a bit more time.', NULL, NULL, '2020-12-23 17:18:32', '2020-12-23 17:18:32'),
(6148, 1006, 11314, NULL, '2021-02-03 00:00:00.000', 'New/Not Initiated', 'Follow up email sent for credentialing to jxalanis@texaschildrens.org', NULL, NULL, '2021-01-27 12:28:01', '2021-01-27 12:28:01'),
(6149, 1006, 11314, NULL, '2021-02-03 00:00:00.000', 'In Process', NULL, NULL, NULL, '2021-01-27 13:48:27', '2021-01-27 13:48:27'),
(6150, 3040, 11314, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org, jxalanis@texaschildrens.org  Subject: Enrollment Status || Longpoint Medical Center || Joseph, Vibitha, Stephen, Ani || TCHP  Greetings,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers.   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 Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-01 13:30:07', '2021-03-01 13:30:07'),
(6151, 3040, 11314, NULL, '2021-03-26 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Location Addition || Longpoint Medical Center || Jose, Julie, George, Jeemol & Stephen, Ani || TCHP  Greetings,  Hope you are doing well. Please find the attached provider information form including the W9 for adding the providers in additional locations.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-19 10:59:05', '2021-03-19 10:59:05'),
(6152, 3040, 11314, 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 15:48:58', '2021-05-31 15:48:58'),
(6153, 3040, 11314, 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 12:21:27', '2021-06-17 12:21:27'),
(6154, 3040, 11314, 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 13:39:13', '2021-07-06 13:39:13'),
(6155, 3040, 11314, 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 13:42:41', '2021-07-06 13:42:41'),
(6156, 3040, 11314, 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 16:39:13', '2021-07-26 16:39:13'),
(6157, 11056, 11314, 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 15:32:06', '2021-08-13 15:32:06'),
(6158, 3040, 11314, 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 08:45:46', '2021-08-26 08:45:46'),
(6159, 11056, 11314, NULL, '2021-10-07 00:00:00.000', 'Approved', 'Approval Email received from : bxgupta@texaschildrens.org  Sub : Welcome Letter - Ani Stephen, FNP  Greetings,      Welcome to TCHP Ani Stephen, FNP is now participating with Texas Children’s Health Plan under the Long Point Medical Center, LLC, group.  Attached you will find a welcome letter with effective dates for all contracted products as well as the contact information for your Provider Relations Representative.    Please reach out to your PR Rep or the Contracting Department phone line at (832) 828-1004 with any questions.      Thank you and have a great day!   Respectfully,  Bharvi Gupta Contract Specialist 6330 West Loop South Bellaire, Texas 77401 bxgupta@texaschildrens.org  Eff date is : 10/01/2021   Please see the attachment.', NULL, NULL, '2021-09-30 08:23:52', '2021-09-30 08:23:52'),
(6160, 2027, 11315, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 12:50:38', '2020-10-27 12:50:38'),
(6161, 2027, 11315, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  Sub: (Abraham, Jeena)-(Normandy Urgent Care Center)-(Amerigroup)  I want to enroll this below mentioned provider with (Amerigroup), Kindly assist me how I can start the process: Provider Name: Abraham, Jeena Provider NPI# 1467901587 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429 Thanks. ', NULL, NULL, '2020-10-27 12:55:15', '2020-10-27 12:55:15'),
(6162, 2027, 11315, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Sent follow up email.', NULL, NULL, '2020-11-03 10:29:57', '2020-11-03 10:29:57'),
(6163, 2027, 11315, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-10 12:33:04', '2020-11-10 12:33:04'),
(6164, 2037, 11315, NULL, '2020-12-04 00:00:00.000', 'In Process', 'New application forms with W9 sent to add the providers txcredentialing@amerigroup.com  (Abraham, Jeena & Ani Stephen)-(Normandy Urgent Care Center)-(Amerigroup)  Greetings, Kindly find the two new application forms attached W9 to add the below mentioned providers to the existing group. Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider Name: Stephen, Ani Provider NPI# 1588959118 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429 Please contact me for any additional information.', NULL, NULL, '2020-11-18 13:51:16', '2020-11-18 13:51:16'),
(6165, 2037, 11315, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Follow up email sent to 	txcredentialing@amerigroup.com for the confirmation of the receiving of the submitted application', NULL, NULL, '2020-12-07 12:27:45', '2020-12-07 12:27:45'),
(6166, 2037, 11315, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Another follow up email sent to latina.small@anthem.com', NULL, NULL, '2020-12-23 16:51:58', '2020-12-23 16:51:58'),
(6167, 1006, 11315, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Sent a follow-up email @ TX Credentialing txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com ', NULL, NULL, '2021-01-20 09:48:22', '2021-01-20 09:48:22'),
(6168, 1006, 11315, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent another follow-up @ TX Credentialing txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com ', NULL, NULL, '2021-02-16 15:20:47', '2021-02-16 15:20:47'),
(6169, 3040, 11315, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Provider Enrollment Status - Normandy Urgent Care Center  Hello,   I want an update regarding the status of enrollment for the following providers under our group as their enrollment requests have been in process since the start of last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Vibitha Joseph Provider NPI# 1952931560  Provider Name: Odette Kourouma Provider NPI# 1134525868  Provider Name: Jeena Abaham Provider NPI# 1467901587  Provider Name: Ani Stephen  Provider NPI# 1588959118  Provider Name: Chennemkara, Mini Philip Provider NPI#  1841755956  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you. ', NULL, NULL, '2021-02-26 14:14:14', '2021-02-26 14:14:14');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(6170, 1006, 11315, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:06:49', '2021-05-31 15:06:49'),
(6171, 11056, 11315, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 12:18:28', '2021-06-17 12:18:28'),
(6172, 3040, 11315, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  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 : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:53', '2021-07-06 09:58:53'),
(6173, 3040, 11315, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers 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# 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 : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  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 for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:40', '2021-07-26 15:24:40'),
(6174, 11056, 11315, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  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 Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:12:55', '2021-08-13 14:12:55'),
(6175, 3040, 11315, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups 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 Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:10', '2021-08-25 15:00:10'),
(6176, 3040, 11315, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup 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  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:51', '2021-09-09 13:07:51'),
(6177, 10057, 11315, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  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	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  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 15:16:24', '2021-10-18 15:16:24'),
(6178, 10057, 11315, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  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	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 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  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:01:07', '2021-11-11 13:01:07'),
(6179, 10057, 11315, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:48:45', '2021-11-30 10:48:45'),
(6180, 10057, 11315, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:04:58', '2021-12-06 16:04:58'),
(6181, 10057, 11315, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:48:49', '2021-12-13 10:48:49'),
(6182, 10057, 11315, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:55:02', '2021-12-20 13:55:02'),
(6183, 10057, 11315, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latina.small@anthem.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning Latina,  We have send the LOI and group roster to credentialing dept, but no one from that department is responding back to us, its been more than 45 calender days we have send them the LOI and can you please get back to me with an update.  Regards, Alex Credentialing Manager', NULL, NULL, '2021-12-27 09:55:00', '2021-12-27 09:55:00'),
(6184, 10057, 11315, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : latina.small@Amerigroup.com & txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning,  You can respond directly to the credentialing  email for assistance with credentialing concerns. I have included them on the email as well.  Thank You in Advance,  Latina Small Provider Experience Consultant Amerigroup, Inc.', NULL, NULL, '2021-12-30 09:22:25', '2021-12-30 09:22:25'),
(6185, 19067, 11315, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:06:05', '2022-01-04 16:06:05'),
(6186, 20067, 11315, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:34:57', '2022-01-14 10:34:57'),
(6187, 20067, 11315, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-24 17:11:38', '2022-01-24 17:11:38'),
(6188, 20067, 11315, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  I added a column with my notes     Group Name  Normandy Urgent Care Center     Tax ID  27-0796429     Group NPI  1407171077     Provider Name  NPI  Location  AGP Notes  Jeny John  1073019493  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190140  Jeny John  1073019493  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Molly Joseph  1396380077  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Molly Joseph  1396380077  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Cini Thomas  1134777238  779 Normandy St STE 114, Houston, TX 77015-3441  Not par at this location, include phone and Fax  Cini Thomas  1134777238  16272 Imperial Valley DR STE K, Houston, TX 77060  -                                        Eff date 11/22/2021 P# 10869221  Ani Stephen  1588959118  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 12/20/2021.  P# 12190275  Ani Stephen  1588959118  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Abdur Rauf  1497726202  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 01641188  Abdur Rauf  1497726202  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 01641188  James Piccione JR  1356321509  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  James Piccione JR  1356321509  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Odette Kourouma  1134525868  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190157  Odette Kourouma  1134525868  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Vibitha Joseph  1952931560  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12221497  Vibitha Joseph  1952931560  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12221497  Julie Jose  1447883061  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 09807037  Julie Jose  1447883061  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 09807037  Jaya Jacob  1194336149  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12205914  Jaya Jacob  1194336149  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12205914  Jeemol George  1497219067  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 05/29/2020 (Amerivantage only) – 09805666   - not par at the Imperial Valley location, include the phone and fax  Limy Fernandus  1972005189  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190801  Limy Fernandus  1972005189  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Brittany Brown  1275163537  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 11/11/2021.  P# 09808410 (not par at the Imperial Valley location, include the phone and fax)  Jeena Abraham  1467901587  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 10286831  Jeena Abraham  1467901587  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Mini Chennemkara  1841755956  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190610  Mini Chennemkara  1841755956  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax', NULL, NULL, '2022-01-24 17:17:35', '2022-01-24 17:17:35'),
(6189, 20067, 11315, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-02-02 14:43:17', '2022-02-02 14:43:17'),
(6190, 20067, 11315, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Afternoon!  Hope you are doing well. Attached are the LOI for the Non-Par Providers. Can you please tell me how I can add a location under the remaining providers?  Thank you,', NULL, NULL, '2022-03-01 13:39:21', '2022-03-01 13:39:21'),
(6191, 20067, 11315, NULL, '2022-03-17 00:00:00.000', 'Approved', 'Received the welcome letter  See the attachment', NULL, NULL, '2022-03-10 09:56:41', '2022-03-10 09:56:41'),
(6192, 2027, 11316, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 12:56:51', '2020-10-27 12:56:51'),
(6193, 2027, 11316, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: 	intake_pdm@cigna.com, 9PSSCENT@cigna.com  Sub; (Abraham, Jeena)-(Normandy Urgent Care Center)-(Cigna)  I want to enroll this below mentioned provider with (Cigna), Kindly assist me how I can start the process: Provider Name: Abraham, Jeena Provider NPI# 1467901587 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429 Thanks. ', NULL, NULL, '2020-10-27 12:59:53', '2020-10-27 12:59:53'),
(6194, 2027, 11316, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Follow up email sent to insurance', NULL, NULL, '2020-11-03 10:35:33', '2020-11-03 10:35:33'),
(6195, 2027, 11316, NULL, '2020-11-17 00:00:00.000', 'In Process', 'This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-10 12:37:32', '2020-11-10 12:37:32'),
(6196, 2037, 11316, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-11-18 14:09:39', '2020-11-18 14:09:39'),
(6197, 2037, 11316, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Application initiated over the phone . Bid ID#19424402', NULL, NULL, '2020-11-19 13:47:52', '2020-11-19 13:47:52'),
(6198, 2037, 11316, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Currently in process need to allow more time', NULL, NULL, '2020-12-11 13:07:17', '2020-12-11 13:07:17'),
(6199, 1006, 11316, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Received following follow-up email from Cigna @ 9psscent@cigna.com: \"Good Afternoon,  Thank you for contacting Cigna.      Your application is currently in process and was started on 11/19/2020. The credentialing/contracting process takes up to 90 business days. If you have any additional questions, please contact the Provider Services Unit at 800.882.4462.   Provider Name: Jeena Abraham Tax ID: 270796429 Application Number: 12399985   Thank you, ConnectedCare PROVIDER OPERATIONS Hailey C Provider Service Unit T: 800.882.4462\"', NULL, NULL, '2020-12-28 11:55:16', '2020-12-28 11:55:16'),
(6200, 1006, 11316, NULL, '2021-01-11 00:00:00.000', 'In Process', 'Received following reply:  \"Re:	Reference number 12399985 Application to participate in the Cigna medical network Dear JEENA ABRAHAM,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.  What happens next?  Once the application review is complete, we will begin the credentialing process. This usually takes 90 business days from the date we receive your completed application. In some states, individual mandates may affect turnaround time. We will contact you if there is any missing information.  Once the credentialing process is complete, we’ll let you know if you’ve been approved as a participating provider in the network(s) for which you\'ve applied.  Sincerely, Cigna\"', NULL, NULL, '2020-12-30 16:08:01', '2020-12-30 16:08:01'),
(6201, 3040, 11316, NULL, '2021-02-04 00:00:00.000', 'Approved', 'We have an ancillary contract with Cigna, attached for reference.  ', NULL, NULL, '2021-01-28 16:37:40', '2021-01-28 16:37:40'),
(6202, 2027, 11317, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 13:01:51', '2020-10-27 13:01:51'),
(6203, 2027, 11317, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Sub: (Brown, Brittany)-(Normandy Urgent Care Center)-(Texas Children Health Plan)  I want to enroll this below mentioned provider with (TCHP), Kindly assist me how I can start the process: Provider Name: Brown, Brittany Provider NPI# 1275163537 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429 Thanks. ', NULL, NULL, '2020-10-27 13:05:43', '2020-10-27 13:05:43'),
(6204, 2027, 11317, NULL, '2020-11-10 00:00:00.000', 'In Process', 'From: jxalanis@texaschildrens.org  Sub: (Brown, Brittany)-(Normandy Urgent Care Center)-(Texas Children Health Plan)  Mr. Rodriguez,  Brown Brittany is non-par provider with TCHP, please complete the attached LOI, please know that credentialing can take up to 90 days.  Thank you     Juanita Alanis  Provider Relations   Texas Children\'s Health Plan  6330 West Loop South', NULL, NULL, '2020-11-03 13:13:10', '2020-11-03 13:13:10'),
(6205, 2027, 11317, NULL, '2020-11-10 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org TCHPNetworkManagemen@texaschildrens.org  Please find the LOI attached in this email for the enrollment process of the provider.', NULL, NULL, '2020-11-03 13:19:39', '2020-11-03 13:19:39'),
(6206, 2027, 11317, NULL, '2020-11-12 00:00:00.000', 'In Process', 'From: tchpnetworkmanagement@texaschildrens.org  Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.     Liz J. Ramirez  Texas Children’s Health Plan', NULL, NULL, '2020-11-05 13:56:36', '2020-11-05 13:56:36'),
(6207, 2037, 11317, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-11-12 10:58:29', '2020-11-12 10:58:29'),
(6208, 2037, 11317, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Received PIFs filled out and submitted back to \"tchpnetworkmanagement@texaschildrens.org\" with IVUC as the secondary Location.= and request.', NULL, NULL, '2020-11-13 14:42:03', '2020-11-13 14:42:03'),
(6209, 2037, 11317, NULL, '2020-12-08 00:00:00.000', 'In Process', 'PIF\'s Submitted need to allow more time.', NULL, NULL, '2020-11-25 13:08:51', '2020-11-25 13:08:51'),
(6210, 2037, 11317, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent for the submitted PIF', NULL, NULL, '2020-12-08 14:51:30', '2020-12-08 14:51:30'),
(6211, 1006, 11317, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Sent a follow-up email to TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org for an updated status of enrollment. ', NULL, NULL, '2020-12-15 18:12:17', '2020-12-15 18:12:17'),
(6212, 2037, 11317, NULL, '2021-01-07 00:00:00.000', 'In Process', 'PIF submitted on 11/03/2020 Need to allow more time ', NULL, NULL, '2020-12-29 16:48:46', '2020-12-29 16:48:46'),
(6213, 1006, 11317, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Received the following update from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org: \"Provider Name: Brittany Brown –in process\" ', NULL, NULL, '2021-01-29 09:42:52', '2021-01-29 09:42:52'),
(6214, 1006, 11317, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Carter, Krisheena J.\" kjcarter@texaschildrens.org regarding the status of the PIF forms that were submitted on 11/13/2020 for the provider.  ', NULL, NULL, '2021-02-16 17:13:00', '2021-02-16 17:13:00'),
(6215, 1006, 11317, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Received the following response from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org: \"Provider Name: Brittany Brown in process NPI# 1275163537 (TCHP use- 20210202034552671)\"', NULL, NULL, '2021-02-19 15:19:25', '2021-02-19 15:19:25'),
(6216, 3040, 11317, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: 	TXCredentialing@amerigroup.com  Subject: Provider Enrollment Status - Normandy Urgent Care Center  Greetings,  Please advise me the enrollment status for the following providers under our group as their enrollment requests have been in process since the start of last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-01 12:56:12', '2021-03-01 12:56:12'),
(6217, 3040, 11317, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Provider Enrollment Status || Normandy Urgent Care Center || TCHP ||   Greetings,  Please advise me the enrollment status for the following providers under our group as their enrollment requests have been in process since last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-01 13:00:28', '2021-03-01 13:00:28'),
(6218, 3040, 11317, NULL, '2021-03-23 00:00:00.000', 'Approved', 'Email rcvd from: axhartma@texaschildrens.org  Subject: TCHP Welcome Letter - Brittany Brown, FNP - Normandy Urgent Care Center PA - Imperial Valley Dr. and Normandy St.  Good Morning,  Welcome to TCHP. Brittany Brown, FNP is now participating with Texas Children’s Health Plan under Normandy Urgent Care Center PA. Attached you will find a welcome letter with an effective date for all contracted products as well as the contact information for your Provider Relations Representative.  Please reach out to your PR Rep or the main Contracting Department phone line at (832) 828-1063 with any questions.  Thank you,  Anna Hartmann Contract Specialist Texas Children\'s Health Plan *: axhartma@texaschildrens.org (: (832) 828-1063', NULL, NULL, '2021-03-16 14:41:59', '2021-03-16 14:41:59'),
(6219, 2027, 11318, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 13:07:34', '2020-10-27 13:07:34'),
(6220, 2027, 11318, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: Kris.Olier@communityhealthchoice.org  Sub: (Stephen, Ani)-(Normandy Urgent Care Center)-(Community Health Choice)  Hello Kris,  I want to enroll this below mentioned provider with (CHC), Kindly assist me how I can start the process: Provider Name: Stephen, Ani Provider NPI# 1588959118 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429 Thanks.', NULL, NULL, '2020-10-27 13:12:11', '2020-10-27 13:12:11'),
(6221, 2027, 11318, NULL, '2020-11-11 00:00:00.000', 'In Process', 'From: Kris.Olier@communityhealthchoice.org  Please complete the attached roster and return to chc.contracting@communityhealthchoice.org', NULL, NULL, '2020-11-04 16:42:11', '2020-11-04 16:42:11'),
(6222, 2027, 11318, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To; Kris.Olier@communityhealthchoice.org  Please find the roster attached in this email.  Thanks.', NULL, NULL, '2020-11-11 13:18:00', '2020-11-11 13:18:00'),
(6223, 2037, 11318, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Received email from the contracting team requesting updated W-9 with new supervising physician form. Submitted along with the roaster request to add the provider to IVUC. -------------- Good Afternoon, Kindly find the attached updated W-9 form and the new supervising physician form.In addition to that we want to add Ani Stephen to another location of Normandy Urgent Care and for that I have attached the roster.Address is listed below: *Imperial Valley Urgent Care Center  16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060. Please do contact me for any additional information.', NULL, NULL, '2020-11-12 14:56:43', '2020-11-12 14:56:43'),
(6224, 2037, 11318, NULL, '2020-12-04 00:00:00.000', 'In Process', 'Confirmation of Receiving of the request from CHC. ---------- Good Afternoon Sherry,     Thank you for providing the requested information. Please see attached letter for your records.  If further questions or concerns, feel free to advise.     Have a great weekend,  Contracting Dept.', NULL, NULL, '2020-11-13 17:28:03', '2020-11-13 17:28:03'),
(6225, 2037, 11318, NULL, '2020-11-27 00:00:00.000', 'Approved', 'Received welcome letter with the effective date 11/18/2020 uploaded in EMRBS .Par plan details added in the notes.', NULL, NULL, '2020-11-20 14:52:53', '2020-11-20 14:52:53'),
(6226, 2027, 11319, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 13:15:20', '2020-10-27 13:15:20'),
(6227, 2027, 11319, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: jxalanis@texaschildrens.org  Sub: (Stephen, Ani)-(Normandy Urgent Care Center)-(Texas Children Health Plan)  I want to enroll this below mentioned provider with (TCHP), Kindly assist me how I can start the process: Provider Name: Stephen, Ani Provider NPI# 1588959118 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429 Thanks.', NULL, NULL, '2020-10-27 13:18:26', '2020-10-27 13:18:26'),
(6228, 2027, 11319, NULL, '2020-11-11 00:00:00.000', 'In Process', 'Sent follow up email', NULL, NULL, '2020-11-04 16:44:38', '2020-11-04 16:44:38'),
(6229, 2027, 11319, NULL, '2020-11-12 00:00:00.000', 'In Process', 'From: tchpnetworkmanagement@texaschildrens.org   Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.     Liz J. Ramirez  Texas Children’s Health Plan', NULL, NULL, '2020-11-05 13:58:42', '2020-11-05 13:58:42'),
(6230, 2027, 11319, NULL, '2020-11-12 00:00:00.000', 'In Process', 'To: TCHPNetworkManagemen@texaschildrens.org  Please find the LOI and W9 attached in this email for the enrollment process of the provider.  Thanks.', NULL, NULL, '2020-11-05 16:53:17', '2020-11-05 16:53:17'),
(6231, 2037, 11319, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-11-12 10:57:50', '2020-11-12 10:57:50'),
(6232, 2037, 11319, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Received PIFs filled out and submitted back to \"tchpnetworkmanagement@texaschildrens.org\" with IVUC as the secondary Location.= and request.', NULL, NULL, '2020-11-13 14:42:21', '2020-11-13 14:42:21'),
(6233, 2037, 11319, NULL, '2020-12-08 00:00:00.000', 'In Process', 'PIF\'s Submitted need to allow more time.', NULL, NULL, '2020-11-25 13:09:07', '2020-11-25 13:09:07'),
(6234, 2037, 11319, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent for the submitted PIF', NULL, NULL, '2020-12-08 14:51:42', '2020-12-08 14:51:42'),
(6235, 1006, 11319, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Sent a follow-up email to TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org for an updated status of enrollment. ', NULL, NULL, '2020-12-15 18:12:24', '2020-12-15 18:12:24'),
(6236, 2037, 11319, NULL, '2021-01-07 00:00:00.000', 'In Process', 'PIF submitted on 11/03/2020 Need to allow more time ', NULL, NULL, '2020-12-29 16:48:55', '2020-12-29 16:48:55'),
(6237, 1006, 11319, NULL, '2021-01-29 00:00:00.000', 'In Process', 'Sent a follow-up email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org: \"Hello,   The LOI & W9 was submitted on November 5, 2020. What is the current status of the request now?  Please get back to me as soon as you can.  Thanks.\"', NULL, NULL, '2021-01-22 17:38:03', '2021-01-22 17:38:03'),
(6238, 1006, 11319, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Received the following reply from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  \"The LOI submitted in November is pending, thank you for your patience.\"', NULL, NULL, '2021-01-27 14:14:59', '2021-01-27 14:14:59'),
(6239, 1006, 11319, NULL, '2021-02-08 00:00:00.000', 'In Process', 'Received the following update from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org: \"Provider Name: Ani Stephen –in process\" ', NULL, NULL, '2021-01-29 09:44:23', '2021-01-29 09:44:23'),
(6240, 1006, 11319, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent a follow-up email @ \"Carter, Krisheena J.\" kjcarter@texaschildrens.org regarding the status of the PIF forms that were submitted on 11/13/2020 for the provider.  ', NULL, NULL, '2021-02-16 17:23:02', '2021-02-16 17:23:02'),
(6241, 1006, 11319, NULL, '2021-03-01 00:00:00.000', 'In Process', 'Received the following response from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org: \"Provider Name: Ani Stephen in process NPI# 1588959118 (TCHP use- 20210212034726376)\"', NULL, NULL, '2021-02-19 15:19:49', '2021-02-19 15:19:49');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(6242, 3040, 11319, NULL, '2021-03-08 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Provider Enrollment Status || Normandy Urgent Care Center || TCHP ||   Greetings,  Please advise me the enrollment status for the following providers under our group as their enrollment requests have been in process since last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider Name: Jose, Julie Provider NPI# 1447883061  Provider Name: George, Jeemol Provider NPI# 1497219067  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-01 13:00:50', '2021-03-01 13:00:50'),
(6243, 3040, 11319, NULL, '2021-03-25 00:00:00.000', 'Approved', 'Email rcvd from: axhartma@texaschildrens.org  Subject: TCHP Welcome Letter - Ani Stephen, FNP - Normandy Urgent Care Center PA - Imperial Valley Dr. and Normandy St.  Good Evening,  Welcome to TCHP. Ani Stephen, FNP is now participating with Texas Children’s Health Plan under Normandy Urgent Care Center PA. Attached you will find a welcome letter with an effective date for all contracted products as well as the contact information for your Provider Relations Representative.  Please reach out to your PR Rep or the main Contracting Department phone line at (832) 828-1063 with any questions.  Thank you,  Anna Hartmann Contract Specialist Texas Children\'s Health Plan *: axhartma@texaschildrens.org (: (832) 828-1063', NULL, NULL, '2021-03-18 12:27:59', '2021-03-18 12:27:59'),
(6244, 2027, 11320, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 13:39:59', '2020-10-27 13:39:59'),
(6245, 2027, 11320, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Sub: (Stephen, Ani)-(Normandy Urgent Care Center)-(Ambetter)  I want to enroll this below mentioned provider with (Ambetter), Kindly assist me how I can start the process: Provider Name: Stephen, Ani Provider NPI# 1588959118 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429 Thanks. ', NULL, NULL, '2020-10-27 13:48:58', '2020-10-27 13:48:58'),
(6246, 2027, 11320, NULL, '2020-11-10 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Sub: (Stephen, Ani)-(Normandy Urgent Care Center)-(Ambetter)  Good Morning  I hope this email finds you well. In order to add providers to an existing contract the process would still be the same. Complete the application process via our website in the links provided below. Our Network Development and Credentialing team will then follow-up with you if anything additional is required. Please be advised that after completion of the application the credentialing process could take 90-120 days to complete. If anything additional is required our Network Development Team or Credentialing Team will follow-up with you.  https://www.superiorhealthplan.com/providers/resources/forms.html (Credentialing Section is where to find packet to print out and email directly to our Network Development Team)     https://www.superiorhealthplan.com/providers/become-a-provider.html (Online Application submission form Medicare/Medicaid)  https://ambetter.superiorhealthplan.com/provider-resources/join-our-network.html (Ambetter Online Application Submission)  Our website is very resourceful tool and could possibly answer all the questions you may need.  Should you have any additional questions please let us know.  Have a great weekend!  Thanks  Brittney Kendle', NULL, NULL, '2020-11-03 15:38:57', '2020-11-03 15:38:57'),
(6247, 2027, 11320, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  I want to enroll this provider in ambetter. kindly assist me with that.  Thanks.', NULL, NULL, '2020-11-10 14:20:28', '2020-11-10 14:20:28'),
(6248, 2037, 11320, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Need to fill application', NULL, NULL, '2020-11-18 13:03:44', '2020-11-18 13:03:44'),
(6249, 2037, 11320, NULL, '2020-12-01 00:00:00.000', 'In Process', 'Need to fill application', NULL, NULL, '2020-11-30 17:49:18', '2020-11-30 17:49:18'),
(6250, 2037, 11320, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Application filled out for the group Normandy', NULL, NULL, '2020-12-01 16:34:44', '2020-12-01 16:34:44'),
(6251, 2037, 11320, NULL, '2021-01-27 00:00:00.000', 'In Process', 'waiting for the confirmation of receiving ', NULL, NULL, '2020-12-11 12:52:08', '2020-12-11 12:52:08'),
(6252, 2037, 11320, NULL, '2021-01-27 00:00:00.000', 'In Process', 'waiting for the confirmation of receiving ', NULL, NULL, '2020-12-11 12:52:08', '2020-12-11 12:52:08'),
(6253, 3040, 11320, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email sent to: 	AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Stephen, Ani || Normandy Urgent Care Center || Ambetter ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status of the below mentioned provider.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077Primary Address: 779 Normandy St Ste 114 Houston , TX 77015-3441Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any additional information please feel free to email me. Waiting to hear from you soon. Thanks', NULL, NULL, '2021-02-16 15:40:19', '2021-02-16 15:40:19'),
(6254, 1006, 11320, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Received the following update from AM Houston AM.Houston@superiorhealthplan.com:  \"Good Morning,  Your email was received. Our offices and sate have been impacted by the winter storm and power outages. We have created case #27236 An Account manager will be contacting you to address your request by end of next week. When contacting Account Management for updates on this issue, you can Reference Case # 27236.   If you are in need of immediate assistance, you can call to speak to an Account Manager by phone at 1-800-656-4817 (English 1, Spanish 2), and Option 3 Provider Relations Team AM.Houston@SuperiorHealthPlan.com  Provider Services is available to help answer questions on claim payments, rejections, denials, to verify eligibility or for help escalating any issues you may have, M-F 8:00 a.m. CST – 6:00 p.m. CST. For claims related questions, be sure to have your claim number available.  Allwell 1-877-391-5921 Ambetter 1-877-687-1196 STAR, MRSA, CHIP, RSA, STAR+PLUS and STAR Kids 1-877-391-5921 STAR Health 1-866-439-2042  Thank you,  Patricia Torres  Provider Account Manager II SUPERIOR 711 N Carancahua Street, Ste. 600 Corpus Christi, Tx 78401 Toll-Free: 1-800-656-4817 Option 1, then Option 3 Fax: 1-866-683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthplan.com\"', NULL, NULL, '2021-02-17 14:04:04', '2021-02-17 14:04:04'),
(6255, 3040, 11320, NULL, '2021-03-03 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject: Enrollment Status || Stephen, Ani || Normandy Urgent Care Center || Ambetter ||  Greetings,  Hope you are doing well. Please find the attached the Individual Provider Contracting form for Ani Stephen.   If you need any additional information please feel free to call or email me. Waiting for your response.   Thanks', NULL, NULL, '2021-02-24 14:52:51', '2021-02-24 14:52:51'),
(6256, 3040, 11320, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Stephen, Ani || Normandy Urgent Care Center || Ambetter ||  Hello, Hope you are doing well. This is a follow up regarding the enrollment status of the below mentioned provider.   Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice 2: 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 Name: Stephen, Ani Provider NPI# 1588959118  Please feel free to contact me if you have any questions. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-03-16 14:19:24', '2021-03-16 14:19:24'),
(6257, 3040, 11320, NULL, '2021-06-09 00:00:00.000', 'New/Not Initiated', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Stephen, Ani || Normandy Urgent Care Center || Ambetter ||  Hello,  Hope you are doing well. This is a follow up regarding the enrollment status of the below mentioned provider.   Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice 2: 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 Information: Provider Name: Stephen, Ani Provider NPI# 1588959118  Please feel free to contact me if you have any questions. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-02 14:45:08', '2021-06-02 14:45:08'),
(6258, 3040, 11320, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Stephen, Ani || Normandy Urgent Care Center || Ambetter ||  Hello,  Hope you are doing well. This is a follow up regarding the enrollment status of the below mentioned provider.   Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice 2: 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 Information: Provider Name: Stephen, Ani Provider NPI# 1588959118  Please feel free to contact me if you have any questions. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-02 14:45:37', '2021-06-02 14:45:37'),
(6259, 3040, 11320, NULL, '2021-06-28 00:00:00.000', 'Approved', 'Provider is participating with Ambetter. Effective date 06/01/2021', NULL, NULL, '2021-06-21 16:43:05', '2021-06-21 16:43:05'),
(6260, 2027, 11321, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 13:51:19', '2020-10-27 13:51:19'),
(6261, 2027, 11321, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  Sub; (Stephen, Ani)-(Normandy Urgent Care Center)-(Amerigroup)  I want to enroll this below mentioned provider with (Amerigroup), Kindly assist me how I can start the process: Provider Name: Stephen, Ani Provider NPI# 1588959118 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429 Thanks. ', NULL, NULL, '2020-10-27 13:55:21', '2020-10-27 13:55:21'),
(6262, 2027, 11321, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Follow up email sent to the insurance', NULL, NULL, '2020-11-03 15:41:29', '2020-11-03 15:41:29'),
(6263, 2027, 11321, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: txcredentialing@amerigroup.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-10 14:22:47', '2020-11-10 14:22:47'),
(6264, 2037, 11321, NULL, '2020-12-04 00:00:00.000', 'In Process', 'New application forms with W9 sent to add the providers txcredentialing@amerigroup.com  (Abraham, Jeena & Ani Stephen)-(Normandy Urgent Care Center)-(Amerigroup)  Greetings, Kindly find the two new application forms attached W9 to add the below mentioned providers to the existing group. Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider Name: Stephen, Ani Provider NPI# 1588959118 Group Name: Normandy Urgent Care Center Group Tax-ID: 27-0796429 Please contact me for any additional information.', NULL, NULL, '2020-11-18 13:51:26', '2020-11-18 13:51:26'),
(6265, 2037, 11321, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Follow up email sent to 	txcredentialing@amerigroup.com for the confirmation of the receiving of the submitted application', NULL, NULL, '2020-12-07 12:32:01', '2020-12-07 12:32:01'),
(6266, 2037, 11321, NULL, '2021-01-07 00:00:00.000', 'In Process', 'Another follow up email sent to latina.small@anthem.com', NULL, NULL, '2020-12-23 16:52:55', '2020-12-23 16:52:55'),
(6267, 1006, 11321, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Sent a follow-up email @ TX Credentialing txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com ', NULL, NULL, '2021-01-20 09:48:26', '2021-01-20 09:48:26'),
(6268, 1006, 11321, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Sent another follow-up @ TX Credentialing txcredentialing@amerigroup.com & Jason.Hughes@amerigroup.com ', NULL, NULL, '2021-02-16 15:20:52', '2021-02-16 15:20:52'),
(6269, 3040, 11321, NULL, '2021-03-05 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Provider Enrollment Status - Normandy Urgent Care Center  Hello,   I want an update regarding the status of enrollment for the following providers under our group as their enrollment requests have been in process since the start of last year:   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Practice Details: Practice Name: Imperial Valley Urgent Care Center Practice NPI# 1407171077 Practice Tax ID# 27-0796429 Practice Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name: Vibitha Joseph Provider NPI# 1952931560  Provider Name: Odette Kourouma Provider NPI# 1134525868  Provider Name: Jeena Abaham Provider NPI# 1467901587  Provider Name: Ani Stephen  Provider NPI# 1588959118  Provider Name: Chennemkara, Mini Philip Provider NPI#  1841755956  Please get back to me as soon as you get a chance. Waiting to hear from you soon.   Thank you. ', NULL, NULL, '2021-02-26 14:14:18', '2021-02-26 14:14:18'),
(6270, 1006, 11321, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Sent f/u email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  \"Hello,   I wanted to find out the enrollment status for the following providers, as well as what locations they are listed under for the following group:   Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Tertiary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1:Provider Name: George, Jeemol Provider NPI# 1497219067 Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-05-31 15:06:54', '2021-05-31 15:06:54'),
(6271, 11056, 11321, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email Sent to : TXCredentialing@amerigroup.com  nucc@claimsmedinc.com  Subj : Enrollment Status - NUCC, IVUC, LPMC - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed or added into under for the following group:  Practice Name: Normandy Urgent Care Center Practice NPI#: 1407171077 Practice TIN# : 27-0796429 Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Address:9504 LONG POINT RD STE E, Houston , TX 77055-4226-  Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider name : PAUL, SIGI Provider NPI # : 1033623616   Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider name : Joseph, Vibitha Provider NPI # : 1952931560   Provider name : Jose, Julie Provider NPI # : 1447883061  Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider name : George, Jeemol Provider NPI # : 1497219067  Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider name : Abraham, Glory Provider NPI # : 1194206490  Please get back to me as soon as you\'re able to.  Thank you!', NULL, NULL, '2021-06-17 12:17:50', '2021-06-17 12:17:50'),
(6272, 3040, 11321, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com, Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Good Morning!  I wanted to inquire about the enrollment status for the following providers, as well as what locations they are listed under for the following group:  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 : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Please get back to me as soon as you\'re able to.Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-07-06 09:58:52', '2021-07-06 09:58:52'),
(6273, 3040, 11321, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers 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# 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 : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  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 for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:39', '2021-07-26 15:24:39'),
(6274, 11056, 11321, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  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 Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:13:05', '2021-08-13 14:13:05'),
(6275, 3040, 11321, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups 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 Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 15:00:09', '2021-08-25 15:00:09'),
(6276, 3040, 11321, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup 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  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:51', '2021-09-09 13:07:51'),
(6277, 10057, 11321, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  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	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  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, '2021-10-21 16:13:16', '2021-10-21 16:13:16'),
(6278, 10057, 11321, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  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	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 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  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:01:01', '2021-11-11 13:01:01'),
(6279, 10057, 11321, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:48:40', '2021-11-30 10:48:40'),
(6280, 10057, 11321, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:04:50', '2021-12-06 16:04:50'),
(6281, 10057, 11321, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:48:41', '2021-12-13 10:48:41'),
(6282, 10057, 11321, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:54:54', '2021-12-20 13:54:54'),
(6283, 10057, 11321, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latina.small@anthem.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning Latina,  We have send the LOI and group roster to credentialing dept, but no one from that department is responding back to us, its been more than 45 calender days we have send them the LOI and can you please get back to me with an update.  Regards, Alex Credentialing Manager', NULL, NULL, '2021-12-27 09:54:55', '2021-12-27 09:54:55'),
(6284, 10057, 11321, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : latina.small@Amerigroup.com & txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning,  You can respond directly to the credentialing  email for assistance with credentialing concerns. I have included them on the email as well.  Thank You in Advance,  Latina Small Provider Experience Consultant Amerigroup, Inc.', NULL, NULL, '2021-12-30 09:22:20', '2021-12-30 09:22:20'),
(6285, 19067, 11321, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:03:58', '2022-01-04 16:03:58'),
(6286, 20067, 11321, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:35:22', '2022-01-14 10:35:22'),
(6287, 20067, 11321, NULL, '2022-01-31 00:00:00.000', 'Approved', 'Kindly see the attachment of directory  Effective Date: 12/20/2021', NULL, NULL, '2022-01-24 12:45:46', '2022-01-24 12:45:46'),
(6288, 1006, 11322, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 14:22:40', '2020-10-27 14:22:40'),
(6289, 1006, 11322, NULL, '2020-11-10 00:00:00.000', 'Initiated', 'Request initiated via PECOS:  \"Application Tracking ID: T102720200002605        NPI: 1982617262        Medicare ID:         Name: BARBARA  HIGNITE          State: MA        Fee-for-Service Contractor: NATIONAL GOVERNMENT SERVICES, INC.\"', NULL, NULL, '2020-10-27 14:23:22', '2020-10-27 14:23:22'),
(6290, 1006, 11322, NULL, '2020-11-24 00:00:00.000', 'In Process', 'Status:  This application is being reviewed to determine that it is complete and that all information and supporting documentation required has been submitted with the application. Please expect to receive more information in 3 – 6 weeks. ', NULL, NULL, '2020-11-12 18:47:45', '2020-11-12 18:47:45'),
(6291, 1006, 11322, NULL, '2020-11-27 00:00:00.000', 'Approved', 'Application Tracking ID: T102720200002605   NPI ID: 1982617262   Medicare ID: S400701622   Name: BARBARA HIGNITE  State: MA   Form Type: 855I  Date: 11/20/2020  Status: APPROVED ', NULL, NULL, '2020-11-20 17:14:19', '2020-11-20 17:14:19'),
(6292, 2027, 11323, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 14:49:38', '2020-10-27 14:49:38'),
(6293, 2027, 11323, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Sub: (Escobar, Angiollet Solis)-(Valley Med Urgent Care)-(Ambetter)  I have checked through your provider directory that this below mentioned provider is linked with ambetter under (Valley Med Urgent Care) but only in the primary location. So I want to add this provider in two other locations of (Valley Med Urgent Care) as well. Kindly assist me how I can start the process. Provider Name:  Escobar, Angiollet Solis  Provider NPI# 1962917997 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-10-27 14:50:12', '2020-10-27 14:50:12'),
(6294, 2027, 11323, NULL, '2020-11-10 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Sub: (Escobar, Angiollet Solis)-(Valley Med Urgent Care)-(Ambetter)  Good Afternoon Martin     I hope you are doing well. I wanted to follow-up regarding your request. Please complete the demo form attached in order to add the locations and send it back. Once the demo form is submitted to our Provider Data Management team it could take up to 14 business days to complete and I will notify you once completed.     Have a great rest of the day!     Thanks  Brittney Kendle', NULL, NULL, '2020-11-03 13:35:11', '2020-11-03 13:35:11'),
(6295, 2027, 11323, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Please find the demo form attached in this email as per your request.  Thanks.', NULL, NULL, '2020-11-10 13:20:24', '2020-11-10 13:20:24'),
(6296, 2027, 11323, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Hi,  May I know the current status of my request as I have already submitted the demo form.  Thanks.', NULL, NULL, '2020-11-18 09:27:28', '2020-11-18 09:27:28'),
(6297, 2027, 11323, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good Morning     I hope you are doing well. The request was just submitted last week. I did advise that it would take up to 14 business days to complete which means it will not be completed until the first or second week of next month. I will follow-up with you once this request is completed.', NULL, NULL, '2020-11-18 12:09:13', '2020-11-18 12:09:13'),
(6298, 2027, 11323, NULL, '2020-12-02 00:00:00.000', 'Approved', 'Provider is linked with insurance and effective date is 06/01/2019. Screenshot from provider directory is attached ', NULL, NULL, '2020-11-25 09:48:56', '2020-11-25 09:48:56'),
(6299, 2027, 11324, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 14:51:11', '2020-10-27 14:51:11'),
(6300, 2027, 11324, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: 	AM.Houston@superiorhealthplan.com  (Escobar, Angiollet Solis)-(Valley Med Urgent Care)-(Ambetter)  I have checked through your provider directory that this below mentioned provider is linked with ambetter under (Valley Med Urgent Care) but only in the primary location. So I want to add this provider in two other locations of (Valley Med Urgent Care) as well. Kindly assist me how I can start the process. Provider Name:  Escobar, Angiollet Solis  Provider NPI# 1962917997 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-10-27 14:51:53', '2020-10-27 14:51:53'),
(6301, 2027, 11324, NULL, '2020-11-10 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good Afternoon Martin     I hope you are doing well. I wanted to follow-up regarding your request. Please complete the demo form attached in order to add the locations and send it back. Once the demo form is submitted to our Provider Data Management team it could take up to 14 business days to complete and I will notify you once completed.     Have a great rest of the day!     Thanks  Brittney Kendle', NULL, NULL, '2020-11-03 13:36:45', '2020-11-03 13:36:45'),
(6302, 2027, 11324, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Please find the demo form attached in this email as per your request.  Thanks.', NULL, NULL, '2020-11-10 13:21:54', '2020-11-10 13:21:54'),
(6303, 2027, 11324, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Hi,  May I know the current status of my request as I have already submitted the demo form.  Thanks.', NULL, NULL, '2020-11-18 09:28:31', '2020-11-18 09:28:31'),
(6304, 2027, 11324, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good Morning     I hope you are doing well. The request was just submitted last week. I did advise that it would take up to 14 business days to complete which means it will not be completed until the first or second week of next month. I will follow-up with you once this request is completed.', NULL, NULL, '2020-11-18 12:13:47', '2020-11-18 12:13:47'),
(6305, 2027, 11324, NULL, '2020-12-02 00:00:00.000', 'Approved', 'Provider is linked with insurance and effective date is 06/01/2019. Screenshot from provider directory is attached  ', NULL, NULL, '2020-11-25 09:52:10', '2020-11-25 09:52:10'),
(6306, 2027, 11325, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 15:17:03', '2020-10-27 15:17:03'),
(6307, 2027, 11325, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: corey_j_ford@uhc.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(United HealthCare - UHC)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care). Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks. ', NULL, NULL, '2020-10-27 15:22:05', '2020-10-27 15:22:05'),
(6308, 2027, 11325, NULL, '2020-11-10 00:00:00.000', 'In Process', 'To: 	Corey J corey_j_ford@uhc.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(United HealthCare - UHC)  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-03 13:48:51', '2020-11-03 13:48:51'),
(6309, 2027, 11325, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: corey_j_ford@uhc.com  Can I have the executed signed contract for the practice.  Thanks.', NULL, NULL, '2020-11-10 13:40:36', '2020-11-10 13:40:36'),
(6310, 2027, 11325, NULL, '2020-11-20 00:00:00.000', 'Approved', 'Provider is showing linked with the insurance in this location and the effective date is 09/01/2019', NULL, NULL, '2020-11-13 10:17:35', '2020-11-13 10:17:35'),
(6311, 2027, 11326, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 15:23:20', '2020-10-27 15:23:20'),
(6312, 2027, 11326, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: 	AM.Houston@superiorhealthplan.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Superior Health)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care). Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-27 15:26:45', '2020-10-27 15:26:45'),
(6313, 2027, 11326, NULL, '2020-11-10 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Superior Health)  Good evening,     To add a provider to an existing contract, please submit to https://www.superiorhealthplan.com/providers/become-a-provider/Add-New-Provider.html        Megan Brooks Regional Manager, Provider Relations  Harris/Jefferson SDA', NULL, NULL, '2020-11-03 13:50:16', '2020-11-03 13:50:16');
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
(6314, 2027, 11326, NULL, '2020-11-17 00:00:00.000', 'In Process', 'The request to add this provider in other locations of VMUC is submitted.', NULL, NULL, '2020-11-10 13:56:04', '2020-11-10 13:56:04'),
(6315, 2027, 11326, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Hi,  I have submitted the online application already. May I know the current status of my request?  Thanks.', NULL, NULL, '2020-11-18 10:12:47', '2020-11-18 10:12:47'),
(6316, 2027, 11326, NULL, '2020-11-27 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good morning Martin,         After reviewing the Credentialing status for the provider below, I see the application is under Credentialing status. Application was received on 11/12/20. Credentialing process can take between 60 -120 days.     Please allow more time for application to process.        Lopez, Mayra Alejandra  NPI# 1265945125   Group Name: Valley Med Urgent Care   Group Tax-ID: 81-5123542               Thank you,     Yesenia Prado', NULL, NULL, '2020-11-20 13:26:42', '2020-11-20 13:26:42'),
(6317, 2027, 11326, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Request is still in process.', NULL, NULL, '2020-11-30 14:41:33', '2020-11-30 14:41:33'),
(6318, 2037, 11326, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-08 14:48:07', '2020-12-08 14:48:07'),
(6319, 1006, 11326, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent a followup email @ AM Houston AM.Houston@superiorhealthplan.com regarding updated status. ', NULL, NULL, '2020-12-15 17:01:28', '2020-12-15 17:01:28'),
(6320, 3040, 11326, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Superior Health || ||  Greetings,  Hope you are doing well.  Please update me regarding the enrollment status for the below provider.     Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks ', NULL, NULL, '2020-12-22 15:56:42', '2020-12-22 15:56:42'),
(6321, 3040, 11326, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Superior Health ||  Greetings,  Hope you are doing well. Please update me regarding the enrollment status for the below provider.  Also I am trying to reach out to Daniel but I wasn\'t able to get in touch with him.   Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks ', NULL, NULL, '2020-12-23 09:17:12', '2020-12-23 09:17:12'),
(6322, 3040, 11326, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email received From: AM.Houston@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Superior Health ||   Good morning Adil,     Per review the provider Name: Lopez, Mayra Alejandra  Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542 is under credentialing status. Application was received on 11/13/2020 with a TAT of 36  business days. Credentialing process can take between 60-120 days.  Thanks ', NULL, NULL, '2020-12-23 09:48:59', '2020-12-23 09:48:59'),
(6323, 3040, 11326, NULL, '2021-01-06 00:00:00.000', 'In Process', 'As per the last email the application received on 11/13/2020 and it will take 36 business days. So need to allow more time. ', NULL, NULL, '2020-12-30 10:17:34', '2020-12-30 10:17:34'),
(6324, 3040, 11326, NULL, '2021-01-27 00:00:00.000', 'In Process', 'I had a word with Veronica in Superior Health plan and she advised the application is still in process. Will take 90-120 Days.   For next follow up send an email to AM.CorpusChristi@superiorhealthplan.com with the reference no.  Ref No: 20913', NULL, NULL, '2021-01-06 10:45:07', '2021-01-06 10:45:07'),
(6325, 3040, 11326, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Email sent to: outreachsupport@aperturecvo.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. Please find the attached the professional liability insurance certificate as per the request from Superior Health for credentialing process.  Please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-08 10:17:09', '2021-01-08 10:17:09'),
(6326, 3040, 11326, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Superior Health || ||  Good Afternoon Adil,  Mayra Alejandra Lopez NPI: 1265945125 TIN: 815123542 identifies (WAITING ON CVO).   Please reach out to CVO (Aperture) to determined what is pending.  Credentialing cannot work the application until it is forward back to Credentialing from the CVO.   If you require any further information, feel free to contact me.', NULL, NULL, '2021-01-08 10:19:56', '2021-01-08 10:19:56'),
(6327, 3040, 11326, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Email rcvd from: outreachsupport@aperturecvo.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Thank you for your response.   Certificate of Insurance has been received and routed to file for processing.  Regards,  Ann', NULL, NULL, '2021-01-11 09:11:57', '2021-01-11 09:11:57'),
(6328, 3040, 11326, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. Please update me regarding the enrollment status for the below provider. As I sent the requested documents to CVO and they sent the file for processing.      Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542 Group NPI # 1518404631  If you need anything else please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-18 13:11:06', '2021-01-18 13:11:06'),
(6329, 3040, 11326, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI # 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider:  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-25 13:44:53', '2021-01-25 13:44:53'),
(6330, 3040, 11326, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Email rcvd from:  Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Provider Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 CVO status completed with end date of 1/20/21.  Currently record is assigned to Credentialing team and is under review.  Please allow additional time to process and feel free to request status updates.  Respectfully,', NULL, NULL, '2021-01-27 10:41:25', '2021-01-27 10:41:25'),
(6331, 3040, 11326, NULL, '2021-02-10 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI # 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider:  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please let me know if you need any additional information. Waiting for your response.  Thanks ', NULL, NULL, '2021-02-03 10:26:46', '2021-02-03 10:26:46'),
(6332, 3040, 11326, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Morning,  Unfortunately, there is no expected time of completion as the Credentialing process undergoes an a extensive review.  However, Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 is in “Make Par” status and is within the final stages of Credentialing.  On 11/12/2020 notes indicates Credentialing request and Credentialing documents were sent to be completed.  Please allow additional time to be completed and feel free to request status updates.', NULL, NULL, '2021-02-10 12:42:15', '2021-02-10 12:42:15'),
(6333, 3040, 11326, NULL, '2021-02-17 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Please advise me how much time the credentialing process takes and when did you receive the application?  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-10 12:42:26', '2021-02-10 12:42:26'),
(6334, 3040, 11326, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject:  Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Morning,  Unfortunately, there is no expected time of completion as the Credentialing process undergoes an a extensive review.  However, Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 is in “Make Par” status and is within the final stages of Credentialing.  On 11/12/2020 notes indicates Credentialing request and Credentialing documents were sent to be completed.  Please allow additional time to be completed and feel free to request status updates.  ', NULL, NULL, '2021-02-17 17:25:16', '2021-02-17 17:25:16'),
(6335, 3040, 11326, NULL, '2021-03-03 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Hello Daniel,  Please advise me the enrollment status for the below mentioned provider. Is there any good news for me?  Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI # 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider:  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please get back to me as soon as you get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-02-24 10:58:11', '2021-02-24 10:58:11'),
(6336, 3040, 11326, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings, Please note that I checked the superior health provider directory and provider is showing in-network. Can you please send me the plan details. If you need any additional information please feel free to call or email me. Waiting for your reply.  Thank you', NULL, NULL, '2021-03-03 13:46:54', '2021-03-03 13:46:54'),
(6337, 3040, 11326, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 displays Completed Provider Record with an effective date 3/1/2021.', NULL, NULL, '2021-03-03 13:47:40', '2021-03-03 13:47:40'),
(6338, 3040, 11326, NULL, '2021-03-18 00:00:00.000', 'Approved', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject:  Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 displays Completed Provider Record with an effective date 3/1/2021.', NULL, NULL, '2021-03-11 15:39:39', '2021-03-11 15:39:39'),
(6339, 2027, 11327, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 15:28:48', '2020-10-27 15:28:48'),
(6340, 2027, 11327, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Ambetter)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care) with ambetter, Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-27 15:31:06', '2020-10-27 15:31:06'),
(6341, 2027, 11327, NULL, '2020-11-10 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Ambetter)  Good evening,     To add a provider to an existing contract, please submit to https://www.superiorhealthplan.com/providers/become-a-provider/Add-New-Provider.html           Megan Brooks Regional Manager, Provider Relations  Harris/Jefferson SDA', NULL, NULL, '2020-11-03 13:51:56', '2020-11-03 13:51:56'),
(6342, 2027, 11327, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  This link is for superior health only. I want to add this provider with ambetter. Kindly assist me in that regard.  Thanks.', NULL, NULL, '2020-11-10 14:07:19', '2020-11-10 14:07:19'),
(6343, 2027, 11327, NULL, '2020-11-17 00:00:00.000', 'In Process', 'provider addition for has been filled and submitted to ambetter', NULL, NULL, '2020-11-10 16:41:29', '2020-11-10 16:41:29'),
(6344, 2027, 11327, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  I have submitted the online application. May I know the current status of it ? ', NULL, NULL, '2020-11-18 09:31:44', '2020-11-18 09:31:44'),
(6345, 2027, 11327, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good morning Martin,     After reviewing the Credentialing status for the provider below, I see the application is under Credentialing status. Application was received on 11/12/20.   Credentialing process can take between 60 -120 days. Please allow more time for application to process.     Lopez, Mayra Alejandra  NPI# 1265945125  Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542           Thank you,', NULL, NULL, '2020-11-18 10:28:18', '2020-11-18 10:28:18'),
(6346, 2027, 11327, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  May I know the current status of my request. Details are mentioned below: Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542   Thanks.', NULL, NULL, '2020-11-25 10:09:28', '2020-11-25 10:09:28'),
(6347, 2027, 11327, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-12-02 10:14:02', '2020-12-02 10:14:02'),
(6348, 2027, 11327, NULL, '2020-12-17 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-12-10 12:54:58', '2020-12-10 12:54:58'),
(6349, 3040, 11327, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to: AM.Houston@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Greetings,  Hope you are doing well.  Please update me regarding the status for the below provider.     Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542   If you need any additional information please feel free to email me. Looking forward to hearing from you soon. ', NULL, NULL, '2020-12-17 13:21:52', '2020-12-17 13:21:52'),
(6350, 3040, 11327, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email rcvd from: AM.Hidalgo@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Good Afternoon,  This has been assigned to Veronica Trevino under Meg 19973  Thank you,', NULL, NULL, '2020-12-23 17:53:40', '2020-12-23 17:53:40'),
(6351, 3040, 11327, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email received from: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter   Good morning,  After further review, last note on file for providers status was on 11/24/20.  Note states record is ready for configuration, but is still undergoing its process.  I have reached out to another department requesting provider status.  Once additional information is received, I’ll get back with you.', NULL, NULL, '2020-12-28 10:52:08', '2020-12-28 10:52:08'),
(6352, 3040, 11327, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Email rcvd from: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Good afternoon,  Credentialing has advised provider is still in the Credentialing process.   Please allow more time to complete.  You can also email credentialing for a status at Credentialing@superiorhealthplan.com.  If there is anythinge else that I may assit with, please advise.  ', NULL, NULL, '2020-12-29 09:12:22', '2020-12-29 09:12:22'),
(6353, 3040, 11327, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email sent to: 	Credentialing@superiorhealthplan.com  Subject; Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||   Greetings,  I hope you are doing well. I wanted to know the status of the below mentioned provider.  Provider Name: Rodriguez Cynthia Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please update me once you get a chance. Waiting to hear from you soon.  Thanks  ', NULL, NULL, '2021-01-05 13:23:19', '2021-01-05 13:23:19'),
(6354, 3040, 11327, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Hi,  I show the provider to be in the credentialing cycle, please allow more time to complete the cycle.   Thank you.', NULL, NULL, '2021-01-05 14:35:48', '2021-01-05 14:35:48'),
(6355, 3040, 11327, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email rcvd from: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter   Good morning,  Provider is still in the credentialing phase, per Credentialing Team.  They advised provider has only 29 days in process.  Credentialing phase can take up to 90 days.  Please allow more time for processing.', NULL, NULL, '2021-01-12 13:49:34', '2021-01-12 13:49:34'),
(6356, 3040, 11327, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Greetings,  Hope you are doing well. I wanted to know the status of the below mentioned provider because we submitted the application on 10/27/2020. Please advise me the time frame.  Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  If you need any additional information please feel free to email me. Looking forward to hearing from you soon.  Thanks', NULL, NULL, '2021-01-12 14:03:42', '2021-01-12 14:03:42'),
(6357, 3040, 11327, NULL, '2021-01-20 00:00:00.000', 'In Process', 'I had a word with Credentialing verification organization and he advised me there is no such documents required from our side. ', NULL, NULL, '2021-01-13 16:42:17', '2021-01-13 16:42:17'),
(6358, 3040, 11327, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Good Afternoon,  I have been notified by our credentialing team we are currently waiting on CVO (Credentialing Verification Organization) to release the file.  Credentialing team cannot proceed to work the application until CVO releases the file.   Please reach out to Credentialing Verification Organization to determine if there is additional information pending. ', NULL, NULL, '2021-01-13 16:43:23', '2021-01-13 16:43:23'),
(6359, 3040, 11327, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Good Morning,  MAYRA ALEJANDRA LOPEZ currently displays as (WAITING ON CVO credentialing verification organization).  CVO has not released the file to Superior Healthplan credentialing team.', NULL, NULL, '2021-01-19 12:42:32', '2021-01-19 12:42:32'),
(6360, 3040, 11327, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject:  Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI # 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider:  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-26 10:50:02', '2021-01-26 10:50:02'),
(6361, 3040, 11327, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Provider Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 CVO status completed with end date of 1/20/21.  Currently record is assigned to Credentialing team and is under review.  Please allow additional time to process and feel free to request status updates.  Respectfully,', NULL, NULL, '2021-02-02 12:50:32', '2021-02-02 12:50:32'),
(6362, 3040, 11327, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Please advise me how much time the credentialing process takes and when did you receive the application?  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-09 10:22:34', '2021-02-09 10:22:34'),
(6363, 3040, 11327, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Morning,  Unfortunately, there is no expected time of completion as the Credentialing process undergoes an a extensive review.  However, Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 is in “Make Par” status and is within the final stages of Credentialing.  On 11/12/2020 notes indicates Credentialing request and Credentialing documents were sent to be completed.  Please allow additional time to be completed and feel free to request status updates.  ', NULL, NULL, '2021-02-16 12:16:27', '2021-02-16 12:16:27'),
(6364, 3040, 11327, NULL, '2021-03-02 00:00:00.000', 'Approved', 'Approval confirmation received in email.   See Attachment', NULL, NULL, '2021-02-23 13:39:16', '2021-02-23 13:39:16'),
(6365, 2027, 11328, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 15:32:00', '2020-10-27 15:32:00'),
(6366, 2027, 11328, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Ambetter)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care) with ambetter, Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-27 15:32:10', '2020-10-27 15:32:10'),
(6367, 2027, 11328, NULL, '2020-11-11 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good evening,     To add a provider to an existing contract, please submit to https://www.superiorhealthplan.com/providers/become-a-provider/Add-New-Provider.html           Megan Brooks Regional Manager, Provider Relations  Harris/Jefferson SDA  ', NULL, NULL, '2020-11-04 16:51:30', '2020-11-04 16:51:30'),
(6368, 2027, 11328, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  This link is for superior health only. I want to add this provider with ambetter. Kindly assist me in that regard.  Thanks.', NULL, NULL, '2020-11-11 12:23:08', '2020-11-11 12:23:08'),
(6369, 2027, 11328, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  I have submitted the online application. May I know the current status of it ?', NULL, NULL, '2020-11-18 09:32:21', '2020-11-18 09:32:21'),
(6370, 2027, 11328, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good morning Martin,     After reviewing the Credentialing status for the provider below, I see the application is under Credentialing status. Application was received on 11/12/20.   Credentialing process can take between 60 -120 days. Please allow more time for application to process.     Lopez, Mayra Alejandra  NPI# 1265945125  Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542', NULL, NULL, '2020-11-18 10:29:12', '2020-11-18 10:29:12'),
(6371, 2027, 11328, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  May I know the current status of my request. Details are mentioned below: Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542   Thanks.', NULL, NULL, '2020-11-25 10:11:48', '2020-11-25 10:11:48'),
(6372, 2027, 11328, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-12-02 10:14:51', '2020-12-02 10:14:51'),
(6373, 2027, 11328, NULL, '2020-12-17 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-12-10 12:55:24', '2020-12-10 12:55:24'),
(6374, 3040, 11328, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Update email sent to AM.Houston@superiorhealthplan.com  Greetings,  Hope you are doing well.  Please update me regarding the status for the below provider.     Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542   If you need any additional information please feel free to email me. Looking forward to hearing from you soon.  Thanks    ', NULL, NULL, '2020-12-17 12:11:09', '2020-12-17 12:11:09'),
(6375, 3040, 11328, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email rcvd from: AM.Hidalgo@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Good Afternoon,  This has been assigned to Veronica Trevino under Meg 19973  Thank you,', NULL, NULL, '2020-12-23 17:53:47', '2020-12-23 17:53:47'),
(6376, 3040, 11328, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email received from: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter   Good morning,  After further review, last note on file for providers status was on 11/24/20.  Note states record is ready for configuration, but is still undergoing its process.  I have reached out to another department requesting provider status.  Once additional information is received, I’ll get back with you.', NULL, NULL, '2020-12-28 10:52:22', '2020-12-28 10:52:22'),
(6377, 3040, 11328, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Email rcvd from: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Good afternoon,  Credentialing has advised provider is still in the Credentialing process.   Please allow more time to complete.  You can also email credentialing for a status at Credentialing@superiorhealthplan.com.  If there is anythinge else that I may assit with, please advise.', NULL, NULL, '2020-12-29 09:12:34', '2020-12-29 09:12:34'),
(6378, 3040, 11328, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email sent to: 	Credentialing@superiorhealthplan.com  Subject; Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||   Greetings,  I hope you are doing well. I wanted to know the status of the below mentioned provider.  Provider Name: Rodriguez Cynthia Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please update me once you get a chance. Waiting to hear from you soon.  Thanks  ', NULL, NULL, '2021-01-05 13:23:08', '2021-01-05 13:23:08'),
(6379, 3040, 11328, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Hi,  I show the provider to be in the credentialing cycle, please allow more time to complete the cycle.   Thank you.', NULL, NULL, '2021-01-05 14:35:56', '2021-01-05 14:35:56'),
(6380, 3040, 11328, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email rcvd from: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter   Good morning,  Provider is still in the credentialing phase, per Credentialing Team.  They advised provider has only 29 days in process.  Credentialing phase can take up to 90 days.  Please allow more time for processing.', NULL, NULL, '2021-01-12 13:49:16', '2021-01-12 13:49:16'),
(6381, 3040, 11328, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Greetings,  Hope you are doing well. I wanted to know the status of the below mentioned provider because we submitted the application on 10/27/2020. Please advise me the time frame.  Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  If you need any additional information please feel free to email me. Looking forward to hearing from you soon.  Thanks', NULL, NULL, '2021-01-12 14:03:25', '2021-01-12 14:03:25'),
(6382, 3040, 11328, NULL, '2021-01-20 00:00:00.000', 'In Process', 'I had a word with Credentialing verification organization and he advised me there is no such documents required from our side. ', NULL, NULL, '2021-01-13 16:42:24', '2021-01-13 16:42:24'),
(6383, 3040, 11328, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Good Afternoon,  I have been notified by our credentialing team we are currently waiting on CVO (Credentialing Verification Organization) to release the file.  Credentialing team cannot proceed to work the application until CVO releases the file.   Please reach out to Credentialing Verification Organization to determine if there is additional information pending. ', NULL, NULL, '2021-01-13 16:43:29', '2021-01-13 16:43:29'),
(6384, 3040, 11328, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Good Morning,  MAYRA ALEJANDRA LOPEZ currently displays as (WAITING ON CVO credentialing verification organization).  CVO has not released the file to Superior Healthplan credentialing team.', NULL, NULL, '2021-01-19 12:42:38', '2021-01-19 12:42:38'),
(6385, 3040, 11328, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject:  Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI # 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider:  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-26 10:49:33', '2021-01-26 10:49:33'),
(6386, 3040, 11328, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Provider Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 CVO status completed with end date of 1/20/21.  Currently record is assigned to Credentialing team and is under review.  Please allow additional time to process and feel free to request status updates.  Respectfully,', NULL, NULL, '2021-02-02 12:50:26', '2021-02-02 12:50:26'),
(6387, 3040, 11328, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Please advise me how much time the credentialing process takes and when did you receive the application?  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-09 10:22:28', '2021-02-09 10:22:28'),
(6388, 3040, 11328, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Morning,  Unfortunately, there is no expected time of completion as the Credentialing process undergoes an a extensive review.  However, Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 is in “Make Par” status and is within the final stages of Credentialing.  On 11/12/2020 notes indicates Credentialing request and Credentialing documents were sent to be completed.  Please allow additional time to be completed and feel free to request status updates.  ', NULL, NULL, '2021-02-16 12:16:32', '2021-02-16 12:16:32'),
(6389, 3040, 11328, NULL, '2021-03-02 00:00:00.000', 'Approved', 'Approval confirmation received in email.   See Attachment', NULL, NULL, '2021-02-23 13:39:37', '2021-02-23 13:39:37'),
(6390, 2027, 11329, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 15:32:37', '2020-10-27 15:32:37'),
(6391, 2027, 11329, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Ambetter)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care) with ambetter, Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-27 15:32:48', '2020-10-27 15:32:48'),
(6392, 2027, 11329, NULL, '2020-11-11 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good evening,     To add a provider to an existing contract, please submit to https://www.superiorhealthplan.com/providers/become-a-provider/Add-New-Provider.html           Megan Brooks Regional Manager, Provider Relations  Harris/Jefferson SDA', NULL, NULL, '2020-11-04 16:52:06', '2020-11-04 16:52:06'),
(6393, 2027, 11329, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  This link is for superior health only. I want to add this provider with ambetter. Kindly assist me in that regard.  Thanks.', NULL, NULL, '2020-11-11 12:23:56', '2020-11-11 12:23:56'),
(6394, 2027, 11329, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  I have submitted the online application. May I know the current status of it ?', NULL, NULL, '2020-11-18 09:32:39', '2020-11-18 09:32:39'),
(6395, 2027, 11329, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: AM.Houston@superiorhealthplan.com  Good morning Martin,     After reviewing the Credentialing status for the provider below, I see the application is under Credentialing status. Application was received on 11/12/20.   Credentialing process can take between 60 -120 days. Please allow more time for application to process.     Lopez, Mayra Alejandra  NPI# 1265945125  Group Name: Valley Med Urgent Care  Group Tax-ID: 81-5123542', NULL, NULL, '2020-11-18 10:29:40', '2020-11-18 10:29:40'),
(6396, 2027, 11329, NULL, '2020-12-02 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  May I know the current status of my request. Details are mentioned below: Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542   Thanks.', NULL, NULL, '2020-11-25 10:12:15', '2020-11-25 10:12:15'),
(6397, 2027, 11329, NULL, '2020-12-09 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-12-02 10:15:23', '2020-12-02 10:15:23'),
(6398, 2027, 11329, NULL, '2020-12-17 00:00:00.000', 'In Process', 'To: AM.Houston@superiorhealthplan.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-12-10 12:55:46', '2020-12-10 12:55:46'),
(6399, 3040, 11329, NULL, '2020-12-24 00:00:00.000', 'In Process', 'Follow up email sent to : AM.Houston@superiorhealthplan.com  Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter |  Greetings,  Hope you are doing well.  Please update me regarding the status for the below provider.     Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542   If you need any additional information please feel free to email me. Looking forward to hearing from you soon.  Thanks    ', NULL, NULL, '2020-12-17 13:21:13', '2020-12-17 13:21:13'),
(6400, 3040, 11329, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Email rcvd from: AM.Hidalgo@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Good Afternoon,  This has been assigned to Veronica Trevino under Meg 19973  Thank you,', NULL, NULL, '2020-12-23 17:53:52', '2020-12-23 17:53:52'),
(6401, 3040, 11329, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Email received from: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter   Good morning,  After further review, last note on file for providers status was on 11/24/20.  Note states record is ready for configuration, but is still undergoing its process.  I have reached out to another department requesting provider status.  Once additional information is received, I’ll get back with you.', NULL, NULL, '2020-12-28 10:52:29', '2020-12-28 10:52:29'),
(6402, 3040, 11329, NULL, '2021-01-05 00:00:00.000', 'In Process', 'Email rcvd from: Veronica.Trevino@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Good afternoon,  Credentialing has advised provider is still in the Credentialing process.   Please allow more time to complete.  You can also email credentialing for a status at Credentialing@superiorhealthplan.com.  If there is anythinge else that I may assit with, please advise.', NULL, NULL, '2020-12-29 09:12:41', '2020-12-29 09:12:41'),
(6403, 3040, 11329, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email sent to: 	Credentialing@superiorhealthplan.com  Subject; Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||   Greetings,  I hope you are doing well. I wanted to know the status of the below mentioned provider.  Provider Name: Rodriguez Cynthia Provider NPI# 1124282553 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Please update me once you get a chance. Waiting to hear from you soon.  Thanks  ', NULL, NULL, '2021-01-05 13:23:27', '2021-01-05 13:23:27'),
(6404, 3040, 11329, NULL, '2021-01-12 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC || Ambetter ||  Hi,  I show the provider to be in the credentialing cycle, please allow more time to complete the cycle.   Thank you.', NULL, NULL, '2021-01-05 14:36:02', '2021-01-05 14:36:02'),
(6405, 3040, 11329, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Greetings,  Hope you are doing well. I wanted to know the status of the below mentioned provider because we submitted the application on 10/27/2020. Please advise me the time frame.  Provider Name:Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  If you need any additional information please feel free to email me. Looking forward to hearing from you soon.  Thanks', NULL, NULL, '2021-01-12 14:03:53', '2021-01-12 14:03:53'),
(6406, 3040, 11329, NULL, '2021-01-20 00:00:00.000', 'In Process', 'I had a word with Credentialing verification organization and he advised me there is no such documents required from our side. ', NULL, NULL, '2021-01-13 16:42:30', '2021-01-13 16:42:30'),
(6407, 3040, 11329, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Good Afternoon,  I have been notified by our credentialing team we are currently waiting on CVO (Credentialing Verification Organization) to release the file.  Credentialing team cannot proceed to work the application until CVO releases the file.   Please reach out to Credentialing Verification Organization to determine if there is additional information pending. ', NULL, NULL, '2021-01-13 16:43:34', '2021-01-13 16:43:34'),
(6408, 3040, 11329, NULL, '2021-01-26 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Status Update || Lopez, Mayra Alejandra ||Valley Med Urgent Care PLLC (Alton Gloor) || Ambetter ||  Good Morning,  MAYRA ALEJANDRA LOPEZ currently displays as (WAITING ON CVO credentialing verification organization).  CVO has not released the file to Superior Healthplan credentialing team.', NULL, NULL, '2021-01-19 12:42:44', '2021-01-19 12:42:44'),
(6409, 3040, 11329, NULL, '2021-02-02 00:00:00.000', 'In Process', 'Follow up email sent to: Daniel.Velez@superiorhealthplan.com  Subject:  Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.   Practice: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI # 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider:  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  If you need anything else please feel free to call or email me. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-01-26 10:49:52', '2021-01-26 10:49:52'),
(6410, 3040, 11329, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Afternoon,  Provider Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 CVO status completed with end date of 1/20/21.  Currently record is assigned to Credentialing team and is under review.  Please allow additional time to process and feel free to request status updates.  Respectfully,', NULL, NULL, '2021-02-02 12:50:38', '2021-02-02 12:50:38'),
(6411, 3040, 11329, NULL, '2021-02-16 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Greetings,  Please advise me how much time the credentialing process takes and when did you receive the application?  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-09 10:22:41', '2021-02-09 10:22:41'),
(6412, 3040, 11329, NULL, '2021-02-23 00:00:00.000', 'In Process', 'Email rcvd from: Daniel.Velez@superiorhealthplan.com  Subject: Lopez, Mayra Alejandra || Ref code: 78G2E ||  Good Morning,  Unfortunately, there is no expected time of completion as the Credentialing process undergoes an a extensive review.  However, Mayra Alejandra Lopez NPI: 1265945125 Tax-ID: 81-5123542 is in “Make Par” status and is within the final stages of Credentialing.  On 11/12/2020 notes indicates Credentialing request and Credentialing documents were sent to be completed.  Please allow additional time to be completed and feel free to request status updates.  ', NULL, NULL, '2021-02-16 12:16:38', '2021-02-16 12:16:38'),
(6413, 3040, 11329, NULL, '2021-03-02 00:00:00.000', 'Approved', 'Approval confirmation received in email.   See Attachment', NULL, NULL, '2021-02-23 13:39:44', '2021-02-23 13:39:44'),
(6414, 2027, 11330, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 15:36:24', '2020-10-27 15:36:24'),
(6415, 2027, 11330, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Tricare)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care), Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-27 15:36:55', '2020-10-27 15:36:55'),
(6416, 2027, 11330, NULL, '2020-11-11 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-04 16:01:48', '2020-11-04 16:01:48'),
(6417, 2037, 11330, NULL, '2020-11-19 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-12 17:17:34', '2020-11-12 17:17:34'),
(6418, 2027, 11330, NULL, '2020-11-26 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  This is a follow up email. Please reply to me as soon as possible.  Thanks.', NULL, NULL, '2020-11-19 10:52:27', '2020-11-19 10:52:27'),
(6419, 2027, 11330, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Tricare)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care), Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-11-30 15:42:51', '2020-11-30 15:42:51'),
(6420, 2037, 11330, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent to Katherine -------------- Hello! May I know the current enrollment status of the below mentioned providers if they are showing certified,credentialed and linked to the below Tax ID.  1)                Group Name: Valley Med Urgent Care (All three locations)                    Group Tax-ID: 81-5123542    Provider Name: Potter, Deborah     Provider NPI# 1861914053     Provider Name: Lopez, Mayra Alejandra                   Provider NPI# 1265945125', NULL, NULL, '2020-12-08 15:27:40', '2020-12-08 15:27:40'),
(6421, 2037, 11330, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Got the following update from Katherine Moten. ---------- Dr. Lopez – pending to be credentialed – application was submitted on 11/13/2020, please allow 90 days for review.', NULL, NULL, '2020-12-09 13:31:09', '2020-12-09 13:31:09'),
(6422, 3040, 11330, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-01-13 13:56:17', '2021-01-13 13:56:17');
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
(6423, 3040, 11330, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email sent to: 	KMoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the status of enrollment for the below mentioned provider. Application was submitted on 11/13/2020.  Group Name: Valley Med Urgent Care (All three location) Group Tax-ID: 81-5123542 Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-20 13:13:37', '2021-01-20 13:13:37'),
(6424, 3040, 11330, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Group Name: Valley Med Urgent Care (All three location) Group Tax-ID: 81-5123542 Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please let me know if you need any additional information. Waiting for your response.   Thanks ', NULL, NULL, '2021-01-28 17:08:30', '2021-01-28 17:08:30'),
(6425, 3040, 11330, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com  Subject:  Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. Provider effective date: 02/02/2021.  Group Name: Valley Med Urgent Care (All three location) Group Tax-ID: 81-5123542 Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please let me know if you need any additional information. Waiting for your response.  Thanks', NULL, NULL, '2021-02-04 13:18:22', '2021-02-04 13:18:22'),
(6426, 3040, 11330, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Re: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find the attached screenshot from Tricare portal and it shows the provider application completed but still it\'s not showing all three locations in the portal.  Please get back to me as soon as possible. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-11 13:32:29', '2021-02-11 13:32:29'),
(6427, 3040, 11330, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider in all three locations.   Group Name: Valley Med Urgent Care (All three location) Group Tax-ID: 81-5123542 Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-18 15:04:03', '2021-02-18 15:04:03'),
(6428, 3040, 11330, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Provider has been added to all 3 locations. Please allow 3 business days for system to update.', NULL, NULL, '2021-02-25 10:35:54', '2021-02-25 10:35:54'),
(6429, 3040, 11330, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you are doing well. I checked the Tricare provider directory for Mayra A Lopez and its showing on only 02 locations. Can you please check and advise because its not showing on our primary location which is 2534 Boca Chica Blvd Brownsville , TX 78521-3496 for your reference I attached the screenshot from website.  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-04 17:17:29', '2021-03-04 17:17:29'),
(6430, 3040, 11330, NULL, '2021-04-01 00:00:00.000', 'In Process', 'Still in process  ', NULL, NULL, '2021-03-12 17:10:46', '2021-03-12 17:10:46'),
(6431, 3040, 11330, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Provider enroll with Tricare.   Effective Date: 02/02/2021', NULL, NULL, '2021-04-15 13:35:08', '2021-04-15 13:35:08'),
(6432, 2027, 11331, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 15:37:40', '2020-10-27 15:37:40'),
(6433, 2027, 11331, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: KMoten4@humana.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Tricare)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care), Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-27 15:37:52', '2020-10-27 15:37:52'),
(6434, 2027, 11331, NULL, '2020-11-11 00:00:00.000', 'In Process', 'From: KMoten4@humana.com  Please provide me with a  credentialing application for this provider.        Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana  T 502-318-5250  F 210-239-0401  kmoten4@humana.com  HumanaMilitary.com', NULL, NULL, '2020-11-04 16:40:14', '2020-11-04 16:40:14'),
(6435, 2037, 11331, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Need to provide the credentialing application', NULL, NULL, '2020-11-12 17:18:38', '2020-11-12 17:18:38'),
(6436, 2027, 11331, NULL, '2020-11-20 00:00:00.000', 'In Process', 'From; KMoten4@humana.com  This application has been submitted for processing. Please allow 90 days.', NULL, NULL, '2020-11-13 09:43:33', '2020-11-13 09:43:33'),
(6437, 2027, 11331, NULL, '2020-11-27 00:00:00.000', 'In Process', 'To: KMoten4@humana.com ywyatt@humana.com  May I know the current status of this below mentioned provider: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.  ', NULL, NULL, '2020-11-20 12:37:47', '2020-11-20 12:37:47'),
(6438, 2027, 11331, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: KMoten4@humana.com ywyatt@humana.com  May I know the current status of this below mentioned provider: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.  ', NULL, NULL, '2020-11-30 15:43:22', '2020-11-30 15:43:22'),
(6439, 2037, 11331, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent to Katherine -------------- Hello! May I know the current enrollment status of the below mentioned providers if they are showing certified,credentialed and linked to the below Tax ID.  1)                Group Name: Valley Med Urgent Care (All three locations)                    Group Tax-ID: 81-5123542    Provider Name: Potter, Deborah     Provider NPI# 1861914053     Provider Name: Lopez, Mayra Alejandra                   Provider NPI# 1265945125', NULL, NULL, '2020-12-08 15:27:45', '2020-12-08 15:27:45'),
(6440, 2037, 11331, NULL, '2021-01-13 00:00:00.000', 'In Process', 'Got the following update from Katherine Moten. ---------- Dr. Lopez – pending to be credentialed – application was submitted on 11/13/2020, please allow 90 days for review.', NULL, NULL, '2020-12-09 13:31:25', '2020-12-09 13:31:25'),
(6441, 3040, 11331, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-01-13 13:56:00', '2021-01-13 13:56:00'),
(6442, 3040, 11331, NULL, '2021-01-27 00:00:00.000', 'In Process', 'Email sent to: 	KMoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the status of enrollment for the below mentioned provider. Application was submitted on 11/13/2020.  Group Name: Valley Med Urgent Care (All three location) Group Tax-ID: 81-5123542 Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-01-20 13:13:59', '2021-01-20 13:13:59'),
(6443, 3040, 11331, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider.  Group Name: Valley Med Urgent Care (All three location) Group Tax-ID: 81-5123542 Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please let me know if you need any additional information. Waiting for your response.   Thanks ', NULL, NULL, '2021-01-28 17:08:23', '2021-01-28 17:08:23'),
(6444, 3040, 11331, NULL, '2021-02-11 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com  Subject:  Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. Provider effective date: 02/02/2021.  Group Name: Valley Med Urgent Care (All three location) Group Tax-ID: 81-5123542 Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please let me know if you need any additional information. Waiting for your response.  Thanks', NULL, NULL, '2021-02-04 13:18:16', '2021-02-04 13:18:16'),
(6445, 3040, 11331, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Re: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find the attached screenshot from Tricare portal and it shows the provider application completed but still it\'s not showing all three locations in the portal.  Please get back to me as soon as possible. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-02-11 13:32:16', '2021-02-11 13:32:16'),
(6446, 3040, 11331, NULL, '2021-02-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I just wanted to follow up regarding the enrollment status for the below mentioned provider in all three locations.   Group Name: Valley Med Urgent Care (All three location) Group Tax-ID: 81-5123542 Group NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address:800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-02-18 15:03:56', '2021-02-18 15:03:56'),
(6447, 3040, 11331, NULL, '2021-03-04 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Provider has been added to all 3 locations. Please allow 3 business days for system to update.', NULL, NULL, '2021-02-25 10:36:11', '2021-02-25 10:36:11'),
(6448, 3040, 11331, NULL, '2021-03-11 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you are doing well. I checked the Tricare provider directory for Mayra A Lopez and its showing on only 02 locations. Can you please check and advise because its not showing on our primary location which is 2534 Boca Chica Blvd Brownsville , TX 78521-3496 for your reference I attached the screenshot from website.  Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-04 17:17:08', '2021-03-04 17:17:08'),
(6449, 3040, 11331, NULL, '2021-04-01 00:00:00.000', 'In Process', 'Still in process  ', NULL, NULL, '2021-03-12 17:10:36', '2021-03-12 17:10:36'),
(6450, 3040, 11331, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Provider enroll with Tricare.   Effective Date: 02/02/2021', NULL, NULL, '2021-04-15 13:35:09', '2021-04-15 13:35:09'),
(6451, 2027, 11332, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 16:49:14', '2020-10-27 16:49:14'),
(6452, 2027, 11332, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Molina Health)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care), Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-27 16:56:34', '2020-10-27 16:56:34'),
(6453, 2027, 11332, NULL, '2020-11-10 00:00:00.000', 'In Process', 'From: Michele.Thomas-Martin@molinahealthcare.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Molina Health)  Record # 146946     Good Morning,     Thank you for your inquiry.  Unfortunately, we don’t add providers under urgent care facilities due to the flat rate billing.  However I did notice that the request to add the facility to Molina is under missing information.  Please reach out to the assigned coordinator listed below for assistance with the missing information and completing the contract request for the facility.                Hidalgo             Jasmine Guerrero             Jasmine.Guerrero@molinahealthcare.com      888-562-5442 x 208473     Thank You,', NULL, NULL, '2020-11-03 13:55:02', '2020-11-03 13:55:02'),
(6454, 2027, 11332, NULL, '2020-11-10 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Molina Health)  Record # 146946     Good Morning,     Thank you for your inquiry.  Unfortunately, we don’t add providers under urgent care facilities due to the flat rate billing.  However I did notice that the request to add the facility to Molina is under missing information.  Please reach out to the assigned coordinator listed below for assistance with the missing information and completing the contract request for the facility.                Hidalgo             Jasmine Guerrero             Jasmine.Guerrero@molinahealthcare.com      888-562-5442 x 208473     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2020-11-03 14:00:16', '2020-11-03 14:00:16'),
(6455, 2027, 11332, NULL, '2020-11-10 00:00:00.000', 'In Process', 'To: 	Jasmine.Guerrero@molinahealthcare.com  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care), Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-11-03 14:00:57', '2020-11-03 14:00:57'),
(6456, 2027, 11332, NULL, '2020-11-11 00:00:00.000', 'In Process', 'From: Jasmine.Guerrero@molinahealthcare.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Molina Health)  Good morning,     We can add the additional urgent care locations however, we don’t add individual providers under urgent care facilities due to the flat rate billing. Would you like to proceed with adding the additional urgent care facilities?        Thank you,     Jasmine Guerrero  Associate Specialist, Provider Contracts  5605 N. MacArthur Blvd. Suite 400 | Irving, TX 75038  www.MolinaHealthcare.com  Your extended Family', NULL, NULL, '2020-11-04 14:34:09', '2020-11-04 14:34:09'),
(6457, 2027, 11332, NULL, '2020-11-11 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  Yes, I want to add the locations in the existing contract. Please assist me with how I can start the process.', NULL, NULL, '2020-11-04 14:34:45', '2020-11-04 14:34:45'),
(6458, 2027, 11332, NULL, '2020-11-18 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com\\  Kindly send me the roster also because I have more than one location which I want to add in this existing contract.  Thanks.', NULL, NULL, '2020-11-11 14:49:14', '2020-11-11 14:49:14'),
(6459, 2027, 11332, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  This is a follow up to my last email. Kindly send me the roster because I have more than one location to add.  Thanks.', NULL, NULL, '2020-11-18 09:50:16', '2020-11-18 09:50:16'),
(6460, 2027, 11332, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: Jasmine.Guerrero@molinahealthcare.com  Hi Martin,     I apologize for the delay in response. How many locations are you wanting to add?', NULL, NULL, '2020-11-18 13:11:58', '2020-11-18 13:11:58'),
(6461, 2027, 11332, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  I want to add all three locations. Below are the details: (1)Valley Med Urgent Care-2534 Boca Chica Blvd Brownsville , TX 78521-3496. (2)Valley Med Urgent Care-800 E Alton Gloor Blvd Brownsville , TX 78526-4248. (3)Valley Med Urgent Care-101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166.  Thanks.', NULL, NULL, '2020-11-18 13:12:25', '2020-11-18 13:12:25'),
(6462, 2027, 11332, NULL, '2020-11-26 00:00:00.000', 'In Process', 'From: Jasmine.Guerrero@molinahealthcare.com  Please find the contract request form attached in this email of each location of the group for this provider.  Thanks.', NULL, NULL, '2020-11-19 13:11:42', '2020-11-19 13:11:42'),
(6463, 2027, 11332, NULL, '2020-11-26 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com MHTContractrequest@molinahealthcare.com  Please find the contract request form attached in this email of each location of the group for this provider.  Thanks.', NULL, NULL, '2020-11-19 13:12:38', '2020-11-19 13:12:38'),
(6464, 2027, 11332, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  May I know the current status of this request?', NULL, NULL, '2020-11-30 13:23:50', '2020-11-30 13:23:50'),
(6465, 2037, 11332, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-08 13:59:24', '2020-12-08 13:59:24'),
(6466, 1006, 11332, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent follow-up email @ \"Guerrero, Jasmine\" Jasmine.Guerrero@molinahealthcare.com: \"Hello Jasmine, I hope you\'re doing well, we submitted the CRF\'s for all the locations for VMUC to you back on 11/20/2020. What other forms are you requesting to be filled out? Thanks. \"', NULL, NULL, '2020-12-15 15:04:32', '2020-12-15 15:04:32'),
(6467, 3040, 11332, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Need to call', NULL, NULL, '2020-12-22 18:00:21', '2020-12-22 18:00:21'),
(6468, 3040, 11332, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Called Molina Health and no one is available due to Christmas Holiday\'s I left the voice mail.', NULL, NULL, '2020-12-23 15:10:36', '2020-12-23 15:10:36'),
(6469, 3040, 11332, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Email sent to: 	Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Greetings,  Hope you are doing well. We submitted the CRF\'s for all the locations for VMUC to you back on 11/20/2020. I wanted to know the status of the location update for the below mentioned provider.  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  If you need anything else please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-30 12:29:04', '2020-12-30 12:29:04'),
(6470, 3040, 11332, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Greetings,  Hope you are doing well. First and foremost I really apologize for the delay response. Please find the attached documents that you are requested.   Kindly advise I have two more locations under the same Tax Id and NPI for that do I need to fill the separate facility application form.   If you need anything else from my side please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-12 14:07:58', '2021-01-12 14:07:58'),
(6471, 3040, 11332, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email sent to: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Greetings,  Hope you are doing well. I really appreciate your prompt response. Please find the attached the location application form 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.   Thanks', NULL, NULL, '2021-01-13 17:38:33', '2021-01-13 17:38:33'),
(6472, 3040, 11332, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email rcvd from: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Good afternoon,  Yes, we would need an application per location, as each location will need to be credentialed. Thank you in advance!  ', NULL, NULL, '2021-01-13 17:39:33', '2021-01-13 17:39:33'),
(6473, 3040, 11332, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from:  Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Good morning,  Thank you! - I am sending the facilities for credentialing. Credentialing does take 30-45 days for processing if no missing information. Please be advised this is not the final step and refrain from seeing patients as this will cause claim denials. Please follow up within this time frame for further assistance regarding the following steps in becoming contracted.  Have a wonderful day!', NULL, NULL, '2021-01-14 15:33:15', '2021-01-14 15:33:15'),
(6474, 3040, 11332, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Follow up email sent to: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned provider. Has there been any update?  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  If you need any additional information please email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-21 12:01:33', '2021-01-21 12:01:33'),
(6475, 3040, 11332, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Good afternoon,  Credentialing does take 30-45 days from the day it was sent for processing which was 1/14/2021. We are also unable to affiliate individual providers to urgent care facilities.  Thank you in advance!  Thank you,', NULL, NULL, '2021-01-28 16:55:18', '2021-01-28 16:55:18'),
(6476, 3040, 11332, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract.  See attachment', NULL, NULL, '2021-02-03 15:55:53', '2021-02-03 15:55:53'),
(6477, 3040, 11332, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:46:19', '2021-04-26 10:46:19'),
(6478, 3040, 11332, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:07:56', '2021-05-31 09:07:56'),
(6479, 2027, 11333, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 17:07:40', '2020-10-27 17:07:40'),
(6480, 2027, 11333, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Molina Health)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care), Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-27 17:07:55', '2020-10-27 17:07:55'),
(6481, 2027, 11333, NULL, '2020-11-10 00:00:00.000', 'In Process', 'To: 	Jasmine.Guerrero@molinahealthcare.com  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care), Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-11-03 14:01:59', '2020-11-03 14:01:59'),
(6482, 2027, 11333, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  Kindly send me the roster also because I have more than one location which I want to add in this existing contract.  Thanks.', NULL, NULL, '2020-11-10 14:12:26', '2020-11-10 14:12:26'),
(6483, 2027, 11333, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  This is a follow up to my last email. Kindly send me the roster because I have more than one location to add.  Thanks.', NULL, NULL, '2020-11-18 09:51:20', '2020-11-18 09:51:20'),
(6484, 2027, 11333, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: Jasmine.Guerrero@molinahealthcare.com  Hi Martin,     I apologize for the delay in response. How many locations are you wanting to add?', NULL, NULL, '2020-11-18 13:13:03', '2020-11-18 13:13:03'),
(6485, 2027, 11333, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  I want to add all three locations. Below are the details: (1)Valley Med Urgent Care-2534 Boca Chica Blvd Brownsville , TX 78521-3496. (2)Valley Med Urgent Care-800 E Alton Gloor Blvd Brownsville , TX 78526-4248. (3)Valley Med Urgent Care-101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166.  Thanks.', NULL, NULL, '2020-11-18 13:13:52', '2020-11-18 13:13:52'),
(6486, 2027, 11333, NULL, '2020-11-26 00:00:00.000', 'In Process', 'From: Jasmine.Guerrero@molinahealthcare.com  Hi Martin,     Please complete the attached contract request form per facility, as each facility will need to undergo credentialing, and submit along with an updated W9.', NULL, NULL, '2020-11-19 13:15:32', '2020-11-19 13:15:32'),
(6487, 2027, 11333, NULL, '2020-11-26 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com MHTContractrequest@molinahealthcare.com  Please find the contract request form attached in this email of each location of the group for this provider.  Thanks.', NULL, NULL, '2020-11-19 13:21:15', '2020-11-19 13:21:15'),
(6488, 2027, 11333, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  May I know the current status of this request?', NULL, NULL, '2020-11-30 13:24:52', '2020-11-30 13:24:52'),
(6489, 2037, 11333, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-08 13:59:33', '2020-12-08 13:59:33'),
(6490, 1006, 11333, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent follow-up email @ \"Guerrero, Jasmine\" Jasmine.Guerrero@molinahealthcare.com: \"Hello Jasmine, I hope you\'re doing well, we submitted the CRF\'s for all the locations for VMUC to you back on 11/20/2020. What other forms are you requesting to be filled out? Thanks. \"', NULL, NULL, '2020-12-15 15:04:23', '2020-12-15 15:04:23'),
(6491, 3040, 11333, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Need to call', NULL, NULL, '2020-12-22 18:00:36', '2020-12-22 18:00:36'),
(6492, 3040, 11333, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Called Molina Health and no one is available due to Christmas Holiday\'s I left the voice mail.', NULL, NULL, '2020-12-23 15:10:43', '2020-12-23 15:10:43'),
(6493, 3040, 11333, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Email sent to: 	Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Greetings,  Hope you are doing well. We submitted the CRF\'s for all the locations for VMUC to you back on 11/20/2020. I wanted to know the status of the location update for the below mentioned provider.  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  If you need anything else please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-30 12:28:49', '2020-12-30 12:28:49'),
(6494, 3040, 11333, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Greetings,  Hope you are doing well. First and foremost I really apologize for the delay response. Please find the attached documents that you are requested.   Kindly advise I have two more locations under the same Tax Id and NPI for that do I need to fill the separate facility application form.   If you need anything else from my side please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-12 14:05:05', '2021-01-12 14:05:05'),
(6495, 3040, 11333, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email sent to: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Greetings,  Hope you are doing well. I really appreciate your prompt response. Please find the attached the location application form 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.   Thanks', NULL, NULL, '2021-01-13 17:38:40', '2021-01-13 17:38:40'),
(6496, 3040, 11333, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email rcvd from: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Good afternoon,  Yes, we would need an application per location, as each location will need to be credentialed. Thank you in advance!  ', NULL, NULL, '2021-01-13 17:39:38', '2021-01-13 17:39:38'),
(6497, 3040, 11333, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from:  Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Good morning,  Thank you! - I am sending the facilities for credentialing. Credentialing does take 30-45 days for processing if no missing information. Please be advised this is not the final step and refrain from seeing patients as this will cause claim denials. Please follow up within this time frame for further assistance regarding the following steps in becoming contracted.  Have a wonderful day!', NULL, NULL, '2021-01-14 15:33:33', '2021-01-14 15:33:33'),
(6498, 3040, 11333, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Follow up email sent to: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned provider. Has there been any update?  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  If you need any additional information please email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-21 12:01:27', '2021-01-21 12:01:27'),
(6499, 3040, 11333, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Good afternoon,  Credentialing does take 30-45 days from the day it was sent for processing which was 1/14/2021. We are also unable to affiliate individual providers to urgent care facilities.  Thank you in advance!  Thank you,', NULL, NULL, '2021-01-28 16:55:04', '2021-01-28 16:55:04'),
(6500, 3040, 11333, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract.  See attachment', NULL, NULL, '2021-02-03 15:56:03', '2021-02-03 15:56:03'),
(6501, 3040, 11333, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:46:12', '2021-04-26 10:46:12'),
(6502, 3040, 11333, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:11:11', '2021-05-31 09:11:11'),
(6503, 2027, 11334, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-27 17:23:28', '2020-10-27 17:23:28'),
(6504, 2027, 11334, NULL, '2020-11-03 00:00:00.000', 'In Process', 'To: Michele.Thomas-Martin@molinahealthcare.com  Sub: (Lopez, Mayra Alejandra)-(Valley Med Urgent Care)-(Molina Health)  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care), Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-10-27 17:23:48', '2020-10-27 17:23:48'),
(6505, 2027, 11334, NULL, '2020-11-10 00:00:00.000', 'In Process', 'To: 	Jasmine.Guerrero@molinahealthcare.com  I want to enroll this below mentioned provider in all three locations of (Valley Med Urgent Care), Please assist me with how I can start the process. Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  Thanks.', NULL, NULL, '2020-11-03 14:02:29', '2020-11-03 14:02:29'),
(6506, 2027, 11334, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  Kindly send me the roster also because I have more than one location which I want to add in this existing contract.  Thanks.', NULL, NULL, '2020-11-10 14:14:01', '2020-11-10 14:14:01'),
(6507, 2027, 11334, NULL, '2020-11-17 00:00:00.000', 'In Process', 'From: Ricardo.Salinas@molinahealthcare.com  Mr. Rodriguez,     As per your request, I have attached the information requested:     VALLEY MED URGENT CARE PLLC  2534 BOCA CHICA BLVD BROWNSVILLE, TX  800 E ALTON GLOOR BLVD BROWNSVILLE, TX', NULL, NULL, '2020-11-10 16:57:30', '2020-11-10 16:57:30'),
(6508, 2027, 11334, NULL, '2020-11-17 00:00:00.000', 'In Process', 'To: Ricardo.Salinas@molinahealthcare.com Jasmine.Guerrero@molinahealthcare.com  I want to add one more location under this group. Below are the details: Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542 Location I want to add: Valley Med Urgent Care 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166).', NULL, NULL, '2020-11-10 16:58:14', '2020-11-10 16:58:14'),
(6509, 2027, 11334, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  This is a follow up to my last email. Kindly send me the roster because I have more than one location to add.  Thanks.', NULL, NULL, '2020-11-18 09:51:39', '2020-11-18 09:51:39'),
(6510, 2027, 11334, NULL, '2020-11-25 00:00:00.000', 'In Process', 'From: Jasmine.Guerrero@molinahealthcare.com  Hi Martin,     I apologize for the delay in response. How many locations are you wanting to add?', NULL, NULL, '2020-11-18 13:14:36', '2020-11-18 13:14:36'),
(6511, 2027, 11334, NULL, '2020-11-25 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  I want to add all three locations. Below are the details: (1)Valley Med Urgent Care-2534 Boca Chica Blvd Brownsville , TX 78521-3496. (2)Valley Med Urgent Care-800 E Alton Gloor Blvd Brownsville , TX 78526-4248. (3)Valley Med Urgent Care-101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166.  Thanks.', NULL, NULL, '2020-11-18 13:14:56', '2020-11-18 13:14:56'),
(6512, 2027, 11334, NULL, '2020-11-26 00:00:00.000', 'In Process', 'From: Jasmine.Guerrero@molinahealthcare.com  Hi Martin,     Please complete the attached contract request form per facility, as each facility will need to undergo credentialing, and submit along with an updated W9.', NULL, NULL, '2020-11-19 13:23:33', '2020-11-19 13:23:33'),
(6513, 2027, 11334, NULL, '2020-11-26 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com MHTContractrequest@molinahealthcare.com  Please find the contract request form attached in this email of each location of the group for this provider.  Thanks.', NULL, NULL, '2020-11-19 13:23:50', '2020-11-19 13:23:50'),
(6514, 2027, 11334, NULL, '2020-12-07 00:00:00.000', 'In Process', 'To: Jasmine.Guerrero@molinahealthcare.com  May I know the current status of this request?', NULL, NULL, '2020-11-30 13:25:18', '2020-11-30 13:25:18'),
(6515, 2037, 11334, NULL, '2020-12-15 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2020-12-08 13:59:39', '2020-12-08 13:59:39'),
(6516, 1006, 11334, NULL, '2020-12-22 00:00:00.000', 'In Process', 'Sent follow-up email @ \"Guerrero, Jasmine\" Jasmine.Guerrero@molinahealthcare.com: \"Hello Jasmine, I hope you\'re doing well, we submitted the CRF\'s for all the locations for VMUC to you back on 11/20/2020. What other forms are you requesting to be filled out? Thanks. \"', NULL, NULL, '2020-12-15 15:04:38', '2020-12-15 15:04:38'),
(6517, 3040, 11334, NULL, '2020-12-23 00:00:00.000', 'In Process', 'Need to call', NULL, NULL, '2020-12-22 18:00:49', '2020-12-22 18:00:49'),
(6518, 3040, 11334, NULL, '2020-12-30 00:00:00.000', 'In Process', 'Called Molina Health and no one is available due to Christmas Holiday\'s I left the voice mail.', NULL, NULL, '2020-12-23 15:10:49', '2020-12-23 15:10:49'),
(6519, 3040, 11334, NULL, '2021-01-06 00:00:00.000', 'In Process', 'Email sent to: 	Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Greetings,  Hope you are doing well. We submitted the CRF\'s for all the locations for VMUC to you back on 11/20/2020. I wanted to know the status of the location update for the below mentioned provider.  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  If you need anything else please let me know. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2020-12-30 12:29:12', '2020-12-30 12:29:12'),
(6520, 3040, 11334, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Email sent to: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Greetings,  Hope you are doing well. First and foremost I really apologize for the delay response. Please find the attached documents that you are requested.   Kindly advise I have two more locations under the same Tax Id and NPI for that do I need to fill the separate facility application form.   If you need anything else from my side please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-12 14:08:11', '2021-01-12 14:08:11'),
(6521, 3040, 11334, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email sent to: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Greetings,  Hope you are doing well. I really appreciate your prompt response. Please find the attached the location application form 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.   Thanks', NULL, NULL, '2021-01-13 17:38:46', '2021-01-13 17:38:46'),
(6522, 3040, 11334, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Email rcvd from: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Good afternoon,  Yes, we would need an application per location, as each location will need to be credentialed. Thank you in advance!  ', NULL, NULL, '2021-01-13 17:39:45', '2021-01-13 17:39:45'),
(6523, 3040, 11334, NULL, '2021-01-21 00:00:00.000', 'In Process', 'Email rcvd from:  Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Good morning,  Thank you! - I am sending the facilities for credentialing. Credentialing does take 30-45 days for processing if no missing information. Please be advised this is not the final step and refrain from seeing patients as this will cause claim denials. Please follow up within this time frame for further assistance regarding the following steps in becoming contracted.  Have a wonderful day!', NULL, NULL, '2021-01-14 15:33:40', '2021-01-14 15:33:40'),
(6524, 3040, 11334, NULL, '2021-01-28 00:00:00.000', 'In Process', 'Follow up email sent to: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Greetings,  Hope you are doing well. This is a follow up email regarding the below mentioned provider. Has there been any update?  Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125 Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  If you need any additional information please email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-01-21 12:01:38', '2021-01-21 12:01:38'),
(6525, 3040, 11334, NULL, '2021-02-04 00:00:00.000', 'In Process', 'Email rcvd from: Jasmine.Guerrero@molinahealthcare.com  Subject: Location Update || Lopez, Mayra Alejandra || Valley Med Urgent Care PLLC || Molina Health  Good afternoon,  Credentialing does take 30-45 days from the day it was sent for processing which was 1/14/2021. We are also unable to affiliate individual providers to urgent care facilities.  Thank you in advance!  Thank you,', NULL, NULL, '2021-01-28 16:55:28', '2021-01-28 16:55:28'),
(6526, 3040, 11334, NULL, '2021-02-10 00:00:00.000', 'Approved', 'Group has an ancillary contract.  See attachment', NULL, NULL, '2021-02-03 15:56:33', '2021-02-03 15:56:33'),
(6527, 3040, 11334, NULL, NULL, 'Revalidation', 'Email sent to: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Hello David,   Hope you are doing well. The contract request form that was sent out in your previous email I would like to ask you in the provider type section what option you want me to mark for the providers. If you could reach out to me on 713-893-6214 that would be better.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you', NULL, NULL, '2021-04-26 10:46:08', '2021-04-26 10:46:08'),
(6528, 3040, 11334, NULL, NULL, 'Revalidated', 'Group has an ancillary contract. No need to add individual providers as per Jasmine.Guerrero@molinahealthcare.com ', NULL, NULL, '2021-05-31 09:09:26', '2021-05-31 09:09:26'),
(6529, 1006, 11335, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-28 10:29:55', '2020-10-28 10:29:55'),
(6530, 1006, 11335, NULL, '2020-11-09 00:00:00.000', 'Initiated', 'Submitted PNP and PCNS Contracting Application via fax @ 617-246-5053. Attached. ', NULL, NULL, '2020-10-28 10:30:28', '2020-10-28 10:30:28'),
(6531, 1006, 11335, NULL, '2020-11-10 00:00:00.000', 'In Process', 'Received following reply from BCBSMA: \"Dear Provider: Blue Cross Blue Shield of Massachusetts (BCBSMA*) has received your request for Barbara Hignite.  Unfortunately, we are unable to process your request due to the following;  Certificate – a copy of a current accreditation ANCC certificate is missing for Psychiatric and Mental Health Nursing.  ***Please Do Not Reply to this message***  Please note; the complete application/update form and required documentation must be resubmitted for processing. If you have any questions, please call Network Management Services at 1-800-316-BLUE (2583).    Sincerely, Contract Operations Blue Cross Blue Shield of Massachusetts\"  Replied  back with: \"Good morning,   We received the following reply from the credentialing department stating that the provider does not have an ANCC certificate with the accreditation of a PMHNP. I wanted to notify you that the provider had completed her PMHNP certification back in 05/1991, I have attached a copy of the enrollment certification for your reference. Please re-initiate the credentialing process for this provider as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2020-11-02 09:42:28', '2020-11-02 09:42:28'),
(6532, 1006, 11335, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Received following reply from BCBSMA: \"Hello,  Please refax the complete application along with this certificate for processing.  Regards, Network Management Services Blue Cross Blue Shield of Massachusetts\"  Submitted CNP application instead to (617) 246-4227 with ANCC, AANP certifications attached. ', NULL, NULL, '2020-11-05 10:02:31', '2020-11-05 10:02:31'),
(6533, 1006, 11335, NULL, '2020-11-23 00:00:00.000', 'In Process', 'Received following email from Blue Cross Case Response noreply-contracting@bcbsma.com: \"***Please Do Not Reply.***  I.NP.Hignite, Barbara  Spectrum Neuro Behavioral Care LLC  Reference: 00013172  Dear Provider:  This is an automatic reply from an email box that is not monitored.  Blue Cross Blue Shield of Massachusetts acknowledges receipt of your recent submission. It will be worked in the order it was received.  Any questions, please contact Network Management & Credentialing Services at 800-316-BLUE (2583).\"', NULL, NULL, '2020-11-16 11:16:44', '2020-11-16 11:16:44'),
(6534, 1006, 11335, NULL, '2020-11-25 00:00:00.000', 'In Process', 'Received a contract for enrollment. Signed and sent back, attached copy. ', NULL, NULL, '2020-11-16 13:11:08', '2020-11-16 13:11:08'),
(6535, 1006, 11335, NULL, '2020-12-02 00:00:00.000', 'In Process', 'Signed contracts have been received, Request is in-process, can take upto 50~60 days.   Rep: Nick', NULL, NULL, '2020-11-25 11:30:06', '2020-11-25 11:30:06'),
(6536, 1006, 11335, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerapplicationstatus@bcbsma.com for updated status. ', NULL, NULL, '2020-12-02 14:18:10', '2020-12-02 14:18:10'),
(6537, 1006, 11335, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent a follow-up email to Bevin Laura @ \"Bevin, Laura J\" Laura.Bevin@aetna.com', NULL, NULL, '2020-12-14 18:00:27', '2020-12-14 18:00:27'),
(6538, 1006, 11335, NULL, '2020-12-25 00:00:00.000', 'In Process', 'Received following reply from providerapplicationstatus@bcbsma.com: \"Contract received 11/16/20.  Standard processing time is approximately 60 days.  Regards,   Network Management Services Blue Cross Blue Shield of Massachusetts\"', NULL, NULL, '2020-12-15 11:49:00', '2020-12-15 11:49:00');
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
(6539, 1006, 11335, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerapplicationstatus@bcbsma.com ', NULL, NULL, '2020-12-28 17:49:17', '2020-12-28 17:49:17'),
(6540, 1006, 11335, NULL, '2021-01-20 00:00:00.000', 'In Process', 'Received following reply from providerapplicationstatus@bcbsma.com:  \"Her enrollment is currently in process.  Please allow approximately another 15 days for processing.  Regards,  Network Management Services Blue Cross Blue Shield of Massachusetts\"', NULL, NULL, '2021-01-07 10:16:44', '2021-01-07 10:16:44'),
(6541, 1006, 11335, NULL, '2021-02-03 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerapplicationstatus@bcbsma.com', NULL, NULL, '2021-01-27 11:44:19', '2021-01-27 11:44:19'),
(6542, 1006, 11335, NULL, '2021-02-09 00:00:00.000', 'In Process', 'Received the following reply from BCBS: \"Provider is the credentialing process.\"', NULL, NULL, '2021-02-02 15:58:45', '2021-02-02 15:58:45'),
(6543, 1006, 11335, NULL, '2021-02-19 00:00:00.000', 'In Process', 'Sent a follow-up email @ providerapplicationstatus@bcbsma.com ', NULL, NULL, '2021-02-12 16:40:21', '2021-02-12 16:40:21'),
(6544, 1006, 11335, NULL, '2021-02-24 00:00:00.000', 'In Process', 'Received the following response: \"Provider is the credentialing process.\"', NULL, NULL, '2021-02-17 17:30:54', '2021-02-17 17:30:54'),
(6545, 1006, 11335, NULL, '2021-03-08 00:00:00.000', 'On Hold', 'Received the following reply from BCBSMA:  \"Hello.    For Barbara Hignite, an email was sent on 2/8/21 to the credentialing contact - Brad Peterson (snbc@claimsmedinc.com) to advise we were discontinuing her credentialing until the provider obtains her full license.   Regards,  Network Management Services Blue Cross Blue Shield of Massachusetts  TH\"', NULL, NULL, '2021-02-23 11:58:04', '2021-02-23 11:58:04'),
(6546, 1006, 11335, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Received following email from Riordan, Francine Francine.Riordan@bcbsma.com:  \"Good morning Brad,  Recently we sent you a credentialing discontinued email due to Barbara having a temporary license.  Our records show she now has a full license.  Please advise if you want Blue Cross to continue with her credentialing/enrollment application.  Thank you, Francine\"', NULL, NULL, '2021-03-30 09:38:48', '2021-03-30 09:38:48'),
(6547, 1006, 11335, NULL, '2021-04-07 00:00:00.000', 'In Process', 'Received the following response from Riordan, Francine Francine.Riordan@bcbsma.com: \"Hi Brad,  Barbara is all set.  Her app should go to Committee tomorrow.  Have a good afternoon,  Francine\"', NULL, NULL, '2021-03-31 11:03:42', '2021-03-31 11:03:42'),
(6548, 1019, 11335, NULL, '2021-04-07 00:00:00.000', 'In Process', 'Received the following response from Riordan, Francine Francine.Riordan@bcbsma.com: Hi,     Well, she will go to vote tomorrow, then she will have to be built in all systems (not done by me).  Hopefully this will take less than a week (busy season is upon us inventory-wise).  Once you receive the Welcome Letter, she will be all set to bill.', NULL, NULL, '2021-03-31 15:11:12', '2021-03-31 15:11:12'),
(6549, 1019, 11335, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Received the executed contract from Blue Cross Blue Shield, see attached', NULL, NULL, '2021-04-02 08:10:47', '2021-04-02 08:10:47'),
(6550, 1019, 11335, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Receive the Welcome Letter from BCBS, see attached. Also sent an email for test claims.', NULL, NULL, '2021-04-06 11:42:50', '2021-04-06 11:42:50'),
(6551, 1019, 11335, NULL, '2021-04-14 00:00:00.000', 'Approved', NULL, NULL, NULL, '2021-04-07 13:05:17', '2021-04-07 13:05:17'),
(6552, 1006, 11336, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-28 11:20:11', '2020-10-28 11:20:11'),
(6553, 1006, 11336, NULL, '2020-11-10 00:00:00.000', 'Initiated', 'Initiated enrollment request online via Aetna Enrollment portal. Copy attached. ', NULL, NULL, '2020-10-28 11:20:49', '2020-10-28 11:20:49'),
(6554, 1006, 11336, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Sent following email to Bevin Laura: \"Hello Laura,  I wanted to follow-up again regarding the status of the following provider, have there been any updates?   Name: Barbara Hignite NPI# 1982617262  Thanks.\"', NULL, NULL, '2020-11-12 18:53:57', '2020-11-12 18:53:57'),
(6555, 1006, 11336, NULL, '2020-12-01 00:00:00.000', 'On Hold', 'Received following update from Laura: \"Hello,  The credentialing for Barbara Hignite, 7980392 has been discontinued due to her license. She has a temporary license for MA and Aetna does not accept temporary licenses for credentialing and contracting.  Please advise when she has a full license for MA and I will have her credentialing placed back in process.  Thank you   Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health\"', NULL, NULL, '2020-11-16 10:39:57', '2020-11-16 10:39:57'),
(6556, 1019, 11336, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Spoke with the Rep Bella C (Ref # 6008522787) Updated her with New License info, as per her will get the welcome letter by 2nd week of 04/21.', NULL, NULL, '2021-03-22 16:21:26', '2021-03-22 16:21:26'),
(6557, 1019, 11336, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent the following email to Laura :Laura.Bevin@aetna.com  Sub: Enrollment Status || Providers || SNBCARE || Aetna Hello Laura, Hope you\'re doing well, can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Barbara HIgnite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-04-08 10:18:11', '2021-04-08 10:18:11'),
(6558, 1019, 11336, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Received the following the email from Laura.Bevin@aetna.com Good afternoon,  Barbara HIgnite, 6369000 – waiting to be linked    Kerry Smith, 6164300 – CAQH application is being reviewed by our Credentialing Dept.  Rodesia Edmundson – very early in the credentialing process, application was received on 04/05/2021  Justin Souliere, 6893422 - CAQH application is being reviewed by our Credentialing Dept.     Thank you', NULL, NULL, '2021-04-08 11:31:01', '2021-04-08 11:31:01'),
(6559, 3040, 11336, NULL, '2021-04-23 00:00:00.000', 'In Process', 'I had a word with Aetna representative and he said the application is still in credentialing process. Effective date: 03/01/2021.   ', NULL, NULL, '2021-04-16 16:10:01', '2021-04-16 16:10:01'),
(6560, 1019, 11336, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to : Laura.Bevin@aetna.com, ChandraKumarU@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-03 10:31:30', '2021-05-03 10:31:30'),
(6561, 1019, 11336, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:02:40', '2021-05-20 08:02:40'),
(6562, 1019, 11336, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from Laura.Bevin@aetna.com  Good afternoon, Please see my comments below. Thank you  Melody L\'Etoile, 6466643 – CAQH application is being reviewed 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson, 6301243 – 06/01/2021 effective date 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite, 6369000 - 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. – 03/01/2021 effective date Secondary Location: 100 New State Highway, Raynham, MA, 02767.  – address can be added via Existing Medical Provider Resources | Aetna  Kerry Smith, 6164300 – 06/01/2021 effective date 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti, 6846902 – 06/01/2021 effective date 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan, 7686597 – 01/01/2021 effective date 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland, 6785859 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767. – address can be added via Existing Medical Provider Resources | Aetna    Peggy Pionke, 6507988 – 02/01/2021 effective date 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid, 6557417 – 01/01/2021 effective date 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Laura Bevin Credentialing Senior Analyst Aetna Behavioral Health', NULL, NULL, '2021-05-31 13:08:13', '2021-05-31 13:08:13'),
(6563, 1019, 11336, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-06-16 07:58:10', '2021-06-16 07:58:10'),
(6564, 1019, 11336, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Providers:  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson  NPI: 1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Jessica Hartman  NPI: 1326665472  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland  NPI: 1598163602  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Jonathan Schubert  NPI: 1235755505   Secondary Location: 100 New State Highway, Raynham, MA, 02767.     Kerry Smith  NPI: 1275083230  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jennifer Ullrich  NPI: 1710489760  Secondary Location: 100 New State Highway, Raynham, MA, 02767      Regards, Alex G.', NULL, NULL, '2021-08-24 11:11:34', '2021-08-24 11:11:34'),
(6565, 1019, 11336, NULL, '2021-09-16 00:00:00.000', 'Approved', 'Received the following email from Laura.Bevin@aetna.com  Hello,  Barbara Hignite NPI: 1982617262  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. – 03/01/2021 effective date Secondary Location: 100 New State Highway, Raynham, MA, 02767. – not linked to this location     Rodesia Edmundson  NPI: 1124622667  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. – 06/01/2021 effective date Secondary Location: 100 New State Highway, Raynham, MA, 02767.  – not linked to this location  Jessica Hartman  NPI: 1326665472  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. – application was not received for MA Secondary Location: 100 New State Highway, Raynham, MA, 02767.  - application was not received for MA   Lynnetta Loveland  NPI: 1598163602  Secondary Location: 100 New State Highway, Raynham, MA, 02767. – not linked to this address     Cemetrice Muhammed NPI: 1548843410  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. – just completed the credentialing process on 08/20/2021     Jonathan Schubert  NPI: 1235755505  Secondary Location: 100 New State Highway, Raynham, MA, 02767. – not linked to this address     Kerry Smith  NPI: 1275083230  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 – 06/01/2021 effective date Secondary Location: 100 New State Highway, Raynham, MA, 02767. - 06/01/2021 effective date  Jennifer Ullrich  NPI: 1710489760  Secondary Location: 100 New State Highway, Raynham, MA, 02767 – not linked to this address  For providers who need another service location added, this can be completed via the below link  Existing Medical Provider Resources | Aetna  The MA application for Jessica Hartman can be submitted via the below link  https://cldaz.aetna.com/pocui/join-the-aetna-network  Thank you           Laura Bevin  Credentialing Senior Analyst  Aetna Behavioral Health', NULL, NULL, '2021-09-09 08:38:38', '2021-09-09 08:38:38'),
(6566, 1006, 11337, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-28 13:34:37', '2020-10-28 13:34:37'),
(6567, 1006, 11337, NULL, '2020-11-10 00:00:00.000', 'Initiated', 'Initiated enrollment via Cigna Behavioral Provider Information Form. Attached.   \"Thank you for your interest in joining the Cigna Behavioral Health network. We have received your application. A Cigna Recruiter will process your application and provide onboarding instructions within 20 business days. Please notate the confirmation number. If you have any questions or concerns, please email us at BehavioralContracting@cigna.com or call Provider Services at 1.800.926.2273.\"', NULL, NULL, '2020-10-28 13:36:29', '2020-10-28 13:36:29'),
(6568, 1006, 11337, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Received following reply from Cigna BHS:   \"Dear BARBARA HIGNITE, Thank you for submitting an online screening form / application for network participation. However, our records indicate that you are already contracted / fully credentialed with the Cigna behavioral network. If you need to submit demographic changes, please do one of the following to make those changes.  . Call the Provider Service center at 800.926.2273 . Fax a written request to Network Operations at 860.687.7257 . Mail a written request to Network Operations at 11095 Viking Dr Ste 350, Eden Prairie, MN 55343 . Log in to CignaforHCP.com and submit changes through the web portal If you have other questions unrelated to updating your demographic information, our Provider Advocates can assist with this as well.  Sincerely, Cigna Behavioral Credentialing\"  Barbara is contracted with Cigna, sent a group addition request via phonecall @ 800.926.2273. It should take 7~10 business days. ', NULL, NULL, '2020-11-05 15:41:21', '2020-11-05 15:41:21'),
(6569, 1006, 11337, NULL, '2020-11-23 00:00:00.000', 'Approved', 'As per my discussion with Cigna representative, provider has been added to the group on 11/06/2020. Proof of addition attached.  Ref: Avita C 11/16/2020', NULL, NULL, '2020-11-16 17:22:22', '2020-11-16 17:22:22'),
(6570, 1006, 11338, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-28 14:14:13', '2020-10-28 14:14:13'),
(6571, 1006, 11338, NULL, '2020-11-10 00:00:00.000', 'Initiated', 'Submitted enrollment request via magellan website. Attached. ', NULL, NULL, '2020-10-28 14:14:36', '2020-10-28 14:14:36'),
(6572, 1006, 11338, NULL, '2020-11-20 00:00:00.000', 'In Process', 'Sent a followup email to \"Jones-Wright, Judith\" JJonesWright@magellanhealth.com> regarding status. ', NULL, NULL, '2020-11-12 18:51:38', '2020-11-12 18:51:38'),
(6573, 1006, 11338, NULL, '2020-11-27 00:00:00.000', 'In Process', 'Sent a follow=up email to Judy: \"Hey Judy,  I just wanted to check in on the status of Barbara again, has she been enrolled? If so, what\'s her effective date?  Thanks. \"', NULL, NULL, '2020-11-20 10:01:56', '2020-11-20 10:01:56'),
(6574, 1006, 11338, NULL, '2020-11-27 00:00:00.000', 'Approved', 'Received following approval notification from Judith: \"Good Afternoon,  The provider has been linked to your group effective date 11/11/2020.  Judy\"', NULL, NULL, '2020-11-20 15:49:42', '2020-11-20 15:49:42'),
(6575, 1006, 11339, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-28 15:17:09', '2020-10-28 15:17:09'),
(6576, 1006, 11339, NULL, '2020-11-10 00:00:00.000', 'Initiated', 'Submitted online enrollment request via Clinician Tax ID - Add / Update Form. Attached. ', NULL, NULL, '2020-10-28 15:20:43', '2020-10-28 15:20:43'),
(6577, 1006, 11339, NULL, '2020-11-19 00:00:00.000', 'In Process', 'Sent follow-up email to Optum Behavioral Health bhcredentialing@optum.com>:  \"Hello,   I hope you\'re doing well, please let me know what the status of enrollment is for the following provider:  Provider Name: Barbara Hignite NPI# 1982617262 Group Name: Spectrum Neuro Behavioral Care LLC NPI# 1356906572  Please get back to me as soon as possible.  Thanks. \"', NULL, NULL, '2020-11-12 18:57:56', '2020-11-12 18:57:56'),
(6578, 1006, 11339, NULL, '2020-11-13 00:00:00.000', 'In Process', 'Need to contact UBH @ 877-614-0484. Since emails aren\'t going through. ', NULL, NULL, '2020-11-12 19:00:47', '2020-11-12 19:00:47'),
(6579, 1006, 11339, NULL, '2020-11-16 00:00:00.000', 'In Process', 'Left a VM, waiting on call back. ', NULL, NULL, '2020-11-13 18:24:13', '2020-11-13 18:24:13'),
(6580, 1006, 11339, NULL, '2020-11-18 00:00:00.000', 'In Process', 'As per the representative, we need to submit an NPRF form as the provider is not individually credentialed. Rep: Jay', NULL, NULL, '2020-11-16 17:48:59', '2020-11-16 17:48:59'),
(6581, 1006, 11339, NULL, '2020-11-20 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-11-19 18:09:59', '2020-11-19 18:09:59'),
(6582, 1006, 11339, NULL, '2020-11-24 00:00:00.000', 'In Process', 'Called into UBH provider services and then they forwarded me to website support, as per them we need to re-attest provider CAQH as it\'s not letting me initiate a new NPRF . Need to check back later. ', NULL, NULL, '2020-11-20 15:20:45', '2020-11-20 15:20:45'),
(6583, 1006, 11339, NULL, '2020-11-30 00:00:00.000', 'In Process', '\"An issue was encountered while attempting to process your request:  We are unable to complete your request as we do not have enough information to authenticate your CAQH Provider ID Number.  Please contact us at 1-877-614-0484 and a representative will assist you.\"  Need to allow more time.', NULL, NULL, '2020-11-24 17:30:34', '2020-11-24 17:30:34'),
(6584, 1006, 11339, NULL, '2020-12-07 00:00:00.000', 'In Process', 'Submitted another TIN Update form after adding provider to our group. ', NULL, NULL, '2020-11-30 18:23:37', '2020-11-30 18:23:37'),
(6585, 1006, 11339, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Received denial on TIN Add/Update form stating that it is group enrollment, submitted an NPRF form for new credentialing request. ', NULL, NULL, '2020-12-03 13:48:09', '2020-12-03 13:48:09'),
(6586, 1006, 11339, NULL, '2020-12-14 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-12-10 17:01:09', '2020-12-10 17:01:09'),
(6587, 1006, 11339, NULL, '2020-12-15 00:00:00.000', 'In Process', NULL, NULL, NULL, '2020-12-14 18:02:33', '2020-12-14 18:02:33'),
(6588, 1006, 11339, NULL, '2020-12-24 00:00:00.000', 'In Process', 'The request has been received, it is currently pending review it can take up 30~45 days. Ref# Karl P', NULL, NULL, '2020-12-17 17:12:41', '2020-12-17 17:12:41'),
(6589, 1006, 11339, NULL, '2020-12-31 00:00:00.000', 'In Process', 'Following status on NRPF: \"Your application has been submitted and is currently waiting to be reviewed by our Network Management Team.\"', NULL, NULL, '2020-12-24 14:16:30', '2020-12-24 14:16:30'),
(6590, 1006, 11339, NULL, '2021-01-22 00:00:00.000', 'In Process', 'The request still has not been updated, need to allow more time. ', NULL, NULL, '2021-01-15 18:06:07', '2021-01-15 18:06:07'),
(6591, 1006, 11339, NULL, '2021-01-25 00:00:00.000', 'In Process', 'Received following reply from \"Gentile, Richard C\" richard_c_gentile_@optum.com:  \"Good morning!  I’ve just submitted this request to credentialing (for SPECTRUM/ TIN ending in 2753.)  Once the application reaches the Credentialing Department, it will take approximately 60 days to process.  As a new fuction, if your application was submitted online,  you may check the status of your application during this time on our Provider Express site here, and you should receive a confirmation packet with an effective date once the process is complete.  Please note:  We cannot review for Telehealth at this point. ZOOM requires a Business Associate Agreement (BAA) be submitted to us for review.  You may return directly that form directly to me vial email. Once I receive, I will update the request, asking them to review for Telehealth. (Going forward, you may also attach the form directly in Salesforce to any submitted application requests.) There is no W9 attched for either TIN ending in 3439 nor 5151, so we cannot credential for either of those.  If you intend to crednetial either of those, please contact us so that we may assess and review needs.   Thanks, Rich  Richard Gentile Network Associate, Behavioral Network Services Richard_C_Gentile_@optum.com 950 Winter Street Suite 2200/3800 Waltham, Ma.  02451 Phone: 781-472-8537 Fax:     844-481-2861 Optum l United Behavioral Health My behavioral style is PROMOTING.\"', NULL, NULL, '2021-01-18 11:39:51', '2021-01-18 11:39:51'),
(6592, 1006, 11339, NULL, '2021-02-08 00:00:00.000', 'In Process', 'As per the initial credentialing application status tool: \"Your application is currently with our Credentialing Department\'s Application Management Team. After it is deemed to be complete, it will be forwarded to the Primary Source Verification Team for validation. Our Credentialing Staff may reach out to you for additional information or clarification.\"', NULL, NULL, '2021-01-28 16:42:40', '2021-01-28 16:42:40'),
(6593, 1006, 11339, NULL, '2021-02-17 00:00:00.000', 'Approved', '\"2/10/2021  000921824  Barbara Hignite  snbc@claimsmedinc.com  Dear Barbara Hignite:  I am pleased to inform you that our Credentialing Committee approved your participation in our network effective 2/10/2021.  You are now a contracted provider eligible to receive Member referrals from Optum and brands covered by other Payors, in accordance with your Agreement.  The information below will help you get started.\"', NULL, NULL, '2021-02-10 17:59:40', '2021-02-10 17:59:40'),
(6594, 1006, 11340, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-28 16:50:18', '2020-10-28 16:50:18'),
(6595, 1006, 11340, NULL, '2020-11-13 00:00:00.000', 'Initiated', 'Enrollment request submitted @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com> with form. Attached. ', NULL, NULL, '2020-10-28 16:50:42', '2020-10-28 16:50:42'),
(6596, 1006, 11340, NULL, '2020-11-26 00:00:00.000', 'In Process', 'Sent a follow-up email to Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com regarding updated status. ', NULL, NULL, '2020-11-19 17:35:19', '2020-11-19 17:35:19'),
(6597, 1006, 11340, NULL, '2020-12-10 00:00:00.000', 'In Process', 'Received following reply from IT Service Desk Tufts_Health_Plan_Credentialing_Department@tufts-health.com:  Sub: PPO0071864 - Provider Enrollment - Barbara Hignite  \"Hi Brad   Looks like BH Contracting missed this app.  I just reached out to them to select a contract.  Once they do so, we will send it out.  Once signed and returned, she will be put into credentialing.  Once cred is complete, she will be all set.  Thank you   Provider Operations   Ref:MSG6181812 thpwatsmr2.tufts-health.com made the following annotations\"', NULL, NULL, '2020-11-30 12:03:10', '2020-11-30 12:03:10'),
(6598, 1006, 11340, NULL, '2020-12-11 00:00:00.000', 'In Process', 'Received another update from Tufts: \"Hi Brad   That contract for Barbara Hignite will be sent out in the next day or so.   Thank you   Provider Operations   Ref:MSG6208421 thpwatsmr2.tufts-health.com made the following annotations\"', NULL, NULL, '2020-12-04 17:55:09', '2020-12-04 17:55:09'),
(6599, 1006, 11340, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Contract was received, signed and sent back to Tufts. Attached for reference. ', NULL, NULL, '2020-12-07 12:02:08', '2020-12-07 12:02:08'),
(6600, 1006, 11340, NULL, '2020-12-21 00:00:00.000', 'In Process', 'Sent a follow-up email @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com regarding status.  ', NULL, NULL, '2020-12-14 18:06:33', '2020-12-14 18:06:33'),
(6601, 1006, 11340, NULL, '2020-12-28 00:00:00.000', 'In Process', 'Sent another followup email @ Tufts Health Plan Credentialing Department Tufts_Health_Plan_Credentialing_Department@tufts-health.com', NULL, NULL, '2020-12-21 18:00:01', '2020-12-21 18:00:01'),
(6602, 1006, 11340, NULL, '2021-01-04 00:00:00.000', 'In Process', 'Received following reply from :  \"incident number - PPO0078656    Hello   Barbara Hignite, NP - in cred   Carlee Rozell, APRN - contract sent to you on 12.18.2020, credentialing will ensue once we receive/process her signed agreement   Thank you Provider Operations   Ref:MSG6296516\"', NULL, NULL, '2020-12-23 13:09:26', '2020-12-23 13:09:26'),
(6603, 1006, 11340, NULL, '2021-01-19 00:00:00.000', 'In Process', 'Sent a follow-up email @ Tufts_Health_Plan_Credentialing_Department@tufts-health.com. ', NULL, NULL, '2021-01-15 18:13:02', '2021-01-15 18:13:02'),
(6604, 1006, 11340, NULL, '2021-02-02 00:00:00.000', 'Approved', 'Received the following reply from IT Service Desk Tufts_Health_Plan_Credentialing_Department@tufts-health.com:  \"Hi Brad   Barbara Hignite, APRN - all set eff 1.7.2021, ID 370708   Carlee Rozell, NP - all set eff 1.22.2021, ID 228943   Jessica Hartman, APRN - all set eff 12.31.2021, ID 869409   Thank you Provider Operations\" ', NULL, NULL, '2021-01-26 17:16:44', '2021-01-26 17:16:44'),
(6605, 1006, 11341, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2020-10-28 17:25:45', '2020-10-28 17:25:45'),
(6606, 1006, 11341, NULL, '2020-11-16 00:00:00.000', 'Initiated', 'Submitted enrollment application online via Beacon enrollment website. Attached form for reference. ', NULL, NULL, '2020-10-28 17:26:47', '2020-10-28 17:26:47'),
(6607, 1006, 11341, NULL, '2020-11-30 00:00:00.000', 'In Process', 'Sent a follow-up email to provider.relations@beaconhealthoptions.com regarding updated status. ', NULL, NULL, '2020-11-19 17:41:56', '2020-11-19 17:41:56'),
(6608, 1006, 11341, NULL, '2020-12-14 00:00:00.000', 'In Process', 'Received the following update from Karla: \"Good morning,  Both applications for the below providers are currently still in process. This typically takes 90-120 business days.  Thank You!  Kayla Moura Provider Relations I, Northeast ––––––––––––––––––––––– Beacon Health Options 500 Unicorn Park Drive Suite 103 Woburn, MA 01801 General Inquiries: 800.397.1630 Direct Line: 781.970.6632 www.beaconhealthoptions.com\"', NULL, NULL, '2020-11-25 11:33:13', '2020-11-25 11:33:13'),
(6609, 1006, 11341, NULL, '2020-12-29 00:00:00.000', 'In Process', 'Sent a follow-up email @ provider.relations@beaconhealthoptions.com.  Sub: Provider Enrollment Status - SNBCare', NULL, NULL, '2020-12-18 15:51:44', '2020-12-18 15:51:44'),
(6610, 1006, 11341, NULL, '2021-01-15 00:00:00.000', 'In Process', 'Request is still processing, need to allow more time. Expected time-frame 90 business days. Event# 8967847 Ref# 12292020-0058739 Rep: John N ', NULL, NULL, '2020-12-29 18:02:41', '2020-12-29 18:02:41'),
(6611, 1006, 11341, NULL, '2021-01-18 00:00:00.000', 'In Process', 'Called Beacon but wasn\'t able to reach anyone, requested a call back from them. ', NULL, NULL, '2021-01-15 17:05:22', '2021-01-15 17:05:22'),
(6612, 1006, 11341, NULL, '2021-02-01 00:00:00.000', 'In Process', 'Request still at 60 days and need to allow more time for processing.  Ref# 01202021-0292859', NULL, NULL, '2021-01-20 13:07:08', '2021-01-20 13:07:08'),
(6613, 1006, 11341, NULL, '2021-02-18 00:00:00.000', 'In Process', 'Called Beacon to send another expedition request and sent an email @ provider.relations@beaconhealthoptions.com for status. ', NULL, NULL, '2021-02-11 15:20:11', '2021-02-11 15:20:11'),
(6614, 1006, 11341, NULL, '2021-03-10 00:00:00.000', 'In Process', 'Sent a follow-up email @ provider.relations@beaconhealthoptions.com:  \"Hello,   I wanted to get an update regarding the enrollment status for the following providers:   Provider Name: Jennifer Ullrich NPI# 1710489760  Provider Name: Barbara Hignite NPI# 1982617262  Provider Name: Carlee Rozell NPI# 1225645393  Provider Name: Joanna Wood NPI# 1801986054  Provider Name: Melody L\'Etoile NPI# 1942687108  Provider Name: Erin Oliva NPI# 1407349632  Provider Name: Jessica Hartman NPI# 1326665472  Please get back to me on the status of these providers ASAP, as the request for most of them has been in process for over the 120-day time-limit.  Thank you.\"', NULL, NULL, '2021-03-03 18:08:25', '2021-03-03 18:08:25'),
(6615, 1019, 11341, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent an email @ provider.relations@beaconhealthoptions.com:  Dear Concern, I\'m writing you on behalf of Medical Director of SNBCARE as the credentialing of our providers is pending since last few months without any progress also the time frame is also exceeded, so we need to discuss with the concern dept because our providers are giving services to Beacon Health patients and we can\'t even reimburse for those services which we provided to your patients so please if some one get back to ASAP so we can set up a meeting to discuss that issue and resolve it.   Regards,', NULL, NULL, '2021-03-23 10:42:16', '2021-03-23 10:42:16'),
(6616, 1019, 11341, NULL, '2021-04-12 00:00:00.000', 'In Process', 'CAQH Application faxed to Network Operations at (866) 612-7790. ', NULL, NULL, '2021-04-05 09:51:37', '2021-04-05 09:51:37'),
(6617, 1019, 11341, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Sent the following email to : provider.relations@beaconhealthoptions.com SUB: Enrollment Status || Providers || SNBCARE || Beacon   Hello, Can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-04-14 07:07:47', '2021-04-14 07:07:47'),
(6618, 1019, 11341, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Received the following email from Sarah: provider.relations@beaconhealthoptions.com Good Morning, I have reviewed each provider file and have left notes below in red.  Rodesia Edmundson – Application received 4/6/21 and still processing – Event 9091975 NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Barbara Hignite – Application received 4/6/21 and still processing – Event 9091459 NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell – Application received 4/7/21 and still processing – Event 9093081 NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer Ullrich – Application received 4/5/21 and still processing – Event 9091316 NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Justin Souliere – Application received 4/7/21 and still processing – Event 1098601 NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Jessica Hartman – CAQH Application needed – please complete attached application and return for processing NPI: 1326665472 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva – Application received 4/7/21 and still processing – Event 9093128 NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile – Application received 4/7/21 and still processing – Event 9093091 NPI: 1942687108  Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Thank You!     Sarah Oakes  Network Management Rep I, Northeast  –––––––––––––––––––––––  Beacon Health Options  500 Unicorn Park Drive Suite 401  Woburn, MA 01801  Office: 800.397.1630  Direct: 781-496-4024  www.beaconhealthoptions.com ', NULL, NULL, '2021-04-14 08:10:55', '2021-04-14 08:10:55'),
(6619, 1019, 11341, NULL, '2021-04-29 00:00:00.000', 'In Process', 'Called Beacon @ (800) 397-1630 spoke with rep Sierra conversation is mentioned below:  All providers applications have been received and are under review and group is added under all three locations under both plans (BHO/BHS) we have request the copy of group contract. we\'ll receive the contract in 3-2 business days.  Ref# 04/22/2021 - 1371173 Sierra Y', NULL, NULL, '2021-04-22 15:51:59', '2021-04-22 15:51:59'),
(6620, 1019, 11341, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: RE: Enrollment Status || Providers || SNBCARE || Beacon attn Shashi Hello Shashi, Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.   Individual Provider   L\'Etoile, Melody NPI: 1942687108 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896. Edmundson, Rodesia NPI: 1124622667 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hefti, Prisca NPI: 1508133182 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Khan, Fauzia Wali NPI: 1699761965 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Pionke, Peggy NPI: 1699307322 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rashid, Mahreen NPI: 1396393146 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Schubert, Jonathan NPI: 1235755505 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Smith, Kerry NPI: 1275083230 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Tawakol, Katie NPI:1609222116 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.  Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-03 11:45:48', '2021-05-03 11:45:48'),
(6621, 1019, 11341, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to provider.relations@beaconhealthoptions.com SUB: Enrollment Query || Group & Providers || SNBCARE || BHS/BHO ATTN Shashi  Hello Shashi,  Hope you are doing good, I need the enrollment status for the following providers, under our group and the following locations under our group.     Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Individual Provider     Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    L\'Etoile, Melody  NPI: 1942687108  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Edmundson, Rodesia NPI: 1124622667 Location: 100 New State Highway, Raynham, MA, 02767.     Hefti, Prisca NPI: 1508133182 Location: 100 New State Highway, Raynham, MA, 02767.     Hignite, Barbara NPI: 1982617262 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Khan, Fauzia Wali NPI: 1699761965 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Loveland, Lynnetta NPI: 1598163602 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Pionke, Peggy NPI: 1699307322 Location: 100 New State Highway, Raynham, MA, 02767. Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.     Rashid, Mahreen NPI: 1396393146 Location: 100 New State Highway, Raynham, MA, 02767.   Rozell, Carlee NPI: 1225645393 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Schubert, Jonathan NPI: 1235755505 Location: 100 New State Highway, Raynham, MA, 02767.     Smith, Kerry NPI: 1275083230 Location: 100 New State Highway, Raynham, MA, 02767.     Tawakol, Katie NPI:1609222116 Location: 100 New State Highway, Raynham, MA, 02767.     Ullrich, Jennifer NPI: 1710489760 Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.     Souliere, Justin NPI: 1710576004 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Hartman, Jessica NPI: 1326665472 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Location: 100 New State Highway, Raynham, MA, 02767.    Oliva, Erin NPI: 1407349632 Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.    Regards, Alex', NULL, NULL, '2021-05-20 08:29:04', '2021-05-20 08:29:04');
